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4

Overview of cancer treatments Surgical treatment

Surgical treatment

Surgery is a primary treatment for early and some

locoregional stomach cancers. Primary treatment is

the main treatment used to rid the body of cancer.

The goal of surgery is to remove the entire tumor

and some normal-looking tissue around its rim. The

normal-looking tissue is called the surgical margin. A

margin width of 4 cm or greater is advised.

You will be given instructions on how to prepare for

your surgery. The week before your surgery you may

have to stop taking some medicines. On the day of

your surgery, you should not eat or drink. General

anesthesia will be used. In some people, general

anesthesia causes nausea with vomiting, confusion,

muscle aches, and itching.

Gastrectomy

A gastrectomy is a surgery that removes some or all

of the stomach.

See Figure 11.

The stomach tumor

may have grown into nearby structures. In this case,

the stomach and other tissue should be removed

together and not in pieces. Removal of your spleen is

not required unless cancer is present.

How much of your stomach will be removed depends

on the extent of the cancer. A total gastrectomy

removes your whole stomach. A subtotal gastrectomy

removes part of your stomach. A distal gastrectomy

is a subtotal gastrectomy of the lower half of your

stomach. A proximal gastrectomy is a subtotal

gastrectomy of the upper half of your stomach.

34

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

35

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

Illustration Copyright © 2014 Nucleus Medical Media, All rights reserved.

www.nucleusinc.com

Figure 11.

Gastrectomy

A gastrectomy removes some or

all of your stomach. Any nearby

structures that have been invaded

by the tumor will be removed, too.

During surgery, some lymph nodes

will be removed and tested for

cancer.

4

Overview of cancer treatments Endoscopic treatment

ESD

ESD (

e

ndoscopic

s

ubmucosal

d

issection) is a newer

type of endoscopic treatment that is more extensive

than EMR. It is likely the preferred endoscopic

method for removing deeper, early stomach tumors.

ESD removes a tumor in one piece with special

knives. Removing the tumor in one piece reduces

the chance of the tumor returning. This is a very

challenging procedure to do. ESD is generally only

done at centers that specialize in such procedures.

Only a small group of people with stomach cancer are

able to have this treatment.

ESD is often performed under general anesthesia.

The procedure may take 2 to 4 hours to complete.

You may stay in the hospital for a few days or up to 5

days if there are major complications like a tear in the

stomach wall. After healing, your stomach will likely

work almost as well as before since only the first layer

of the stomach wall is removed.

Side effects of endoscopic treatment

Side effects are unhealthy or unpleasant physical

or emotional responses to treatment. Endoscopic

treatments may cause a sore throat, pain in the chest,

or gas. More serious but less common problems

are bleeding, a tear through the stomach wall, or

narrowing of the stomach. The chances for bleeding

and tears are greater for ESD than for EMR.

Not all side effects of endoscopic treatment are listed

here. Please ask your treatment team for a complete

list of common and rare side effects. If a side effect

bothers you, tell your treatment team. There may be

ways to help you feel better.

Illustration Copyright © 2016 Nucleus Medical Media, All rights reserved.

www.nucleusinc.com

Supportive care

Supportive care doesn’t aim to treat cancer but aims to improve quality of life. It is also

called palliative care. It can address many needs.

One example is treatment for physical and emotional symptoms. Supportive care can

also help with treatment decisions as you may have more than one option. It can also

help with coordination of care between health providers.

Talk with your treatment team to plan the best supportive care for you.