How do I prepare for Stomach Cancer surgery

Preparing for Stomach Cancer Surgery

Preparing for stomach cancer surgery is a comprehensive process that involves medical evaluation, physical preparation, and planning for recovery. Here's what you should know based on current medical guidelines.

Pre-Surgery Medical Workup

According to NCCN Guidelines for Gastric Cancer, before surgery your medical team will conduct several important evaluations:

Imaging and Staging Tests:

• CT scan of your chest, abdomen, and pelvis (with contrast dye) to see the full extent of disease
• Endoscopic ultrasound (EUS) to assess how deeply the cancer has invaded the stomach wall and nearby lymph nodes
• FDG-PET/CT scan if you have locally advanced or metastatic disease
• Possible diagnostic laparoscopy (a minimally invasive procedure to look inside your abdomen) to check for cancer spread to the peritoneum (abdominal lining)

Laboratory Tests:

• Complete blood count (CBC) and comprehensive chemistry panel to assess your overall health
• Tests for specific biomarkers that may guide treatment decisions

Biomarker Testing: The NCCN Guidelines recommend universal testing for:

• Microsatellite instability (MSI) or mismatch repair deficiency (dMMR) - these findings may influence whether immunotherapy is recommended
• PD-L1 status - helps determine if immunotherapy might be beneficial
• HER2 status and CLDN18.2 if you have advanced disease

Neoadjuvant Therapy (Pre-Surgery Treatment)

An important part of modern stomach cancer care is perioperative systemic therapy (chemotherapy given before and/or after surgery). According to NCCN Guidelines, this is a Category 1 recommendation - meaning it's strongly recommended for most patients with resectable gastric cancer.

Why pre-surgery chemotherapy?

• It shrinks the tumor, making surgery easier and more effective
• It treats cancer cells that may have spread beyond what imaging can detect
• It improves long-term survival outcomes

If your tumor is MSI-H/dMMR positive, your team may consider immunotherapy as part of your neoadjuvant approach.

Physical and Nutritional Preparation

Nutritional Assessment:

• Your medical team should provide nutritional counseling before surgery
• A dietitian can help you optimize your nutrition before the procedure
• This is especially important because stomach surgery affects how your body processes food

Lifestyle Modifications:

• Smoking cessation - if you smoke, your team will offer counseling and medication to help you quit, as smoking impairs healing
• Exercise - discuss with your doctor whether a "prehabilitation program" (exercise before surgery) might be appropriate for you

H. pylori Testing:

• You'll be tested for H. pylori infection (a bacteria that can increase stomach cancer risk)
• If positive, it should be eradicated before or after surgery

Questions to Ask Your Surgical Team

Before your surgery, make sure you understand:

1. What type of surgery will I have? (Will the entire stomach be removed, or just part of it? What about nearby lymph nodes?)

2. What is the goal of my surgery? (Complete removal with no cancer at margins, or is this palliative to relieve symptoms?)

3. Will I receive chemotherapy before surgery, and if so, for how long?

4. What are the specific risks and side effects I should expect?

5. How will my digestion and nutrition be affected after surgery, and what support will I need? (Many patients need pancreatic enzyme supplements like Creon after stomach surgery)

6. What is the recovery timeline, and when can I return to normal activities?

7. Will I need additional treatment after surgery? (Post-operative chemotherapy or chemoradiation)

8. What support services are available? (Nutritional support, physical therapy, mental health counseling)

Multidisciplinary Team Approach

The NCCN Guidelines emphasize that stomach cancer care should involve a multidisciplinary team - meaning your care should be coordinated among:

• Surgical oncologist
• Medical oncologist
• Radiation oncologist (if needed)
• Gastroenterologist
• Nutritionist/dietitian
• Nursing staff

This team approach ensures all aspects of your care are coordinated and optimized.

Important Reminders

• Bring a support person to appointments to help take notes and ask questions
• Ask for written summaries of your treatment plan
• Request copies of all test results so you understand your specific situation
• Discuss any concerns about side effects or recovery early - your team can help manage these

Your oncologist will determine the most appropriate surgical approach and timing based on your complete clinical picture, including your overall health, the extent of disease, and your biomarker results.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.