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Controlling symptoms of advanced cancer

If you have advanced stomach cancer it is not generally possible to cure it. Advanced stomach cancer means the cancer has spread from where it started in the stomach or has come back some time after you were first treated. Stomach cancer can spread to lymph nodes, the liver and to the inside of the abdomen. Less commonly, it can spread to the lungs. 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 advanced stomach cancer can't be cured, there is treatment available to relieve your symptoms. Chemotherapy, biological therapy, radiotherapy, stents or surgery may be used. Which treatment is best for you depends on different factors including the size of the cancer, where it is, whether it has spread to another part of your body, the treatment you have already had and your general health.

It can be difficult to decide which treatment to try, or whether to have treatment at all when you have an advanced cancer. Your doctor or clinical nurse specialist will discuss the options for treatment with you. If you would like to talk things through with someone outside your circle of family and friends, ask your doctor or nurse about counselling services.
 

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What advanced stomach cancer is

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 lungs. 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.We have information about cancer that has spread to the liver and cancer that has spread to the lungs.

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.

 

How radiotherapy and chemotherapy can help

Chemotherapy, radiotherapy, stents and occasionally surgery can all be used to help relieve symptoms of 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 and to which part of the body
  • The treatment you have already had
  • Your general health

If your cancer has a large amount of a protein called HER2, you may have a biological therapy called trastuzumab (Herceptin) with chemotherapy. There is information about Herceptin on the page about biological therapy for stomach cancer.

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 cancer that has spread to the lungs (lung secondaries) with chemo or radiotherapy may help to relieve breathlessness. There is more information about radiotherapy for symptoms in the radiotherapy section.

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 consider 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 to and from 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.

 

Reducing weight loss

If you are not able to eat or drink much, you may have liquid food directly into your bowel through a feeding tube called a jejunostomy. Another way of giving liquid food is through a tube down your nose and into the bowel (a nasojejunal tube). In some cases 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. Your dietician and clinical nurse specialist will give you information and support with these. 

We have information about managing diet problems.

 

Treating a blockage in the digestive system

If your cancer is blocking part of your digestive system, your specialist may suggest having a stent put in. This is a thin flexible tube that can relieve a blockage. It can also keep open an area that is being squashed by the cancer. A stent may help you to eat and drink normally for longer.

In some cases, if you are fit enough, your specialist may offer you surgery to bypass or remove part of your stomach to relieve the blockage.

 

Treating a build up of fluid in the abdomen

Sometimes with advanced stomach cancer, fluid can begin to collect inside your abdomen. This will make you feel and look bloated. 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 the fluid off. You may be offered chemotherapy into the abdomen. We have information about ascites and how it is treated. 

 

Controlling symptoms with drug treatments

There are medicines to help control symptoms caused by cancer. Symptoms such as

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 the 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.

We have information about pain control

Sickness and nausea

Medicines can also help with sickness. There are several different types of anti sickness medicine and which one you need depends on what is causing your sickness. For example, if you are 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 your specialist may use a drug called octreotide 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.

We have more information about bowel problems

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Updated: 6 March 2014