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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.
If these stage 0 cancers are small, they 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 stomach cancer is often detected early
because of screening. (Screening is done in Japan because stomach
cancer is so common there.) It is rare to find stomach cancer so early
in the United States, so this treatment has not been practiced much
here. If it is done, it should be at a center that has a great deal of
experience with this technique.
Stage I
People with stage I stomach cancer typically have their cancer
removed by removing all or part of the stomach. The omentum (an
apron-like layer of fatty tissue in the abdomen) and nearby lymph nodes
are also removed. Endoscopic mucosal resection may rarely be an option
for some small stage I cancers. Any additional treatment will depend on
the stage.
Stage IA: No
further treatment is usually needed after surgery.
Stage IB:
For patients whose lymph nodes (removed at surgery) show no signs of
cancer spread, no further treatment may be needed. For those with
cancer in the lymph nodes, chemotherapy with radiation therapy may be
given after surgery. The chemo drug 5-FU is used most often. Studies
have shown that this may help people with stage IB stomach cancer live
longer. Another option for patients who were treated with chemotherapy
before surgery is to give them the same chemo (without radiation) after
surgery. In this instance, the chemo drugs etoposide, cisplatin, and
5-FU are used.
If someone with stomach cancer is too sick (from other
illnesses) to have surgery, they may be treated with radiation, which
may be given with chemo.
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, treatment may be chemo alone
or 5-FU along with radiation therapy.
Stage III
Surgery is still the main treatment for patients with this
stage disease (unless they have other medical conditions that make them
too ill for it). Some of these patients may be cured by surgery, while
for others the surgery may be able to help relieve symptoms from the
cancer. Some people may get chemotherapy before surgery (neoadjuvant
chemotherapy) to shrink the cancer and make it more likely that it will
be able to be removed completely at surgery. Patients who get chemo
before surgery will probably get chemo after, as well. For patients who
don't get chemo before surgery and for those who have surgery but some
cancer was left behind, treatment after surgery, includes chemotherapy
with 5-FU along with radiation therapy.
Stage IV
Because stage IV stomach cancer has grown so far into nearby
organs or has spread to distant organs, a cure is usually not possible.
A few patients with stage IV disease and no distant metastasis may
still be able to have surgery to try to cure the cancer, but most
patients will not be helped by this. 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 into
the small intestine 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, prior treatments
and the person's general state of health must be taken into account and
may affect their treatment options. Clinical trials may be an option
and should always be considered.
Last Medical Review: 11/03/2009
Last Revised: 11/03/2009
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