Controlling symptoms of advanced stomach cancer

Advanced stomach cancer means the cancer has

• Spread from where it started in the stomach
• Come back in another area of the body some time after you were first treated

Stomach cancer can spread to the liver, the lymph glands, and to the inside of the abdomen. Less commonly, it can spread to the lung. It is rare for it to spread anywhere else in the body. If you have advanced stomach cancer it is not generally possible to cure it.

You may also be told your cancer is advanced if it is too large to be removed when you are first diagnosed. Even if your cancer can’t be cured, treatment is available to control your symptoms. This treatment may also shrink the cancer and slow it down, even if it cannot get rid of it completely.

Chemotherapy, radiotherapy and surgery can all be used to treat advanced stomach cancer. Which treatment is best for you depends on

• The size of the cancer and where it is
• Whether the cancer has spread to another part of the body, and where
• The treatment you have already had
• Your general health

Radiotherapy and chemotherapy can both help control symptoms by shrinking a cancer so that it does not cause pressure and pain. Radiotherapy can help to stop a cancer bleeding. Shrinking lung secondaries with chemo or radiotherapy may help to relieve breathlessness. There is more information about radiotherapy for symptoms in the radiotherapy section of CancerHelp UK.

It can be difficult to decide which treatment to try, or whether to have treatment at all when you have an advanced cancer. You may want to take into consideration your quality of life while you are having the treatment. This includes the possibility of side effects from the treatment, as well as stresses such as travelling back and forth to the hospital. Most importantly, you will need to understand what can be achieved with the treatment you are being offered.

Your doctor or clinical nurse specialist will discuss the options for treatment with you. There may be a counsellor at the hospital you can chat to. You may also wish to talk things over with a close relative or friend.

It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends. Contact a counselling organisation to find out more about counselling and how to find a counsellor in your area.

If you are not able to eat or drink much, you may have liquid food into a central line. The central line goes into a large vein in your chest. This is called parenteral nutrition. Or you may have liquid food directly into your bowel through a tube called a feeding jejunostomy. Another way of giving liquid food is through a tube down your nose and into the bowel (a nasojejunal tube). Your dietician and clinical nurse specialist can help you with these.

If your cancer is blocking part of your digestive system, you may be offered surgery to relieve the blockage. This should help you to eat and drink more easily. Or your specialist may suggest that you have a stent put in. A stent is a tube that can relieve a blockage or keep open an area that is being squashed closed by the cancer. You can have stents put in under local anaesthetic using an endoscopy and X-ray guidance. Once the stent is in, it can stay there permanently. In stomach cancer, a stent can help you to eat and drink normally for longer. This may be particularly helpful if you have a slow growing cancer.

Sometimes, with advanced stomach cancer, fluid can begin to collect inside your abdomen. This will make you feel and look bloated. With stomach cancer, this usually happens because the cancer has spread to the lining of your abdomen. Cancer spread to the liver may also make fluid collect in the abdomen.

The fluid is called ascites. It is usually treated by draining it off. You may be offered chemotherapy into the abdomen. There is information about ascites and how it is treated in the about cancer section of CancerHelp UK.

Whether or not you decide to have cancer treatment such as chemotherapy, radiotherapy or surgery, medicines can help to control symptoms such as

• Pain
• Sickness and nausea
• Diarrhoea and constipation

Pain

There are many different painkillers and ways of taking them. With help from your doctor and nurse or a symptom control specialist, it should be possible for you to be pain free most of time. It may not be possible to ensure you are completely pain free when you are moving around, but you should be when you are resting.

There is more about pain control in the CancerHelp UK section on pain control. There is also information in that section on how you and your family can help control pain yourselves, for example with relaxation or breathing exercises.

Sickness and nausea

Sickness can also be helped with medicines. There are several different types of anti-sickness medicine and which one you need depends on what is causing your sickness. For example, are you feeling sick because of a chemical imbalance in your body, or because you are having difficulties with food passing through your digestive system? It will help your doctor or nurse if you are able to tell them what relieves your sickness and what makes it worse.

Sickness can be due to fluid collecting in your stomach because your digestive system is blocked. The most effective way of relieving this is with a tube down your nose into your stomach to drain the excess fluid away. You may also have a stent put in to hold open the digestive system so that the fluid does not collect in your stomach. Occasionally a drug called octreotide may be used to stop the stomach producing so much fluid.

Diarrhoea and constipation

Relieving these symptoms depends on what is causing them. Constipation due to a blockage in the upper part of the digestive system may be temporarily relieved with treatment that reduces inflammation, such as steroids. However, constipation can also be caused by painkillers. If you are taking regular painkillers, you need to also take a laxative. Your doctor or nurse can prescribe this for you if the constipation is due to taking painkillers.

Diarrhoea can happen because of infection or as a side effect of cancer treatment. If you have been constipated for a long time and develop diarrhoea, tell your doctor or nurse. The diarrhoea could be a sign that the constipation has got worse, and the diarrhoea is running past the constipated stools (faeces). In this situation, taking anti-diarrhoea medicines will make the problem worse.

There is more information about bowel problems in the section on coping physically with cancer of CancerHelp UK.