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Stomach cancer, also called gastric cancer, begins when cells grow abnormally in the stomach. More than 30,000 people in the U.S. are diagnosed with stomach cancer each year.
When stomach cancer is found early and has not spread, treatment can sometimes cure it. For cancer that has grown through the stomach wall or spread to other parts of the body, treatments may focus on controlling the cancer, relieving symptoms and helping people live longer.
In this Mayo Clinic Minute, Dr. Travis Grotz, a surgical oncologist at Mayo Clinic Comprehensive Cancer Center, explains how surgical innovations can help patients preserve stomach function and quality of life.
Journalists: Broadcast-quality video (1:07) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.
What happens during stomach cancer surgery?
Treatment depends on where the cancer is located in the stomach and its stage. Options may include chemotherapy, radiation therapy, targeted therapy, immunotherapy and surgery.
"Surgery involves removing all or part of the stomach, and that depends on the extent of the tumor in the stomach and the lymph nodes around the stomach," says Dr. Grotz.
The goal of surgery is to remove all the cancer. In some cases, that means removing the entire stomach in a procedure called a total gastrectomy. The surgeon then connects the esophagus to the small intestine so food can move through the digestive system.
"If patients need a total gastrectomy, what they've lost is their storage reservoir, so they're limited to eating very, very small meals frequently," says Dr. Grotz. "But what we can do is, we can recreate a new stomach out of their intestine. We call that a J-pouch, and that restores some of that capacity for patients to eat larger meals afterward. And so then when they recover, they can have more normal function in eating than if they didn't have that pouch."
For stomach cancer surgery, a J-pouch is made from the jejunum, a portion of the small intestine, and is therefore referred to as a jejunal J-pouch. The J-pouch technique is more commonly used in colorectal surgery, where a pouch similarly serves as a storage reservoir. With a jejunal J-pouch reconstruction after total gastrectomy, the surgeon folds a segment of jejunum into a J shape and connects it to itself, creating a larger reservoir before connecting it to the esophagus.
"Although less commonly used in stomach cancer surgery and technically demanding, at Mayo Clinic we routinely perform this specialized reconstruction, offering an additional option to select patients," says Dr. Grotz.
Can part of the stomach be preserved?
Mayo Clinic surgeons are also studying techniques that can preserve part of the stomach.
In many Western countries, including the U.S., stomach cancer often starts in the upper part of the stomach, near the esophagus, and may be more advanced when diagnosed.
"For a long time, we have saved the upper part of the stomach whenever there's a tumor in the lower part, but it's been more challenging to remove the upper part of the stomach and save the bottom," explains Dr. Grotz. "We adapted a surgical technique and have a lot of experience here at Mayo Clinic in removing all the cancer and saving that bottom part of the stomach to get the benefits of stomach preservation."
