What gastric cancer is, and how it shows itself
Stomach cancer arises in the mucosal lining of the stomach and can grow into the deeper layers of the wall, reach the surrounding lymph nodes and involve neighbouring organs. In its early stages it often produces no symptoms at all, or symptoms indistinguishable from ordinary indigestion — which is the main reason diagnosis is sometimes delayed.
Common complaints include persistent upper abdominal pain or discomfort, feeling full after only a small amount of food, loss of appetite, nausea, bloating, unintended weight loss and fatigue. Anaemia from slow blood loss, black stools or vomiting blood are later signs. Helicobacter pylori infection, chronic atrophic gastritis, smoking, a diet heavy in salted and processed foods, and a family history of gastric cancer are recognised risk factors.
Most of these symptoms have benign causes far more often than not. What justifies endoscopy is stomach trouble lasting more than a few weeks that does not settle with medication — particularly over the age of 45, or when accompanied by weight loss or anaemia.
Diagnosis and staging
Diagnosis rests on upper endoscopy with biopsies examined by a pathologist. Endoscopy also shows where in the stomach the tumour sits and how far it extends along the lining — information needed to plan how much of the stomach must be removed. Staging then usually involves CT of the abdomen and chest, with endoscopic ultrasound and PET-CT in selected cases. Where there is a question of spread to the peritoneal lining, a diagnostic laparoscopy may be performed first, so that the plan rests on what is actually found in the abdomen.
These findings are then reviewed by a multidisciplinary tumour board. Early-stage disease may go straight to surgery, while more advanced tumours are often treated with chemotherapy first and operated on afterwards. The sequence depends on the stage, the biology of the tumour and the patient's general condition.
Gastrectomy: what the operation involves
The objective is to remove the tumour with an adequate margin of healthy tissue. When the tumour lies in the lower part of the stomach, that part is removed and the remaining stomach is joined to the small intestine — a subtotal, or partial, gastrectomy. When the tumour lies high in the stomach or is spread diffusely through the lining, the entire stomach is removed and the esophagus is connected directly to the small intestine — a total gastrectomy.
In both operations the second, inseparable component is systematic removal of the regional lymph nodes. Reconstruction of the digestive tract is completed in the same procedure, so that patients return to eating by mouth during their recovery.
- Subtotal gastrectomy: removal of the tumour-bearing portion of the stomach
- Total gastrectomy: removal of the whole stomach
- Regional lymph node dissection (lymphadenectomy)
- Reconstruction of the digestive tract using the small intestine
Why lymph node removal is standard
Removing the regional lymph nodes is a foundational principle of modern cancer surgery throughout the digestive tract. The stomach is surrounded by a dense network of nodes, and tumour cells can settle there while still far too small to appear on any scan. Removing the tumour alone and leaving those nodes in place risks leaving microscopic disease behind.
A systematic dissection is also what makes accurate staging possible. The number of nodes examined and the number found to contain tumour are the most decisive lines in the pathology report, and they largely determine whether chemotherapy is recommended after surgery. The extent of the dissection therefore follows established anatomical definitions rather than being decided case by case at the table.
Laparoscopic (keyhole) gastric surgery
In a laparoscopic gastrectomy the operation is performed through several small incisions in the abdominal wall, using a camera and long instruments. The camera gives a magnified, well-lit view that helps in working around the vessels and nodal tissue surrounding the stomach. The portion of stomach removed and the lymph node fields cleared are the same as in open surgery.
For the patient, the practical difference is a far smaller wound: usually less postoperative pain, earlier mobilisation and fewer wound complications. Getting out of bed sooner matters in its own right, because it reduces the risk of chest and clotting problems during recovery.
Not everyone is suited to the closed approach. Tumour size, involvement of adjacent organs, previous abdominal surgery and other medical conditions all bear on it, and an operation begun laparoscopically may be completed as an open procedure if that is safer — a planned judgement, not a complication. Our surgeons make this assessment individually after examination and imaging.
Eating after surgery, and long-term follow-up
Eating has to be re-learned for a period after gastric surgery. With a smaller stomach — or none — meals become smaller and more frequent, and eating slowly, chewing thoroughly and taking fluids between meals rather than with them are standard advice. Sugary or very concentrated foods can pass too quickly into the intestine and cause palpitations, sweating and weakness, known as dumping; this is usually manageable with dietary adjustment. After total gastrectomy, lifelong vitamin B12 supplementation is required and iron and calcium levels are monitored.
Follow-up does not end with the operation. Depending on the pathology result, chemotherapy may be recommended, and patients are reviewed at set intervals with examination, blood tests, imaging and endoscopy where appropriate — surveillance shared between the surgical team and medical oncology.
The information here is general. The right treatment for any individual depends on where the tumour sits, its stage, the patient's age and other medical conditions, and can only be determined after examination at İzmir Cerrahi Merkezi in Konak, İzmir.
Frequently asked questions
If my whole stomach is removed, how will I eat?
After a total gastrectomy the esophagus is joined directly to the small intestine and you continue to eat by mouth. Meals become smaller, more frequent and slower. Most patients settle into a workable routine over the following months, at a pace that varies from person to person, with dietitian support. Lifelong vitamin B12 supplementation is needed.
Why are lymph nodes removed as well as the tumour?
Because tumour cells can reach the nodes long before they are visible on any scan. Removing them reduces the microscopic disease that would otherwise be left behind, and examining them establishes the true stage. That pathology result is the main basis for deciding whether chemotherapy is needed after surgery.
Can gastric cancer be operated on laparoscopically?
In suitable patients, yes — and the same portion of stomach and the same lymph node fields are removed as in open surgery. Tumour size, involvement of neighbouring organs and previous abdominal operations affect suitability, so the approach is chosen individually after assessment.
Will I need chemotherapy after the operation?
Some patients do and some do not. It depends on the stage and on the pathological examination of the tissue removed at surgery. The recommendation is made together with medical oncology as part of the multidisciplinary review, not by the surgeon alone.
How long is the hospital stay and the recovery?
Both vary from patient to patient, according to the extent of the operation, the approach used, age and other medical conditions. Recovery tends to begin sooner after a laparoscopic operation. Realistic expectations for your own case are discussed during the consultation.
Is there a screening programme for stomach cancer?
Türkiye has no routine population-wide screening for gastric cancer. Endoscopic assessment is nevertheless advised for people with a family history, chronic atrophic gastritis, Helicobacter pylori infection or persistent upper abdominal symptoms. How often endoscopy should be repeated is decided on an individual basis.