April is Oesophageal Cancer Awareness Month

Gastric and oesophageal cancers treatments

Surgery

For some earlier stage oesophageal or gastric cancers, surgery can be used to try to remove the cancer and some of the normal surrounding tissue. In some cases, it might be combined with other treatments, such as chemotherapy and/or radiation therapy.

Surgery for oesophageal cancer

Oesophagectomy

Surgery to remove some or most of the oesophagus is called an oesophagectomy. If the cancer is diagnosed at an early stage, it is possible that this surgery can cure the cancer. However, most oesophageal cancers are not diagnosed early enough to cure them with surgery.

An oesophagectomy is not a simple operation, and it may require a long hospital stay.

Exactly how much of the oesophagus is removed depends upon the stage of the cancer and where it’s located.

If the tumour is in the upper part of the oesophagus, it’s likely that most of the oesophagus will be removed. The stomach will then be brought up and connected to the oesophagus in the neck, or the surgeon may use a piece of the intestine to bridge the gap between the two.

If the cancer is in the lower part of the oesophagus, the surgeon will remove part of the oesophagus and part of the stomach. Then the stomach is connected to what is left of the oesophagus.

There will likely be a considerable recovery period needed after surgery, and there are several potential complications. Lung complications such as pneumonia are common. Some patients have problems swallowing, requiring another procedure. It is important to record all symptoms and inform your doctor.

Oesophagectomy

An anatomical illustration of an oesophagectomy. The exact details of the operation and reconstruction may differ from the picture and the surgeon will talk you through this.

Surgery for gastric cancer

Partial gastrectomy

If the tumour is only in one part of the stomach, then a partial gastrectomy may be possible. Only part of the stomach is removed, sometimes along with part of the oesophagus or part of the small intestine. The remaining section of the stomach is then reattached.

Partial gastrectomy

An anatomical illustration of a partial gastrectomy. The exact details of the operation and reconstruction may differ from the pictures and the surgeon will talk you through this.

Total gastrectomy

If the cancer has spread throughout the stomach, then your doctor may recommend a total gastrectomy. The entire stomach is removed, and the end of the oesophagus is attached to the small intestine to allow food to travel through.

People who have had their stomach removed can only eat a small amount of food at a time. Because of this, some people have difficulties taking in enough nutrition. You may receive some nutrition support either through a feeding tube into your bowel (enteral nutrition) or through a line that goes directly into your blood stream (parenteral nutrition).

If the surgeons put a feeding tube directly into the small bowel during surgery (a jejunostomy tube or J tube) your dietitian will prescribe a liquid nutrition which can be digested and absorbed by your small intestine. It has all the nutrients your body needs to help you recover.

The tube feed may be continued on discharge to supplement your diet when you are at home. This will help you to get all the protein and calories you need to have a successful recovery.

There will likely be a considerable recovery period needed after surgery, and there are several potential complications. These include nausea, heartburn, abdominal pain, and diarrhoea, particularly after eating (because food is entering the intestines too quickly after eating). The side effects often get better over time.

Changes in diet will be needed after a partial or total gastrectomy, with the biggest change being the need to eat smaller, more frequent meals.

Full Gastrectomy

An anatomical illustration of a total gastrectomy. The exact details of the operation and reconstruction may differ from the pictures and the surgeon will talk you through this.

Palliative surgery

Sometimes minor types of surgery are used to help prevent or relieve problems caused by the cancer, instead of trying to cure it. For example, minor surgery can be used to place a feeding tube directly into the stomach or small intestine in people who need help getting enough nutrition. Your doctor will discuss these options with you.

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