Therapy is based on the type of tumor and prognosis. It’s also critical to know the stages of stomach cancer. Staging occurs during diagnosis, and ranges from early-stage disease to stage IV stomach cancer, which means the cancer cells have already spread to distant sites in the body. The stage of disease impacts stomach cancer survival rates. Additional tests may be used during the staging process, such as an endoscopic ultrasound.
Some patients' cases are also discussed at Wilmot’s multidisciplinary tumor board — a conference that is attended by all different specialties that might be required for your care.
Four types of treatment are commonly used for stomach cancer: surgery, radiation, chemotherapy, and targeted drugs. Sometimes they are used in combinations.
The type of surgery depends on where the cancer is located in the stomach and the stage of the cancer. Possible stomach cancer surgeries include:
Endoscopic resection, which is not done very often and is only for very early-stage cancer. The surgeon uses an endoscope to remove the tumor and some surrounding tissue, without having to make an incision.
Partial gastrectomy, which involves removing the cancer, many nearby lymph nodes, and part of the stomach. Sometimes the spleen or parts of other nearby organs are also removed. Doctors then reattach the remaining part of the stomach so that the patient can resume eating after surgery.
Total gastrectomy, or removal of the entire stomach and many nearby lymph nodes when the cancer has spread throughout the organ. Doctors sometimes must also remove part of the esophagus, spleen, or small intestine. The esophagus is then reattached to the small intestine so that the patient can resume eating after surgery.
Stent placement, for tumors blocking the stomach but when standard surgery cannot be done to remove the cancer. This opens the stomach at either the beginning or end of the organ and allows food to pass through.
Tumor ablation, which involves using an endoscope to guide a laser beam to vaporize the tumor. This is also used when standard surgery is not an option.
Gastric bypass, which removes cancer and the part of the stomach near the small intestine, and then reattaches the rest of the stomach to the intestines so that food and medicine can pass through. It's done when the patient is healthy enough for surgery but the cancer is not completely removable.
Feeding tube placement, which is done when a patient is not able to eat or drink enough to get adequate nutrition. It's a minor surgery to place a thin tube through the skin of the abdomen into the stomach or small intestine, through which liquid nutrients can pass.
Surgery for stomach cancer is difficult and sometimes comes with side effects and complications such as bleeding, blood clots, difficulty eating after surgery, and vitamin deficiencies. Wilmot offers nutritional services and physical therapy to help patients regain quality of life after stomach cancer surgery.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and eradicate cancer cells. Radiation can be used before surgery to shrink the tumors or after surgery to kill small remnants of the cancer. It can also be used in advanced cases of stomach cancer to control bleeding or ease pain. Radiation for stomach cancer can also be given in combination with chemotherapy.
Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. Chemo can be given before or after surgery for stomach cancer, or as the primary treatment if the stomach cancer has spread to other parts of the body. Increasingly, Wilmot stomach cancer specialists are giving some amount of chemotherapy ahead of surgery because research shows it can improve survival. This approach could be a critical part of your treatment plan — which is why it’s important to have a team of specialists directing your care.
These are newer drugs designed to target specific gene changes that result in stomach cancer. They single out cancer cells without harming normal cells and tend to have less severe side effects compared to chemotherapy. Some stomach cancers have too much of protein called HER2/neu on the surface of cells (the same protein is present in some breast cancers). Herceptin is an example of a targeted therapy that attacks the HER2 protein. Other drugs that target HER2 are being studied. Another drug, Cyramza, is a targeted therapy known as a monoclonal antibody that attacks the protein that causes blood vessels to grow too fast and feed stomach cancer cells. Researchers are studying other approved cancer therapies to find out if they are useful to treat stomach cancer.
Many cancer treatments cause side effects such as hair loss or fatigue, and stomach cancer has some of its own side effects as patients learn how to adjust to eating habits. Not everyone experiences side effects the same way.
The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.
Wilmot's Cancer Control & Survivorship Program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects.