Treatment of stomach cancer depends to a large degree on where the cancer started in the stomach and how far it has spread.

Stage 0

Because stage 0 cancers are limited to the inner lining layer of the stomach and have not invaded deeper layers, they can be treated by surgery alone. No chemotherapy or radiation therapy is needed. Gastrectomy (surgical removal of part or all of the stomach) and lymphadenectomy (removal of the nearby lymph nodes) is usually done.

Small cancers that are caught very early can sometimes be treated by endoscopic mucosal resection. In this procedure the cancer is removed through an endoscope passed down the throat. This is done more often in Japan, where cancers are often detected early because of screening. (Screening is done in Japan because stomach cancer is so common there.) It is not done as often in the United States, as cancers found here are usually more advanced. If it is done, it should be at a center with experience with this procedure.

Stage I

People with stage I stomach cancer typically have their cancer removed by a total or partial gastrectomy, as well as removal of the omentum (fatty tissue in the abdomen) and nearby lymph nodes. Endoscopic mucosal resection may also be an option for some small stage I cancers. No additional treatment is usually needed for stage IA patients. Those with stage IB disease might be considered for adjuvant chemotherapy after surgery with a drug such as 5-FU, along with radiation therapy. Studies have shown that this may help people with stage IB stomach cancer to live longer.

Stage II

People with stage II stomach cancer are treated by surgically removing all or part of their stomach, the omentum, and removal of nearby lymph nodes. Some people may get chemotherapy before surgery (neoadjuvant chemotherapy). After surgery, adjuvant chemotherapy with 5-FU along with radiation therapy has been shown to help people with stage II stomach cancer to live longer.

Stage III

Patients with this stage disease should have surgery (unless they have other medical conditions that make them too ill for surgery), as some of these cancers may be cured. The surgery may also help relieve symptoms from the cancer. Some people may get chemotherapy before surgery (neoadjuvant chemotherapy). After surgery, adjuvant chemotherapy with 5-FU along with radiation therapy has been shown to help people with stage III stomach cancer to live longer.

Stage IV

Because stage IV stomach cancer has grown so extensively into nearby organs or has spread to distant organs, a cure is usually not possible. Select patients with stage IV disease and no distant metastasis may still be able to have surgery to try to cure the cancer but most will not. Patients with advanced stomach cancer may receive palliative treatment, including palliative surgery to prevent the stomach and/or intestines from becoming obstructed (blocked) or to control bleeding.

In some cases, a laser beam directed through an endoscope (a long, flexible tube passed down the throat) can vaporize most of the tumor and relieve obstruction without surgery. If needed, a stent (a hollow metal tube) may be placed at the junction of the esophagus and stomach to help keep it open and allow food to pass through it. This can also be done at the junction of the stomach and the small intestine.

Chemotherapy and/or radiation therapy can often help shrink the cancer and relieve some symptoms as well as help patients to live longer, but is usually not expected to cure the cancer. The chemotherapy drugs often used include 5-FU, cisplatin, and either epirubicin or etoposide. Docetaxel, oxaliplatin, capecitabine, or irinotecan may also be used. Combinations of these drugs are most commonly used, but which combination is best is not clear. The preferred way to give the 5-FU is by continuous infusion through a catheter (a thin tube used to inject or withdraw fluids) placed into a large vein. But other approaches may be just as successful. New treatments being tested in clinical trials may benefit some patients.

Even if treatments do not succeed in destroying or shrinking the cancer, there are ways to relieve the pain and symptoms from the disease. Patients should tell their cancer care team about any symptoms or pain they have right way, so they can be effectively managed.

Nutrition is another area of concern for many patients with stomach cancer. There is help available for those who have trouble eating, ranging from nutritional counseling to placement of a tube in the stomach to help provide nutrition, if needed.

Recurrent cancer

Cancer that comes back after initial treatment is known as recurrent cancer. Treatment options for recurrent disease are generally the same as they are for stage IV cancers. However, both prior treatments and the person's general state of health must be taken into account and may affect treatment options. Clinical trials may be an option and should always at least be considered.

Last Medical Review: 11/07/2008
Last Revised: 05/14/2009