Having your operation for stomach cancer

This section is about what needs to happen before you have your operation. You can find information on

• Tests to find out how fit you are for surgery
• Learning breathing and leg exercises
• Being told what to expect by your team

Tests to find out how fit you are for surgery

You may have had some of these tests while your cancer was being diagnosed. If so, you may not need to have them done again. You may have

• Blood tests to check your general health and how well your kidneys are working
• A chest X-ray to check your lungs are healthy
• An ECG to check your heart is healthy
• Breathing tests (called lung function tests)
• An ECG while you are exercising

These tests are to make sure you are fit enough for your anaesthetic and to make a good recovery from your surgery.

Learning breathing and leg exercises

You can help yourself to get better by doing these exercises after your operation. Your nurse or physiotherapist will teach you the exercises. You should do them as often as you are told you need to.

Breathing exercises will help to stop you getting a chest infection. If you smoke, it really will help if you can stop at least a few weeks before your operation. You will be less likely to get a chest infection afterwards if you do stop.

Leg exercises help to stop clots forming in your legs. You may also have drugs to stop the blood from clotting so easily. You usually have them as small injections of heparin, tinzaparin, or dalteparin just under the skin. These usually start just before the surgery and continue for a couple of weeks afterwards. You may also be given compression stockings to wear.

Both chest infections and blood clots can happen because you are not moving around as much as you would normally be. Your nurses will encourage you to get up and about as soon as possible after your operation. But stomach operations are major surgery, and you may have to stay in bed for the first couple of days.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

Being told what to expect by your team

When you go into hospital for your operation, your surgeon, anaesthetist, physiotherapist and nurse will all come to talk to you about what will happen. Your surgeon will explain what is going to be done and what to expect when you come round from the anaesthetic. Do ask as many questions as you need to. It may help to make a list of your questions before you go into hospital for your operation. There are some suggestions for questions at the end of this section. The more you know about what is going to happen, the less frightening it will seem. Don’t worry if you think of more questions later. Just speak to your nurses. If they can't answer your questions, they can ask the doctor to come and talk to you again.

If you find eating and drinking difficult, you may have a drip (intravenous infusion) put into your arm before your surgery so that you can be given fluids. This makes sure you are not dehydrated before your operation. Lastly, if you have body hair on your abdomen, you may need it shaved before your operation. This can reduce the risk of a wound infection after surgery. You may be shaved in the operating theatre after you are under the anaesthetic.

There is information here about

• Waking up in intensive care
• Tubes you might have (drips and drains)
• Painkillers
• Eating and drinking
• Your wound
• Getting up and about
• Making progress

Waking up in intensive care

If you've had a big operation you may wake up in intensive care (ICU) or a high dependency recovery unit. This is routine after a big operation and as soon as your doctors are sure you are recovering well, you will be moved back to the ward. This is usually within a day or so. In ICU you have one to one nursing care, and are checked very regularly. Again, this is normal and doesn't mean there is something wrong. Your surgeon and anaesthetist will keep a close eye on your progress. ICUs are very busy places and can be noisy. You'll be feeling drowsy because of the anaesthetic and painkillers. Some people find the experience of being in ICU a bit strange and disorientating.

Tubes you might have (drips and drains)

When you wake up, you will have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You will have

• Drips (intravenous infusions) to give you blood transfusions, and fluids until you are eating and drinking again
• One or more drains coming out of your abdomen near your wound - these stop blood, bile and tissue fluid collecting around the operation site
• A tube down your nose into your stomach (nasogastric tube) to drain it and stop you feeling sick
• A tube into your bladder (catheter) so that your urine output can be measured

If you have had an oesophagogastrectomy, you will also have a drainage tube into your chest as well. This may connect to a suction bottle. The gentle suction helps your lung to inflate properly again after your chest has been operated on.

You will have a blood pressure cuff on your arm when you first wake up. And a little clip on your finger to measure your pulse and the level of oxygen in your blood. This is called a pulse oximeter. You may also have an oxygen mask on for a while. Your blood pressure will be measured often for the first few hours after you come round from the anaesthetic. The nurses will measure how much urine you pass because it can help to show whether you have too much fluid or are getting dehydrated.

Painkillers

When you come round, you may have a couple of electronic pumps attached to your drips. One of these might have painkillers in it. You may have a hand control with a button to press to give yourself extra painkillers, as you need them. This is called PCA or patient controlled analgesia.

Some hospitals use painkillers given into the spine (epidural) for the first few days after surgery. This usually works very well. You will have a very fine tube taped to your back. This connects to a pump, which gives you a continuous dose of painkiller into your spine. Tell your nurse if you still have pain as the dose can be increased.

You will almost certainly have some pain for the first week or so after your operation. But there are many different painkilling drugs you can have. It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly. If you have a button you can press to give yourself extra painkillers (PCA), do use it whenever you need to. You can’t overdose - the machine is set to prevent that. Tell your nurse if you need to press the button very often as you may need a higher dose in the pump.

Eating and drinking

After surgery to any part of the digestive system, the bowel often stops working for a while. Until it starts up again, you will not be able to eat or drink. About a week after your surgery, before you are allowed to start eating, you may have an X-ray just to make sure there are no leaks where the stomach or intestine has been stitched together. Before the X-ray, you swallow a type of dye called Gastrograffin. This shows up on the X-ray so that your doctor can see any leaks clearly.

While you are not able to eat or drink you may have fluids through a drip and 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).

Because you have had surgery to your stomach, and may have had it totally removed, you will have to start drinking very gradually at first. You will start with sips of clear fluids at first. If you manage those, the amount you can have will slowly be increased. Then you can move on to other drinks such as milk, tea and soup. Once you are able to drink without feeling or being sick, your nurse will take your drip and nasogastric tube out.

Your wound

Your wound will be covered up with a dressing when you come round. It will be left covered for a couple of days. Then the dressings will be changed and the wound cleaned. The wound drains will be left in until they stop draining fluid. If they have bottles attached to them, these will be changed every day. Wound drains can usually be taken out about 3 to 7 days after your operation. Your stitches or clips will be left in for at least 10 days.

Getting up and about

Moving about may seem impossible at first. It helps you to get better, but you will need to start very gradually. Your physiotherapist will visit you every day after your operation to help you with your breathing and leg exercises.

Your nurses will encourage you to get out of bed and sit in a chair one or two days after your surgery. They will help you with all the drips and drains. Over the next couple of days, the tubes, bottles and bags will start to be taken out. Then, it will be much easier to get around and you will really feel that you are beginning to make progress.

Making progress

After a few days you will be able to be up and about more. Gradually you will start to feel better. Soon you will be able to eat more. At first you will find it easier to have lots of very small meals rather than 3 large meals a day. It can take a long time to get back to having only 3 meals and some people prefer to carry on eating little and often. You will see the hospital dietician before you go home, who will give you help and advice with managing your diet. You may be advised to take regular vitamins and eat iron rich foods.

You may have a vitamin B12 injection before you leave the hospital. If you have had most or all of your stomach removed, you will no longer be able to take in vitamin B12 from your food. You will need these injections from your GP regularly to make sure you get enough.

There is more about diet after stomach surgery in the living with stomach cancer section of CancerHelp UK.