Stomach and oesophageal cancers

The oesophagus and stomach

The oesophagus and stomach are part of the upper gastrointestinal (GI) tract, which is part of the digestive system. Food travels down the oesophagus and into the stomach where it is mixed with stomach juices that help to digest food.

About stomach cancer

Stomach cancer develops when cells in the lining of the stomach change and grow out of control. If it is not found and treated early stomach cancer can spread to other parts of the body.
About 2,580 people are diagnosed with stomach cancer each year in Australia. Men are almost twice as likely as women to be diagnosed with stomach cancer. It is more common in people over 60, but it can occur at any age.

About oesophageal cancer

Oesophageal cancer begins when abnormal cells develop in the innermost layer of the oesophagus. There are two types: oesophageal adenocarcinoma, which is most common in Australia, and oesophageal squamous cell carcinoma.
If it is not found and treated early, oesophageal cancer can spread to other parts of the body, most commonly the liver and lungs. In Australia, about 1740 people are diagnosed with oesophageal cancer each year, with men much more likely to be diagnosed.

Signs and symptoms

Stomach and oesophageal cancers may not cause symptoms in the early stages and the symptoms are usually common for other medical conditions.

Common symptoms of stomach cancer

• unexplained weight loss or loss of appetite
• difficulty swallowing
• indigestion (pain or burning sensation in the abdomen, burping often, reflux)
• persistent nausea and/or vomiting with no apparent cause
• abdominal pain
• sense of fullness, even after a small meal
• swelling of the abdomen or feeling bloated
• unexplained tiredness
• vomit containing blood
• black-coloured or bloody stools.

Common symptoms of oesophageal cancer

• difficulty swallowing
• new heartburn or reflux
• reflux that doesn’t go away
• food or fluids “catching” in the throat, regurgitation or vomiting when swallowing
• pain when swallowing
• unexplained weight loss or loss of appetite
• feeling uncomfortable in the upper abdomen, especially when eating
• unexplained tiredness that won’t go away
• vomit that has blood in it
• black or bloody stools (poo).

Not everyone with these symptoms has stomach or oesophageal cancer. If you have any of these symptoms or are worried, always see your doctor.

Risk factors

There are some things that can make it more likely to develop stomach or oesophageal cancer. These are called risk factors.

Stomach cancer risk factors

• older age (being over 60)
• infection with the bacteria Helicobacter pylori, which is a type of bacteria found in the stomach
• having had part of your stomach removed to treat non-cancerous conditions
• smoking tobacco
• low red blood cell levels (pernicious anaemia)
• a family history of stomach cancer
• having an inherited genetic condition such as familial adenomatous polyposis (FAP), Lynch syndrome, gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) or hereditary diffuse gastric cancer (HDGC)
• chronic inflammation of the stomach (chronic gastritis)
• being overweight or obese
• drinking alcohol
• eating foods preserved by salt.

Oesophageal cancer risk factors

Adenocarcinoma

• being overweight or obese
• medical conditions, including gastro-oesophageal reflux disease (GORD) and Barrett’s oesophagus
• smoking tobacco
• older age (being over 60)

Squamous cell carcinoma

• drinking alcohol
• smoking tobacco
• older age (being over 60)
• damage to the oesophagus from hot or corrosive liquids such as acid

Having one or more of these risk factors doesn’t mean you will develop stomach or oesophageal cancer. Often there is no clear reason for getting either cancer. If you are worried about your risk factors, ask your doctor for advice.

Stomach and oesophageal cancer tests

Your doctor may do some tests to check for stomach or oesophageal cancer:

• Endoscopy (also called gastroscopy, oesophagoscopy or upper endoscopy) – a doctor passes a long, flexible tube with a light and small camera on the end (endoscope) into your mouth, down your throat and oesophagus, and into your stomach and small bowel. This allows the doctor to look inside your digestive tract to examine the lining.
• Biopsy – during an endoscopy if the doctor sees any suspicious-looking areas they may remove a small amount of tissue from the stomach or oesophageal lining, known as a biopsy. A pathologist will then examine the tissue under a microscope to check for signs of disease.
• Endoscopic ultrasound (EUS) – a doctor passes an endoscope with an ultrasound probe on the end into your mouth, down your throat and oesophagus, and into your stomach and small bowel. The ultrasound probe then uses sound waves that echo when they bounce off anything solid, such as an organ or tumour, helping to see if the cancer has spread.

If these tests show you have stomach or oesophageal cancer you will then have some of the following tests to check your general health and to find out if the cancer has spread to other parts of your body:

• Blood tests – a small amount of blood will be taken from a vein to check your general health.
• Computerised tomography (CT) scan– a scan that uses x-rays and a computer to take pictures of the inside of the body, which can help to determine if the cancer has spread to other parts of the body.
• Positron emission tomography (PET)-CT scan – a CT scan combined with a PET scan, which provides more detail than a CT scan on its own and can also be used to determine if the cancer has spread to other parts of the body.
• Laparoscopy – a surgical procedure that allows your doctor to look inside your abdomen and examine the outer layer of your stomach and the lining of the wall of the abdomen for signs that the cancer has spread.

Stomach and oesophageal cancer types

Stomach cancer

The most common type of stomach cancer is adenocarcinoma of the stomach (also known as gastric cancer). This cancer starts in the glandular tissue found on the stomach’s inner surface.

Other less common types of cancer can affect the stomach including small cell carcinomas, lymphomas, neuroendocrine tumours and gastrointestinal stromal tumours. Your doctor will be able to explain more about these types of stomach cancer.

Oesophageal cancer

There are two main types of oesophageal cancer:

• Oesophageal adenocarcinoma – This often starts near the gastro-oesophageal junction and is linked with Barrett’s oesophagus. Adenocarcinomas are the most common form of oesophageal cancer in Australia.
• Oesophageal squamous cell carcinoma – This starts in the thin, flat cells of the mucosa, which are called squamous cells. It often begins in the middle and upper part of the oesophagus.

Stomach and oesophageal cancer stages

The stage of a cancer means how far it has grown in your body. The most common way doctors decide on a stage for stomach oesophageal cancer is the TNM (tumour, nodes metastasis) staging system. The stages are based on the size of the tumour, whether or not lymph nodes are affected, and whether the cancer has spread:

• Stage 1 – describes early or limited cancer where tumours are found only in the stomach.
• Stage 2–3 – describes locally advanced cancer where tumours have spread deeper into the layers of the stomach and to nearby lymph nodes.
• Stage 4 – describes metastatic or advanced cancer where tumours have spread beyond the stomach to nearby lymph nodes or parts of the body, or to distant lymph nodes and parts of the body.

Prognosis and survival rates

When someone is diagnosed with cancer, their doctor will give them a prognosis. A prognosis is the doctor’s opinion of how likely it is that the cancer will spread and the chances of getting better. A prognosis depends on the type and stage of cancer, as well as the person’s age and general health.

Generally, the earlier stomach and oesophageal cancer is diagnosed the better the chances of successful treatment. If the cancer is found after it has spread from the stomach or oesophagus, the prognosis is not usually as good.

Your doctor will talk to you about your individual situation when working out your prognosis. Every person’s experience is different, and there is support available to you.

Treatment for stomach and oesophageal cancer

Treatment for stomach and oesophageal cancer depends on the stage of the cancer, your age, medical history, nutritional needs and general health.

You might feel confused or unsure about your treatment options and decisions. It’s okay to ask your treatment team to explain the information to you more than once. It’s often okay to take some time to think about your decisions.

Endoscopic resection

Very early-stage tumours that have not spread from the stomach or oesophageal walls may be removed with a long, flexible tube (endoscope) that is passed down your throat and oesophagus, and into your stomach.

For some people, this may be the only treatment they need.

Surgery

Surgery is the main treatment for stomach cancer that has not spread to other parts of the body. Surgery aims to remove all of the stomach cancer while keeping as much normal tissue as possible. There are 2 main types of surgery for stomach cancer:

• Gastrectomy – this procedure removes all or part of the stomach, leaving as much healthy tissue as possible.
• Lymphadenectomy – this removes the lymph nodes around your stomach to reduce the risk of the cancer coming back and help in the staging.

Surgery to remove part or all of the oesophagus is called an oesophagectomy (surgical resection). Nearby affected lymph nodes are also removed. Depending on where in the oesophagus the cancer is, the surgeon may also remove part of the upper stomach.

Surgery for oesophageal cancer is complex. Surgeons who regularly perform this type of surgery have better outcomes, which means that if you live far from a specialist centre, you will have to travel to have surgery.

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth cancer cells. For stomach or oesophageal cancer, chemotherapy may be given before surgery to shrink large tumours and destroy any cancer cells that may have spread. It may also be used after surgery to reduce the chance of the cancer coming back or as part of palliative treatment to help control the cancer and improve quality of life.

Targeted therapy

Targeted therapy is a type of drug treatment that attacks specific parts of cancer cells to stop the cancer growing and spreading. Targeted therapy is only available for certain types of stomach cancer.

Radiation therapy

Radiation therapy, also known as radiotherapy, is a type of treatment that uses a controlled dose of radiation to kill or damage cancer cells so they cannot multiply.

Radiation therapy for stomach cancer is commonly used to control bleeding and is sometimes used before or after surgery.

Radiation therapy is the main treatment for oesophageal cancer that has not spread to other parts of the body and cannot be removed with surgery.

Immunotherapy

There have been some advances in treating advanced stomach or oesophageal cancer with immunotherapy drugs known as checkpoint inhibitors. These use the body’s own immune system to fight cancer. Speak to your doctor about whether immunotherapy is the right treatment for you.

Side effects of cancer treatments

All cancer treatments can have side effects. Your treatment team will discuss these with you before you start treatment. Talk to your doctor or nurse about any side effects you are experiencing.

Some side effects can be upsetting and difficult, but there is help if you need it. Call Cancer Council Victoria Tel. 13 11 20 or contact cancer support to speak with a caring cancer nurse for support.

Having a feeding tube

Some people with stomach or oesophageal cancer will have a feeding tube before and/or during treatment to help them maintain their weight and build up their strength.

Many people find that having a feeding tube makes eating easier and less uncomfortable. A feeding tube can be placed into your small bowel either through a nostril or with an operation that places a tube through the skin of your abdomen.

Your treatment team will show you how to care for the tube. It will be removed when it is no longer required. Having a feeding tube is a major change and it’s common to have a lot of questions. For information, talk to a dietitian or nurse. A counsellor or psychologist can provide emotional support and coping strategies.

What to do before treatment starts

Before you start your treatment it is recommended you:

• Improve diet and nutrition – people with stomach cancer often lose a lot of weight and can become malnourished. Your doctor may refer you to a dietitian for advice on how to slow down the weight loss. This will help improve your strength, reduce side effects, and may mean the treatment works better.
• Stop smoking – if you smoke, aim to quit before starting treatment. If you keep smoking, you may not respond as well to treatment. For support, see your doctor or call Quit Tel. 13 78 48.
• Begin or continue an exercise program – exercise will help build up your strength for recovery. Talk to your doctor or physiotherapist about the right type of exercise for you.
• Avoid alcohol – talk to your doctor about your alcohol use. Alcohol can affect how the body works and increase the risk of complications after surgery (including bleeding and infections), and of the cancer returning.
• Talk to someone – you may find it useful to talk to a counsellor or psychologist about how you are feeling. This can help you deal with any anxiety about diagnosis and treatment. Or call 13 11 20 to find out about Cancer Council’s support services.
  

Sexuality and stomach or oesophageal cancer

Having stomach or oesophageal cancer and treatment can change the way you feel about yourself, other people, relationships and sex. These changes can be very upsetting and hard to talk about. Doctors and nurses are very understanding and can give you support. You can ask for a referral to a counsellor or therapist who specialises in body image, sex and relationships.

Living with advanced cancer

Advanced cancer usually means cancer that is unlikely to be cured. Some people can live for many months or years with advanced cancer. During this time palliative care services can help.

Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives. Many people think that palliative care is for people who are dying but palliative care is for any stage of advanced cancer. There are doctors, nurses and other people who specialise in palliative care.

Treatment may include chemotherapy, radiation therapy or another type of treatment. It can help in these ways:

• Slow down how fast the cancer is growing.
• Shrink the cancer.
• Help you to live more comfortably by managing symptoms, like pain.

Treatment depends on:

• Where the cancer started.
• How far it has spread.
• Your general health.
• Your preferences and what you want to do.

Ask your doctor about treatment and palliative care services that may help you.

Support for carers, family and friends of someone with stomach or oesophageal cancer

Caring for someone with cancer can be difficult sometimes. If you are caring for someone with stomach or oesophageal cancer, these organisations can help:

• Cancer Council Victoria Tel. 13 11 20
• Carer Gateway Tel. 1800 422 737
• Carers Australia Tel. 1800 242 636

Where to get help

• Your GP (doctor)
• Your treatment team
• Cancer Council Victoria Tel. 13 11 20
  • Information and support line Tel. 13 11 20 (or Tel. 13 14 50 for an interpreter)
  • Stomach and oesophageal cancers
  • Cancer Council Victoria, My Cancer Guide - Find support services that are right for you.
• WeCan website – helps people affected by cancer find the information, resources and support services they may need following a diagnosis of cancer