Cancer Care Pathway for Gastric Cancer

FACTS

  • 2000 Australians are diagnosed with gastric cancer annually

  • Gastric cancer is 2 times more common in men

  • Makes up 1.5% of all new cancers cases diagnosed in 2020

SYMPTOMS

  • Indigestion

  • Frequent burping

  • Heartburn/Reflux

  • Feeling “full” after a small meal

  • Ongoing nausea and/or vomiting

  • Loss of appetite

  • Unintentional weight loss

  • Abdominal swelling/bloating

  • Blood when vomiting

  • Fatigue

What is Gastric Cancer?

Gastric cancer refers to cancer of the stomach. There are four layers that make up the stomach these include:

  • Mucosa: this is where the fluid is produced that help to commence the breakdown of food, also known as “digestive enzymes”

  • Submucosa: this layer provides the stomach with blood and nutrients

  • Muscle layer (Muscularis): as a muscle, this layer contracts and assists to breakdown your food and push it in to the digestive system

  • Outer layer (Subserosa): smooth muscle layer around the stomach.

The most common type of gastric cancer starts in the mucosal layer and is termed “adenocarcinoma”. This makes up 90-95% of gastric cancers.

To make a diagnosis of gastric cancer, the first thing you will be asked is about your past medical history, your family history of cancer and your current symptoms. The symptoms of gastric cancer are listed to the left.

To confirm your diagnosis, your GP, gastroenterologist or surgeon will organise a series of tests.

Diagnosis: What to Expect

  • Gastroscopy

    A gastroscopy is a minor procedure where a small flexible camera is inserted down your oesophagus and into your stomach. At this time, they may take a biopsy, to confirm if it is malignant or benign. This procedure involves a light anaesthetic/sedation and you will go home the same day.

  • Endoscopic Ultrasound (EUS)

    Like the gastroscopy, an EUS involves a small flexible camera that is inserted down the oesophagus, however this camera also has a ultrasound probe at the tip allowing the doctor to see all the layers of the stomach. This will show whether the cancer has spread beyond the stomach. They will also take a biopsy during this procedure.

  • CT Scan

    A CT Scan stands for “Computerized tomography” which will use x-ray beams to get pictures inside your body. This will take multiple x-rays and compile them, making it different from single x-ray image. This will help the doctors identify the location of cancer. This may, or may not, require you to ingest “contrast” which is a medical dye. This can help to make the images clearer and easier to see the tumour. This is a non-invasive scan, but will require you to lie still on a table for approximately 10-30 minutes.

  • PET/CT Scan

    A PET scan stands for “positron emission tomography”. This is not always used in gastric cancer, more commonly for oesophageal cancer. This scan can be done at the same time as the CT Scan. A PET scan is a method of identifying very small cancer cells that are not detectable through other imaging. You will receive a glucose solutionthrough an IV line. After waiting for 30-90 minutes (so that the solutionon can spread throughout the body) you will then have the scan. The solutionon collects in all cells, but particularly in cancer cells as they use more energy.

  • Laparoscopy

    A laparoscopy is a diagnostic procedure that will require you to undergo a general anaesthetic. This is a minimally invasive procedure where “Ports” (thin tubes) are inserted, using small cuts (5 - 12 mm into the belly button and abdomen. The abdomen is inflated with gas and the surgeon is able to visually inspect the surrounding organs and, in some cases, the tumour itself. They will also take more biopsies of the surrounding tissue to determine if there are any cancer cells present.

Multidisciplinary Meeting

After your investigations have been completed, your case will be discussed at a multidisciplinary meeting (MDM). This meeting is made up of surgeons, oncologists, radiologists, pathologists and the allied health team to collaboratively discuss your diagnosis and determine the best individualised treatment pathway for your disease. Your cancer will be staged by what is referred to as the “TNM” Staging System. Once this has been determined, you will meet with your surgeon again. This will take you through to the treatment phase of your journey.

 

Treatment Team

  • Surgeon

    At this appointment, you will meet with the surgeon, fellow or registrar to discuss your diagnosis and treatment options. If this includes surgery, the surgeon will talk you through the operation, risks and benefits so that you can make informed decisions.

  • Cancer Nurse Coordinator

    Your meeting with the cancer nurse may coincide with any of the above appointments depending on your treatment. Here, you will be provided with contact details for a central contact at the hospital, educational resources and you will have the opportunity to ask any questions you have about your care.

  • Medical/Radiation Oncologist

    If your treatment involves pre-operative chemotherapy (known as neoadjuvant treatment), you will meet the medical oncologist. At this point, you may also meet the radiation oncologist. The oncologists work collaboratively with the surgeons to ensure you are receiving the best care possible.

  • Anaesthetist

    Will assess your fitness for surgery and talk you through the medications and pain relief administered during the surgery.

  • Dietitian

    Some of you will be referred to a dietitian at the time of diagnosis. This will give you an opportunity to optimise your nutrition prior to treatment and allow ongoing support both in and out of the hospital.

  • Physiotherapist

    Will guide you in enhancing your physical fitness for pre-habilitation before surgery and in mobilising and keeping active after surgery.

  • Psych-Oncologist

    Will review mental health issues related with your cancer diagnosis.

Please Note: If you are having surgery, you will also meet a number of people involved in your “Pre-Surgery” planning and assessment. Your Cancer Nurse Coordinator will take you through this in more detail during your appointment.

 

Resources