Image caption Learning to cope without a stomach

Sisters Ravindra and Meeta Singh both had their stomachs removed to beat the cancer which had killed five members of their family.

They both carry the rare mutant E-cadherin gene, seen in around 100 families worldwide, which makes them more prone to stomach cancer and breast cancer.

Ravindra, 30, already had stomach cancer by the time she had her operation, Meeta decided on the surgery as a preventative measure.

Almost a year after surgery the sisters, from Liverpool, say they are learning to live again, but admit things have been very hard.

"I am a lot better than I was in the earlier months, but obviously there are still side effects from having no stomach," said Ravindra, who says she often feels tired and dizzy.

If you have not got a stomach then you have to have lots of small meals Simon Dexter

"It's a year since the surgery and I'm still scared to go out and enjoy a meal out," she said.

"When I first came out of surgery the amount I could eat was very minimal, almost spoonfuls. But almost a year has gone by now and I probably eat about a third of what I used to be able to eat - so it is improving.

"But if I overeat, a few moments after I've finished eating, I'll feel discomfort, indigestion, have some acid reflux and then you get what's called 'dumping' syndrome which is unfortunately just what it sounds like - urgent diarrhoea."

Meeta agreed: "It depends what food we're eating but if it's a food we're not supposed to eat, like bread for instance, you can feel the sensation passing down your throat - you can feel it expanding."

Both sisters have lost about 20% of their body weight over the year - with Ravindra dropping to just eight stones (50.8 kilos).

Surgery - the only answer

Simon Dexter, a consultant at Leeds Teaching Hospitals and Meeta's surgeon, said that although it was a major operation it was possible to live without a stomach.

"The gut is basically a tube, which goes from top to bottom. The stomach is basically a swelling in the tube, so when you take it out you close the gap," he said.

"The main function of the stomach is storage. It allows us to have a big meal and then not worry about it for a while.

"If you have not got a stomach then you have to have lots of small meals.

"The acid in the stomach also helps to sterilise food, but that is not so relevant today as we are not scratching around in the dirt digging up grubs.

"It also helps absorption of iron and vitamin B12, so you do need extra supplements. As long as you supplement the various minerals then it should not have any profound effect on general well-being."

And he said removing the stomach was the only answer for patients who had the disease.

"I do get screening every six months - histology said the cancer had not spread," said Ravindra.

"It was the only option. If I hadn't had it I wouldn't be here."

But Meeta, aged 25, said she had felt that she too had no option.

"I elected for the surgery as a preventative measure partially based on family history, the fact that my dad died of it when I was 10 years old.

"When my sister had cancer, it made me change my mind. I'd been quite reluctant up to then."

And she said she would not have been happy relying on her regular screening.

"It's so easily missed," she said. "Gastric cancer, it doesn't form a tumour so it's really hard to catch, and it's not until later on when the cancer is more developed that you begin to get symptoms."