Stomach Cancer: Symptom Management for Advanced Cases

According to the American Cancer Society, stomach cancer (gastric cancer) makes up just 1.5% of all new cancer diagnoses each year in the United States. Although less common, it’s still a condition that raises concern when it’s discovered.

Stomach cancer tends to be asymptomatic (showing no signs of symptoms) at first. But during later stages, it can disrupt your ability to eat or swallow and cause a number of other symptoms like:

• Loss of appetite
• Unexplained weight loss
• Fatigue or weakness
• Nausea and vomiting
• Stomach pain and bloating
• Heartburn and indigestion

When these symptoms surface, they can sometimes be confused for other gastrointestinal conditions, like stomach ulcers or gastroesophageal reflux disease. But the longer the cancer goes undiagnosed, the higher the risk that it could metastasize, or spread, outside of your stomach.

“It’s not fast spreading in the same way that someone who has leukemia might have the cancer become very aggressive in a matter of days. Gastric cancer typically develops over months if not years,” explains oncologist Alok Khorana, MD. “But if it’s left untreated over a period of months, you can have cancer spread to other organs like your liver or your lungs.”

That means it’s important to acknowledge and understand your symptoms, particularly if you’re trying to avoid an advanced-stage diagnosis of stomach cancer.

Managing stomach cancer symptoms

If your symptoms persist or worsen, you may need an upper endoscopy to determine whether or not you have stomach cancer. And if you’ve been diagnosed with stomach cancer, your symptoms may persist or change over time depending on the approach to treatment and how your cancer shrinks or grows in size.

Everyone experiences symptoms of stomach cancer differently. Some may experience severe stomach pain, while others may have trouble swallowing. And still others may experience both, along with other symptoms.

The symptoms you experience largely depend on how far the cancer spreads, how large tumors become and where the cancer is located. In general, the following tend to be the most common symptoms when you’re living with advanced stomach cancer.

Changes to your appetite

A loss or decline in appetite is one of the most common symptoms of stomach cancer. When the cancer itself is widespread and causes that feeling of not wanting to eat, healthcare providers may use medications like mirtazapine and olanzapine to help stimulate your appetite.

“Other times, appetite can be lost because of the location of the tumor,” notes Dr. Khorana. “If we remove the tumor successfully or shrink it down, your appetite might return.”

And if you’re experiencing stomach pain that results in a loss of appetite, a palliative medicine specialist can assist with pain management to improve your appetite as well.

Problems with nutrition

You want to continue eating as healthy as possible for as long as possible to keep up your strength and energy levels. You may not be able to eat all the foods you once loved, but you can work with a dietitian or nutritionist on a healthy meal plan that benefits you and your body.

If you continue to lose interest in eating or if difficulty swallowing makes it harder for you to eat, you increase your risk for malnutrition and unexpected weight loss.

“For someone with gastric cancer, it’s important to maintain calorie intake because you don’t want to lose too many calories,” explains Dr. Khorana. “If your nutrition suffers, then it’s hard for your body to be able to tolerate treatment.”

You may find it hard to have larger meals or eat three meals a day anymore. To get the nutrition you need without compromising quality, you may need to eat smaller portions and more calorie-dense foods like eggs, avocados or nuts. Foods high in protein are also helpful in making sure you get the calories you need quickly.

“Some people prefer high-calorie supplements like Boost® or Ensure®,” shares Dr. Khorana. “Energy bars, protein powders and milkshakes are all ways to get a lot of calories in smaller portions. If you don’t have diabetes, ice cream can be a good way to get a ton of calories in smaller portions, too.”

For anyone having difficulty swallowing, a liquid diet might also be helpful.

Feeling weak, tired or fatigued

Having low energy and feeling fatigued throughout the day is another common symptom of stomach cancer and its associated treatments.

Of course, trying to maintain a healthy meal plan that’s high in calorie content can sometimes help improve energy levels. Getting a full night of sleep does the same. But even then, fatigue may be persistent or get worse over time.

“It’s very easy to get deconditioned with a disease like cancer,” acknowledges Dr. Khorana. “If you’re feeling tired and the treatment is weighing you down, the natural response is to want to take it easy and not do any activity.”

But the less activity you do, the more deconditioned your body gets. That can lead to a vicious cycle where you feel more tired. Over time, it becomes even more difficult to pick up any physical activity. So, anything you can do to stay active earlier on and throughout your treatment is beneficial. Even if you try to do some small physical activity every day, that may help improve your energy levels.

“It doesn’t have to be to the same extent that you would be exercising before your diagnosis of cancer either. But you want to maintain some level of low-intensity exercise that raises your heart rate,” he advises. “Brisk walking is the easiest thing to do for most people. The more you maintain that, the better.”

Feeling nauseated or vomiting

Although vomiting is less common, nausea and vomiting are symptoms that can occur as a result of the stomach cancer itself or as a side effect of chemotherapy.

“Thankfully, we have a lot of antiemetics that have improved the control of nausea in all types of cancers, including stomach cancer,” says Dr. Khorana. “We use them very widely in preventing nausea and vomiting from happening in people who are undergoing chemotherapy.”

At home, you want to stay hydrated by drinking clear liquids and trying to get some rest until your nausea subsides. If you have uncontrolled vomiting for any period of time, a trip to the emergency room may be needed so you can get the fluids and nutrients you need through an IV.

Persistent stomach pain and other stomach issues

It’s not uncommon to have stomach pain when you have stomach cancer. A palliative medicine specialist can assist you with a variety of pain management techniques and medications.

“Sometimes, pain management can be low-grade pain medications with something as simple as Tylenol®,” explains Dr. Khorana. “Sometimes, they require more heavy-duty medications like opioids. But there are a lot of options for people to manage their pain.”

Anxiety, depression and other mental health conditions

“With a diagnosis of stomach cancer, you’re not just dealing with the cancer itself. You’re also dealing with the consequences of cancer,” emphasizes Dr. Khorana. “Your regular life is interrupted.”

Things that give you pleasure like eating food may be more of a challenge than they were in the past. And if you’re of working age, you may have to stop working for a bit or modify how and when you work.

“For many people, their work is a very important part of their identity. It’s also where a lot of socialization happens,” notes Dr. Khorana.

Confronting the reality of the condition may be particularly difficult for younger people with stomach cancer who aren’t going through the same experiences as others in their age group. And when your social networks break down, you may feel more isolated.

“These experiences can certainly add to the burden of illness and contribute to depression and anxiety associated with a cancer diagnosis,” he continues.

That makes your mental health a top priority. Try working with a therapist or getting connected with a social worker. They can help you understand what’s happening so you can learn how to process the situation healthily and how to make the most out of every day.

Living with advanced stomach cancer

Catching the early warning signs of stomach cancer is key to avoiding a late-stage diagnosis. But it’s not always possible or probable.

If you’re living with advanced stomach cancer, you’re not alone. Your multidisciplinary team of healthcare providers will work with you to figure out which treatments will make the most positive impact for you and your health. Along the way, they’ll also assist with making certain lifestyle modifications that can help improve your quality of life at home.