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Gastric cancer|Gastric Cancer


1. Treatment method

(1) Surgery

        The standard treatment for stomach cancer is surgery. The extent of gastrectomy depends on the location and stage of the cancer. At the same time as the stomach is removed, we will also perform a lymphadenectomy to remove the lymph nodes around the stomach and reconstruct the gastrointestinal tract.

  • Type of surgery

       Surgery is roughly divided into curative surgery (surgery aimed at healing) and non-curative surgery (surgery aimed at relieving symptoms while healing). According to the degree of stomach and lymph node resection, healing surgery can be divided into typical surgery and atypical surgery, and non-healing surgery can be divided into palliative surgery and reduction surgery according to the purpose.

  • Surgical methods

       Representative operations include total gastrectomy, pyloric side gastrectomy, pylorus-preserving gastrectomy, and cardia side gastrectomy.

  • Lymph node Qing Guo

       Lymph node metastasis of stomach cancer is formed by cancer cells that enter the lymphatic flow and gradually flow from the stomach to the vicinity of the aorta deep inside the stomach. During surgery, removing the stomach and surrounding lymph nodes at the same time is called lymphadenectomy.

  • Gastrointestinal reconstruction

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_Gastrointestinal reconstruction is connected by suturing at the same time as gastrectomy Digestive tracts such as the stomach and intestines, recreate a new food digestion path. Depending on the type of surgery, there are several ways to reconstruct the GI tract, and the reconstruction method will depend on the extent of the gastrectomy.

  • Complicated resection of peripheral organs

       The organs surrounding the stomach are the liver, diaphragm, pancreas, gallbladder, transverse colon, etc. If the primary site or metastatic disease directly invades these organs, resection of part of the affected organs at the same time as gastric resection is called combined resection. Combined resection Although extensive, the goal is to completely remove and cure the cancer.

  • Major complications and measures associated with surgery

      The main complications after gastric cancer surgery are abdominal abscess, pancreatic juice leakage, wound infection, intestinal obstruction, and bleeding. If complications arise, treatment will be done on a case-by-case basis.

side effect:

        Wound infection, anastomotic leakage, pulmonary incompetence, delayed gastric emptying, etc. Long-term complications may include: bile reflux, dumping syndrome, intestinal adhesion or obstruction, iron and vitamin B12 deficiency, abnormal nutrient metabolism, etc.


(2) Laparoscopic gastrectomy

        Laparoscopic surgery is a procedure in which small holes are opened in the abdomen and surgery is performed using specialized cameras and instruments. Compared with normal laparotomy, surgery is less burdensome on the body, and recovery from surgery is expected to be earlier, so the number of operations is increasing.

        In the treatment guidelines for gastric cancer, laparoscopic gastrectomy is also one of the treatment options. If the clinical treatment stage before treatment is stage I, and pyloric side gastrectomy is required, the surgical method has not been confirmed by the results of clinical trials. It should be pointed out that the complication rate may be slightly higher than that of usual surgery because of the difficulty of lymph node dissection compared with laparotomy and the inability to establish a technique for reconnecting the gastrointestinal tract. In addition, no long-term follow-up reports of cancer treatment in this way have been reported. Talk to your doctor when considering laparoscopic surgery.

(3) Endoscopic treatment

        This is a procedure in which cancer is removed from the stomach using an endoscope. The stomach can also be preserved after resection, which has almost no impact on eating habits, and at the same time can maintain the quality of life, which is the biggest advantage of cancer treatment.


        Resection methods include endoscopic mucosal resection (EMC) and endoscopic submucosal ablation (ESD), or endoscopic submucosal ablation (ESD). Treatment adaptation, early stage gastric cancer and cancer depth is that it will stay in the mucosa and it is impossible to spread to the lymph nodes. In recent years, endoscopic submucosal dissection (ESD) has become common due to advances in therapeutic indications and techniques. It is confirmed by pathological examination/pathological diagnosis whether gastric cancer is definitely resected by endoscopic treatment, and if the cancer has exceeded the indications for endoscopic treatment, additional surgery (surgical treatment) is required later.

side effect:Abdominal pain, bleeding and perforation.

  (4) Chemotherapy

        Drug treatment (chemotherapy) for stomach cancer includes "adjuvant chemotherapy" performed in combination with surgery, and "palliative chemotherapy" performed in cases where healing surgery is difficult, with the aim of prolonging life and controlling symptoms. Palliative chemotherapy is difficult to completely cure gastric cancer, but it can inhibit the development of cancer and relieve symptoms, and the degree of side effects depends on the individual.

        The drugs used are fluoropyrimidine drugs (fluorouracil [trade names: 5-FU, S-1, Zetumar, etc.), platinum drugs (cisplatin, oxaliplatin), paclitaxel drugs (paclitaxel, docetaxel ), irinotecan hydrochloride, anticancer drugs such as Ramucirumab can be used alone or in combination.In addition, in 10% to 20% of stomach cancers, since a protein called "HER2 (Hartz)" is involved in the proliferation of cancer cells, when the HER2 test is positive, chemotherapy is given with trastuzumab combined with molecular targeted drugs.


  • Chemotherapy for progressive and recurrent cancers that are refractory to surgery

       HER2 testing before starting chemotherapy. Which drug to use is decided based on the results (figure). In HER2-positive cases, the combination with trastuzumab is the standard of care. In addition to standard treatments with adequate information on effects and side effects, as well as new drugs and new combinations of existing drugs, there is the option of participating in clinical trials aimed at developing new treatments and treating them.

Chemotherapy Drugs and Treatment Options

  • postoperative adjuvant chemotherapy

       Even if the cancer can be removed surgically, for microscopic cancers, the treatment is performed to prevent the recurrence of incurable diseases. The adaptive trial was stage II/III (T1 and excluding T3 without lymph node metastasis), and treatment with oral administration of S-1 anticancer drug for 1 year after surgery was the standard treatment. It is known that the cure rate (5-year survival rate) has increased by about 10%.


  • preoperative adjuvant chemotherapy

       Treatment for micrometastases that are not visible and lead to recurrence, in addition, the cancer is relatively large and difficult to remove, and the goal of treatment is to make it easy to remove. There are various combinations of drugs, and the tried-and-true treatment is positioned as a treatment performed in a clinical trial because the effect to be added is not fixed compared with postoperative adjuvant chemotherapy.

side effect:

        Chemotherapy affects not only cancer cells but also normal cells. In particular, hair cells, oral cavity and gastrointestinal mucosa, etc., and bone marrow cells that are active in cell division, such as bone marrow that produces blood cells, are easily affected, resulting in hair loss, stomatitis, diarrhea, and decreased white blood cells and platelets. In addition, general malaise, nausea, swelling of the extremities, pigmentation, numbness, palpitations (arrhythmias) and arrhythmias, and liver and kidney diseases may also occur.

2. Rehabilitation

(1) Daily life after surgery

        In life after surgery, the biggest change is eating and drinking. When partial or total gastrectomy is performed, it is associated with sequelae of the operation depending on the state of the gastrointestinal tract, so please consult with the doctor in charge, nurse, nutritionist, etc., and find out your own countermeasures. Get used to life incrementally, while designing meals to make your own medical care more comfortable. It's also important to keep fit with light daily exercise, such as walking.


  • Digestive symptoms after surgery

       By removing the stomach, the digestive system also has various roles. Symptoms caused by surgery (total gastrectomy, pyloric side gastrectomy, pylorus-preserving gastrectomy, cardia side gastrectomy) are different, but there are dumping syndrome, reflux symptoms, gastric phlegm, etc.

  • Symptoms after surgery

       After the stomach is removed, various symptoms may occur because the food passing through the stomach flows directly into the intestine, which is called dumping syndrome. Dumping syndrome can be divided into early and late two types. Other symptoms caused by gastrectomy include reflux esophagitis, anemia, osteoporosis, etc.


(2) Daily life after endoscopic treatment

        Because the function of the stomach will not be greatly damaged, the health of the body will recover quickly, and basically the same meal as before the treatment can be taken. It seems that in many cases, you can come back as often as you like within 2 to 3 weeks of being discharged from the hospital. However, avoid strenuous exercise, drinking and eating, and prolonged bathing for about 1 to 2 months after treatment.


(3) Daily life during chemotherapy

        In recent years, with advances in anticancer drugs and supportive care, outpatient chemotherapy administered by hospitals with anticancer drugs is increasing. While daily life is not affected, such as work, housework, parenting, etc., and you can treat it, anxiety can develop and a doctor isn't always around. It is best to know the attending physician's expected side effects and how to deal with them in advance, and to advance treatment while consulting with points of doubt and anxiety at the outpatient clinic. Also, with regards to side effects, it is important to know how to deal with yourself while gaining the support of your family and other people around you. Instead, you don't have to worry too much about the chemotherapy process. Please try to maintain your daily routine as much as possible according to your physical condition.


(4) Daily diet

        During or after gastric cancer treatment, the amount of meals and the way of eating are different from the past. It is necessary to set the menu and cooking method. While observing the condition of the gastrointestinal tract, it is also necessary to create a diet rhythm that suits you.


  • Diet after surgery

       Even when the stomach is nourished according to the operation method, the remaining stomach does not become larger over time, and the space for storing food is reduced, so the amount of single food intake needs to be reduced. Because digestion takes a while and the original action delivered to the gut is hindered, symptoms such as damper syndrome may occur. It is important to eat "in small amounts", "chew", "eat slowly", and let the new stomach adapt to the eating pattern, compared with before treatment or after discharge, few patients suffer from emaciation. However, if the symptoms are stable, the weight will often be reduced than before treatment, so don't worry too much, pay attention to how you eat, not the weight.

For gastric cancer-related drug information, please refer to the Medical Assistant Blog gastric cancer

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