Stomach Cancer Surgery

What is stomach cancer?

Cancer is a condition that can affect any organ. It is the result of cells multiplying abnormally. This results in growths or tumours. When we talk about cancer we talk about primary and secondary cancers. The primary cancer is where the cancer originates. Therefore in Stomach cancer the primary cancer is in the stomach.

Secondary cancer is where the primary cancer cells have moved to. In stomach cancer the most likely organ of spread is the liver. This is called metastatic cancer.

This concept is important in the treatment of cancer as primary tumours with no evidence of spread are often able to be removed surgically giving a good chance of remission or cure. Tumours that spread to other organs may be not removable through surgery and need other forms of treatment such as chemotherapy, radiotherapy or both.

Cancer can also spread to the lymph nodes. If the lymph nodes are involved it may make it harder to cure the cancer but an operation is still possible in some cases. 

What are Lymph nodes?

Lymph nodes are small solid structures that drain a substance called lymph. There is a complex system of vessels that carry lymph that is important in processing certain immune cells. There are millions of lymphatics in the bodies and in the gastrointestinal tract the nodes tend to follow arteries around the organs. Therefore in cancer surgery we tend to take a big sample of the Lymph nodes around the organ we remove. In stomach cancer, I perform what is called a radical dissection of the lymph nodes or a D2 resection. I take all the lymph nodes that drain the stomach and even some of the ones around this. When the stomach is given to the pathologist to look at under the microscope he/she will carefully examine the lymph glands for evidence of tumour as this will affect treatment and prognosis. 

What causes stomach cancer?

There are a number of risk factors including:

• Smoking
• Older age
• Family history/genetics
• Pernicious anaemia
• Chronic gastritis
• Helicobacter pylori 

What is Helicobacter pylori?

This is a spiral shaped bacteria that inhabits some peoples stomach. You may not know it is there. It has a strong relationship to cancer at the bottom of the stomach. 20% of people will get ulcers related to their H.pylori infection. It is treatable with strong antibiotics and can be found with breath tests or at the time of gastroscopy.  

Surgery

Stomach cancer requires pre-operative investigation before surgical treatment. Pre-operative investigations include CT scan, gastroscopy and staging laparoscopy and sometimes a PET scan.

Once all test results are received your diagnosis and results will be discussed at a multi-disciplinary team meeting (MDT). The doctors involved in this MDT are oncologists who are specialists in medical treatment of cancer and chemotherapy, as well as radiation specialists and other surgeons.

Many patients will require chemotherapy before surgery to shrink the tumour.

The location of the cancer will determine how much of your stomach is removed (a gastrectomy involving the entire stomach or partial gastrectomy). If the entire stomach is removed your small bowel will become your new stomach. Eventually you will be able to eat a normal diet again including meat, chicken and vegetables. Post-operative information will be given to you about this transition.