Life after Stomach Cancer

OncoLink
Last Modified: May 8, 2012

Question

Are there any long term concerns of having your stomach removed for stomach cancer?

Answer

Carolyn Vachani, RN, MSN, AOCN OncoLink Nurse Educator responds:

You can create a survivorship care plan to learn more at: www.livestrongcareplan.org

Removal of all (gastrectomy) or part of the stomach (partial gastrectomy) leads to changes in absorption of nutrients and digestion. Survivors should be followed by a dietician. Vitamin B12 is absorbed by the stomach and will need to be supplemented by injections of B12 once or twice a month for life. Survivors may require supplemental calcium, foliate and iron. When the stomach is removed, the esophagus is connected directly to the small bowel, changing the way food is digested. This will require the person to eat smaller, more frequent meals, with more proteins and fewer sugars and carbohydrates, to prevent complications such as nausea, vomiting and diarrhea. Dumping syndrome, nausea and abdominal cramping followed by diarrhea shortly after a meal, can also occur in survivors. This syndrome can be managed with dietary changes including eating small, frequent meals that are high in protein and low in carbohydrates, and taking-in minimal fluids while eating food so as to not flush out the food before nutrients are absorbed.

Heartburn or reflux may also be experienced by survivors especially early after treatment. It may be beneficial to remain in an upright sitting position for at least one hour after meals to help prevent reflux. Medications may also be beneficial in reducing reflux and maintaining esophageal health. Given the changes from surgery and other cancer treatment, survivors often have difficulty maintaining weight and getting adequate nutrition. A dietician can help with adapting to dietary changes, which can sometimes become less restrictive over time.

In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

Complications regarding inadequate nutrition can result after gastrectomy, in particular Vitamin B12 deficiency. Make sure to work with dietician and healthcare provider to ensure proper nutrition and to help manage problems resulting from surgery.
Medications and behavioral adjustments may help with symptoms of dumping syndrome and reflux.
In addition, gastrectomy increases the risk for developing osteoporosis, so consider the following reccs for osteoporosis prevention and screening:
- Avoid smoking and excessive alcohol intake
- Perform weight bearing exercise 2-3 times per week
- Calcium intake of 1200-1500mg per day plus Vitamin D 400-800iu or 800-1000iu per day (either in dietary intake or supplements)
- Consider screening with DEXA scan.

This question and answer was part of the OncoLink Brown Bag Chat Series. View the entire transcript from the Focus on GI Cancers webchat.