Oesophageal and Stomach Cancer

Cancers can develop from the lining of the stomach and oesophagus.  They are usually one of two types, 'adenocarcinoma' which can occur in the stomach or oesophagus, or a 'squamous cell carcinoma', a cancer found in the oesophagus.  Treatment can be complicated and require the input of multiple specialists and allied health members.

Once you have been diagnosed you will be referred to see Dr Hamer who will oversee your cancer treatment. 

Cancers of the stomach and oesophagus can require different treatments depending on what sort of cancer they are, where exactly in the stomach or oesophagus they are located, and how far they have spread.  Before you commence treatment, it is vital that you undergo a series of tests to work all this out as it will determine exactly which treatment is best for you.

Initial tests that may be arranged:

• CT scan.  Almost all patients will undergo a CT scan to determine the size and location of the cancer.
• PET scan.  A PET scan is a highly specialized nuclear medicine scan which can help determine if the tumour is localised to one spot, or if it has spread.  Depending on what your other tests show, a lot of patients with oesophageal cancer will require this scan
• Staging laparoscopy.  A staging laparoscopy is a key hole operation to have a look at your stomach from the inside.  It is a day surgery operation, and can provide extra information particularly in stomach cancer cases that sometimes won't show up on other scans. 
• Endoscopy.  If you have an earlier or smaller cancer, you may be referred for a specialised endoscopy.  This may include an endoscopic ultrasound to look at how far through the wall of the oesophagus the tumour has spread, or an endoscopic resection where the endoscope can remove part or all of very small cancers to treat or to get further information.

With this information Dr Hamer will have a discussion with you about the likelihood of being able to cure your cancer, and which treatment will be best for you.  Often your best treatment will not be just one treatment, but a combination of things to optimize your treatment.  Your case will be discussed at a multidisciplinary meeting, a meeting where Dr Hamer will discuss your treatment with other specialists, including chemotherapy doctors (medical oncologists), radiotherapy doctors (radiation oncologists), pathologists (the specialists who analyze biopsies of your cancer or the cancer itself if it is removed) and radiologists (specialists responsible for interpreting the scans you have undergone).

Major surgery is sometimes recommended to remove part of your oesophagus or stomach to cure your cancer.  In most cases you will undergo chemotherapy or a combination of chemotherapy and radiotherapy prior to your operation as we know that it will increase your chances of beating the cancer in the long term.  The operation you undergo depends on where exactly your cancer is located.  This may be either an oesophagectomy where part of your oesophagus and stomach are both removed, a total gastrectomy where your entire stomach is removed or a partial or distal gastrectomy where a portion of your stomach is removed.

Oesophagectomy

Oesophagectomy is the surgery performed to remove the oesophagus for cancer.  It is major surgery involving operating in the chest (thoracic cavity) and belly (abdominal cavity) during the same operation.  Firstly the lower part of the oesophagus and the upper part of the stomach are removed, and secondly the remaining stomach is brought up/stretched up into the chest and sewn in place of the removed section of oesophagus.  

Although Dr Hamer usually performs this surgery key-hole, it is still major surgery with most patients spending 10-14 days in hospital recovering.

Gastrectomy

Gastrectomy is surgery to remove the whole, or part of the stomach, usually to remove a cancer.  It is major surgery, depending on your personal circumstances may require key-hole or an open surgery, and  usually requires a 5-10 day stay in hospital.  

The small bowel is brought up to replace the removed stomach, and people find that after surgery they may need to eat 6 small meals a day rather than 3 larger meals.  

Chemotherapy can be recommended either as an adjunct to surgery to increase your chances of survival, or in cases where the cancer has spread where it is used to slow the growth of the tumour.

Radiotherapy may be recommended to shrink the size of the tumour in your oesophagus.  This may be done to either increase your ability to swallow, or to shrink the cancer prior to removal.

In some cases where the tumour is threatening to block off the oesophagus, an endoscopy can be performed and an expanding stent placed to reopen your oesophagus to allow you to eat and swallow more normally.

An important part of any cancer treatment, but particularly if you have stomach or oesophageal cancer, is optimising your health.  You may be losing weight and having difficulty swallowing, and it is useful to see a dietician to help with your diet and usually you will need nutritional supplements.  It is recommended that if you are not already active, embarking on an exercise program will help you through your cancer treatment. 

If you smoke you should cease immediately.  This is particularly important if you are working towards an operation.  If you smoke even 1-2 cigarettes within 1 month of major surgery it makes it harder for your body to heal from surgery, increasing your risk of suffering major complications.