GASTRIC CANCER SURGERY

Gastric Cancer Surgery Details

In the early stages of gastric cancer, you may not notice any symptoms. Common symptoms include:

• Indigestion or heartburn

• Stomach pain or discomfort

• Loss of appetite

• Unexplained weight loss

• Feeling full after eating small amounts

• Nausea or vomiting (which may include blood, or altered blood products)

• Swelling or fluid retention in the abdomen

• Fatigue

• Difficulty swallowing (if cancer spreads to the oesophagus)

• Discoloured stools (melaena)

Several tests and procedures can be used to diagnose gastric cancer:

1. Endoscopy: A procedure where a thin tube with a camera (endoscope) is inserted through your mouth to view the stomach lining and take biopsies of any abnormal tissue

2. Imaging Tests: These may include CT scan and/or PET scan to determine the size, location, and spread of the cancer

3. Blood Tests: Certain blood tests may help detect anaemia or other signs of cancer

4. Staging laparoscopy & peritoneal washings (for cytology): A laparoscopic procedure in which a small camera is placed through the abdominal wall into the abdominal cavity, and fluid is sampled and analysed under the microscope, looking for cancer cells. It also allows for visual inspection to see if the cancer has spread/metastasized beyond the stomach

Staging describes how far cancer has spread and helps guide treatment decisions. The stages of gastric cancer are Stages 0-4:

• Stage 0 (Tumour in-situ, Tis): Cancer cells confined only to the most superficial, mucosal layer of the stomach

• Stage 1: Cancer cells have grown deeper into the second layer of the stomach wall (submucosa) and/or 1-2 adjacent lymph nodes

• Stage 2: Cancer cells have grown further into the stomach wall into its muscular layer and have also spread to adjacent, removable, lymph nodes

• Stage 3: Considered locally advanced gastric cancer, where the tumour has spread through all layers of the stomach wall and into several adjacent lymph nodes (this is the most common stage of gastric cancer in Australia)

• Stage 4: Unfortunately Stage 4 is metastatic disease, with tumour seen in solid organs in the abdomen, chest, or lymph nodes that are unremovable, or tumour within the abdominal cavity that has spread from the stomach

Treatment options for gastric cancer depend on the stage, location, and general health of the patient. Most commonly, the treatment for gastric cancer is “multi-modal” including chemotherapy first, then surgery, followed by more chemotherapy. Sometimes, upfront surgery only is recommended.

South East Upper GI Surgical Group manage all of their oesophageal and gastric cancer patients through an Upper GI cancer “multi-disciplinary team” (MDT) Meeting, which includes medical oncologists, radiation oncologists, surgeons, gastroenterologists, radiologists, pathologists, dieticians and Upper GI cancer specialist nurses.

Common treatment methods include:

1. Surgery: Surgery is the most common treatment for early-stage and locally advanced (but not metastatic) gastric cancer. It involves removing part or all of the stomach. During the operation, the nearby lymph nodes which may be harbouring cancer cells, are also removed.

• Gastrectomy: Removal of part (subtotal gastrectomy) or all (total gastrectomy) of the stomach

Dr. Matthew Stokes & Dr. Joshua Hammerschlag are specialists in minimally invasive gastric cancer surgery, often using laparoscopic or robotic techniques (where appropriate). These approaches aims to minimize post-operative pain, shorten recovery and hospital stays, reduce scarring, and lower the risk of complications.

2.        Chemotherapy: Uses drugs to kill or slow the growth of cancer cells. It may be used before surgery (neoadjuvant therapy) to shrink tumours or after surgery (adjuvant therapy) to kill any remaining cancer cells.

The most commonly used chemotherapy regimens in gastric cancer including FLOT-4 Chemotherapy (4 cycles prior to surgery, 4 cycles after surgery), or FOLFOX Chemotherapy

1. Endoscopy: In some early stages of gastric cancer (stage 0/1) it is possible to remove the tumour via a specialised gastroscopy. Endoscopy is also used in advanced cases to control symptoms such as bleeding, and alleviate obstructions with Self Expanding Metallic Stents (SEMS).

2. Radiation Therapy: Uses high-energy rays to kill cancer cells. It is often used alongside chemotherapy, particularly in advanced stages

3. Targeted Therapy: Targets specific molecules involved in cancer cell growth. Targeted therapy is usually used for advanced or metastatic gastric cancer

4. Immunotherapy: Uses the body’s immune system to fight cancer. Immunotherapy may be an option for some patients with advanced gastric cancer, and in the small minority of resectable gastric cancer patients who have specific markers on their tumour cells (i.e. high PDL1-CPS or are MSI-High)

5. Palliative Care: If the cancer is advanced and cannot be cured, palliative treatments may be used to manage symptoms, such as pain and nausea, to improve quality of life