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Treatment
Getting a Second Opinion
Treatment Methods
Surgery
Chemotherapy
Radiation Therapy
Many people with stomach cancer want to take an active part in making decisions
about their medical care. It is natural to want to learn all you can about the
disease and your treatment choices. However, shock and stress after the
diagnosis can make it hard to think of everything you want to ask your doctor.
It often helps to make a list of questions before an appointment.
To help remember what the doctor says, you may take notes or ask whether you
may use a tape recorder. You may also want to have a family member or friend
with you when you talk to the doctor - to take part in the discussion, to take
notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances
to ask your doctor or nurse to explain things that are not clear and to ask for
more details.
Your doctor may refer you to a specialist who has experience treating stomach
cancer, or you may ask for a referral. Specialists who treat stomach cancer
include
gastroenterologists,
surgeons,
medical oncologists,
and
radiation oncologists.
Before starting treatment, you might want a second opinion about your diagnosis
and treatment plan. Many insurance companies cover a second opinion if you or
your doctor requests it. It may take some time and effort to gather medical
records and arrange to see another doctor. Usually it is not a problem to take
several weeks to get a second opinion. In most cases, the delay in starting
treatment will not make treatment less effective. To make sure, you should
discuss this delay with your doctor. Sometimes people with stomach cancer need
treatment right away.
There are a number of ways to find a doctor for a second opinion:
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Your doctor may refer you to one or more specialists. At cancer centers,
several specialists often work together as a team.
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NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby
treatment centers. Information Specialists also can assist you online through
LiveHelp at http://www.cancer.gov/cis.
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A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists.
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The American Board of Medical Specialties (ABMS) has a list of doctors who have
had training and passed exams in their specialty. You can find this list in the
Official ABMS Directory of Board Certified Medical Specialists. The Directory
is in most public libraries. Also, ABMS offers this information at
http://www.abms.org. (Click on "Who's Certified.")
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NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment
Facility If You Have Cancer."
The choice of treatment depends mainly on the size and place of the tumor, the
stage of disease, and your general health. Treatment for stomach cancer may
involve
surgery,
chemotherapy,
or
radiation therapy.
Many people have more than
one type of treatment.
Your doctor can describe your treatment choices and the expected results. You
and your doctor can work together to develop a treatment plan that meets your
needs.
Cancer treatment is either
local therapy
or
systemic therapy:
-
Local therapy: Surgery and radiation therapy are local therapies. They remove
or destroy cancer in or near the stomach. When stomach cancer has spread to
other parts of the body, local therapy may be used to control the disease in
those specific areas.
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Systemic therapy: Chemotherapy is systemic therapy. The drug enters the
bloodstream and destroys or controls cancer throughout the body.
Because cancer treatments often damage healthy cells and tissues,
side effects
are common. Side effects depend mainly on the type and extent of the treatment.
Side effects may not be the same for each person, and they may change from one
treatment session to the next.
Before treatment starts, your health care team will explain possible side
effects and suggest ways to help you manage them. NCI provides helpful booklets
about cancer treatments and coping with side effects. These include
Chemotherapy and You, Radiation Therapy and You, and Eating Hints for Cancer
Patients.
At any stage of disease, supportive care is available to relieve the side
effects of treatment, to control pain and other symptoms, and to ease emotional
concerns. Information about such care is available on NCI's Web site at
http://www.cancer.gov/cancertopics/coping, and from Information
Specialists at 1-800-4-CANCER or
LiveHelp (http://www.cancer.gov/cis).
You may want to talk to your doctor about taking part in a
clinical trial,
a
research study of new treatment methods. The section on "The Promise of Cancer
Research" has more information about clinical trials.
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You may want to ask your doctor these questions about treatment:
- What is the stage of the disease?
- What are my treatment choices? Which do you suggest for me? Why?
- Would a clinical trial (research study) be a good choice for me?
- Will I have more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment? What can we do to control my side effects? How else can I take care of myself during treatment?
- How will treatment affect my normal activities? Am I likely to have eating or other problems?
- Whom should I call if I have problems during treatment?
- What is the treatment likely to cost? Does my insurance cover this treatment?
- How often should I have checkups?
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Surgery is the most common treatment for stomach cancer. The type of surgery
depends on the extent of the cancer. There are two main types of stomach cancer
surgery:
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Partial (subtotal)
gastrectomy: The surgeon removes the part of the stomach
with cancer. The surgeon also may remove part of the esophagus or part of the
small intestine. Nearby lymph nodes and other tissues may be removed.
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Total gastrectomy: The doctor removes the entire stomach, nearby lymph nodes,
parts of the esophagus and small intestine, and other tissues near the tumor.
The spleen also may be removed. The surgeon then connects the esophagus
directly to the small intestine. The surgeon makes a new "stomach" out of
tissue from the intestine.
It is natural to be concerned about eating after surgery for stomach cancer.
During surgery, the surgeon may place a feeding tube into your small intestine.
This tube helps you get enough nutrition while you heal. Information about
eating after surgery is in the "Nutrition" section.
The time it takes to heal after surgery is different for each person. You may
be uncomfortable for the first few days. Medicine can help control your pain.
Before surgery, you should discuss the plan for pain relief with your doctor or
nurse. After surgery, your doctor can adjust the plan if you need more pain
relief.
Many people who have stomach surgery feel tired or weak for a while. The
surgery also can cause
constipation
or
diarrhea.
These symptoms usually can be
controlled with diet changes and medicine. Your health care team will watch for
signs of bleeding, infection, or other problems that may require treatment.
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You may want to ask your doctor these questions about surgery:
- What kind of surgery do you recommend for me?
- Will you remove lymph nodes? Will you remove other tissue? Why?
- How will I feel after surgery?
- Will I need a special diet?
- If I have pain, how will you control it?
- How long will I be in the hospital?
- Am I likely to have eating problems? Will I need a feeding tube? If so, for how long? How do I take care of it? Who can help me if I have a problem?
- Will I have any lasting side effects?
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Chemotherapy uses anticancer drugs to kill cancer cells. The drugs enter the
bloodstream and can affect cancer cells all over the body.
Most people who receive chemotherapy have it after surgery. Radiation therapy
may be given along with chemotherapy.
Anticancer drugs for stomach cancer are usually injected into a blood vessel.
But some drugs may be given by mouth. You may have your treatment in a clinic
at the hospital, at the doctor's office, or at home. Some people may need to
stay in the hospital during treatment.
The side effects of chemotherapy depend mainly on the specific drugs and the
dose. The drugs affect cancer cells and other cells that divide rapidly:
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Blood cells: These cells fight infection, help blood to clot, and carry oxygen
to all parts of your body. When drugs affect your blood cells, you are more
likely to get infections, bruise or bleed easily, and feel very weak and tired.
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Cells in hair roots: Chemotherapy drugs can cause hair loss. Your hair will
grow back, but it may be somewhat different in color and texture.
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Cells that line the digestive tract: Chemotherapy can cause poor appetite,
nausea and vomiting, diarrhea, or mouth and lip sores.
The drugs used for stomach cancer also may cause a skin rash or itching. Your
health care team can suggest ways to control many of these side effects.
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You may want to ask your doctor these questions about chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- When will treatment start? When will it end?
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Radiation therapy (also called radiotherapy) uses high-energy rays to kill
cancer cells. It affects cells only in the treated area.
The radiation comes from a large machine outside the body. Most people go to a
hospital or clinic for treatment. Treatments are usually 5 days a week for
several weeks.
Side effects depend mainly on the dose of radiation and the part of your body
that is treated. Radiation therapy to the abdomen may cause pain in the stomach
or the intestine. You may have nausea and diarrhea. Also, your skin in the
treated area may become red, dry, and tender.
You are likely to become very tired during radiation therapy, especially in the
later weeks of treatment. Resting is important, but doctors usually advise
patients to try to stay as active as they can.
Although the side effects of radiation therapy can be distressing, your doctor
can usually treat or control them. Also, side effects usually go away after
treatment ends.
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You may want to ask your doctor these questions about radiation therapy:
- Why do I need this treatment?
- When will the treatments begin? When will they end?
- How will I feel during treatment?
- How will we know if the radiation treatment is working?
- Are there any lasting effects?
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