Prof. Dr. Emin Ersoy General Surgery
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General Surgery

Stomach Cancer Surgery

Part or all of the stomach is removed with nearby lymph nodes when surgery is possible; otherwise chemotherapy is given.

Stomach cancer suitable for surgery

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Overview of stomach cancer surgery

Stomach cancer surgery is an operation to remove the part of the stomach affected by cancer, or the whole stomach, together with the nearby lymph nodes. If surgery is possible, it is the most suitable treatment for stomach cancer. Knowing who is more likely to develop the disease, and which conditions can lead to it, helps to find it early, when treatment options are wider.

Stomach cancer is more common in people with a family history of stomach cancer, in people with anaemia (a low red blood cell count) and in people with blood group A.

Diet and lifestyle

A diet with a lot of heavily salted and smoked foods raises the risk. Stomach cancer is less common in people who eat plenty of fruit and vegetables. Smoking is also a risk factor.

Helicobacter pylori and Epstein-Barr virus

Infection with the bacterium Helicobacter pylori raises the risk of stomach cancer. The risk is raised with a stomach ulcer, and less so with a duodenal ulcer (an ulcer in the first part of the small bowel). If you have the infection together with a condition such as a stomach ulcer or inflammation of the stomach lining (gastritis), the infection should also be treated. The Epstein-Barr virus has also been linked to the development of stomach cancer.

Family history

If stomach cancer runs in your family, your own risk is higher. If you have stomach symptoms and other family members have similar symptoms, you should be examined by a doctor.

Conditions that can lead to stomach cancer

  • Polyps: there are different types. They should be checked regularly and removed if needed. Polyps larger than 2 cm in particular have a strong tendency to become cancerous.
  • Atrophic gastritis: with long-lasting inflammation of the stomach lining, the lining can change over time. Cancer can develop in these changed areas.
  • Intestinal metaplasia: the permanently changed stomach lining can take on a structure similar to the small bowel. The risk of cancer is high.
  • Stomach ulcers: cancer can also develop from a stomach ulcer. Close monitoring and treatment are needed.
  • Previous stomach surgery: years after stomach surgery, cancer can develop where the new connection to the bowel was made. Regular check-ups after stomach surgery are therefore important.

Symptoms and early detection

The first signs are often weight loss and loss of appetite. Because stomach complaints are common, they are often not taken seriously for a long time while the disease progresses. Weight loss and loss of appetite can be a sign of an advanced stage. Weakness and blood loss can also occur. A gastroscopy can detect stomach cancer at an early stage, and tissue samples taken during the test confirm the diagnosis.

Who is it for?

If surgery is possible, it is the most suitable treatment. If surgery is not possible, chemotherapy is given. Whether an operation is possible depends mainly on the stage of the cancer, that is, how far it has grown and whether it has spread, and on your general health.

To find out the stage, further tests are done after the diagnosis, such as a CT scan. The results are then assessed, and the treatment plan is discussed and decided together with you.

Risks

Stomach cancer surgery is a major operation, and it carries the general risks of any major operation on the abdomen: bleeding, infection of a wound or inside the abdomen, lung problems, reactions to the anaesthetic and blood clots in the legs or lungs. There is also a risk of a leak where the remaining stomach or the oesophagus has been joined to the bowel, which may need further treatment.

After the operation, the smaller stomach, or the absence of a stomach, changes the way you eat. You may feel full quickly, and after some meals, especially sugary ones, you may have symptoms of dumping syndrome, such as feeling unwell, sweating or diarrhoea, as described on the gastric bypass page. In the long term, you may become short of vitamin B12 and iron, so supplements may be needed.

Preparation

Preparation for stomach cancer surgery includes the tests needed to plan the operation, and, depending on your age and health, blood tests, a chest X-ray and an ECG (heart tracing). Because eating may have been difficult before the operation, your nutrition is also assessed, and you may receive advice from a dietitian.

Tell your surgeon about all the medicines you take, especially blood-thinning medicines, because some may need to be stopped for a while. You will be asked not to eat or drink for a set time before the operation. If you smoke or drink alcohol, you will be advised to stop. Finally, the possible risks and benefits are discussed with you and you give your written consent.

What happens

On the day

The operation is done under general anaesthesia, so you are asleep throughout. Depending on where the cancer is and how far it has grown, either part of the stomach (partial gastrectomy) or the whole stomach (total gastrectomy) is removed, together with the nearby lymph nodes. The remaining stomach, or the lower end of the oesophagus, is then joined to the small intestine so that food can pass through again. The operation can be done as open surgery or, in suitable cases, by keyhole surgery.

The tissue that has been removed is examined under the microscope (pathology). The result shows how far the cancer had spread and helps to decide whether any further treatment is needed.

Aftercare

After the operation, your diet is built up step by step, starting with fluids and moving on to soft and then solid food. Small, frequent meals are usually easier than large ones, and a dietitian can help you adjust to the new way of eating. You will be encouraged to get up and walk soon after the operation, which helps your recovery and lowers the risk of blood clots. As part of your follow-up, a routine blood test check is done at 6 months, and the results of the tissue examination and any further treatment are discussed with you.

When should you contact your doctor?

Contact your doctor straight away if, after you go home, you have:

  • a high temperature or shivering (chills)
  • increasing pain or swelling in the abdomen
  • nausea or vomiting that does not stop
  • being unable to eat or drink
  • redness, swelling or fluid leaking from the wound
  • shortness of breath or swelling of the calf

Frequently asked questions

What increases the risk of stomach cancer?

The risk is higher with a family history of stomach cancer, Helicobacter pylori infection, a diet high in heavily salted and smoked foods, and smoking. Some conditions, such as certain polyps and intestinal metaplasia, can also lead to cancer.

What are the first signs of stomach cancer?

The first signs are often weight loss and loss of appetite. Weakness and blood loss can also occur.

How is stomach cancer detected early?

A gastroscopy can detect stomach cancer at an early stage, and tissue samples taken during the test confirm the diagnosis.

Is surgery always possible?

No. If surgery is possible, it is the most suitable treatment. If it is not possible, chemotherapy is given.

How will eating change after the operation?

You may feel full quickly, so small, frequent meals are usually easier. You may also need vitamin B12 and iron supplements in the long term.

Would you like to discuss this?

The right method for you is decided together after examination and tests. You can start with the pre-assessment or call directly.

Request an appointment +90 533 300 35 75

Other methods in this group

Reflux Surgery A keyhole operation (fundoplication) that wraps the top of the stomach around the oesophagus to rebuild the valve against reflux. Reflux not controlled by medicines Learn more › Hernia Surgery An inguinal, umbilical or incisional hernia is repaired by open or keyhole surgery, usually with a synthetic mesh. Groin, belly button or scar hernia Learn more › Gallbladder Surgery When gallstones cause problems, the gallbladder is usually removed by keyhole surgery through four small openings. Gallstones causing symptoms Learn more ›

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