Treatment Plans

The treatment of stomach cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors, including a gastroenterologist (a doctor who specializes in the function and disorders of the gastrointestinal tract, including the stomach, intestines, and associated organs), surgeon, medical oncologist, and radiation oncologist, will work with the patient to determine the best treatment plan.

Stomach cancer may be treated with surgery, radiation therapy, or chemotherapy. Often, a combination of these treatments is used. It can be difficult to cure stomach cancer because it is often not detected until it is at an advanced stage. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials Section.

Surgery

In early stages (0 or I), when the cancer is still contained within the stomach, treatment usually consists of surgery alone to remove the affected part of the stomach and nearby lymph nodes. If the cancer has spread to the outer stomach wall or lymph nodes (stage II or III), surgery plus either chemotherapy or radiation therapy may be used.  For gastric cancer that has invaded nearby organs or blood vessels or spread to distant sites (stage IV) gastrectomies are usually not performed.

The surgeon can perform a subtotal or partial gastrectomy (removal of part of the stomach) or a total gastrectomy (removal of all of the stomach). During a gastrectomy, the surgeon attaches the esophagus directly to the small intestine. In a partial gastrectomy, the surgeon connects the remaining part of the stomach to the esophagus or small intestine. After this surgery, the patient will only be able to eat a small amount of food at a time.

Gastrectomy is major surgery and can have serious complications or side effects. One common side effect is a group of symptoms known as dumping syndrome, which includes cramps, nausea, diarrhea, and dizziness after eating. This happens when food enters the small intestine too fast. The doctor can suggest ways to avoid this and can prescribe medication to help control these symptoms. The symptoms usually disappear in a few months, but in some cases, they may be permanent. Patients who have their entire stomachremoved will need regular injections of vitamin B12 because they will no longer be able to absorb this essential vitamin through their stomach.

Regional lymph nodes are often removed during surgery (lymphadenectomy) because the cancer may have spread to those lymph nodes. There is still debate as to how extensive the lymphadenectomy should be. In Europe and especially in Japan, more lymph nodes are routinely removed than in the United States.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy can be given by mouth or injection. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or to reduce cancer-related symptoms.  It also may be combined with radiation therapy. Currently, there is no standard chemotherapy treatment plan that is accepted worldwide. Fluorouracil (5-FU, Adrucil) and cisplatin (Platinol) are commonly used drugs in treating stomach cancer.
The side effects of chemotherapy depend on many factors (the individual person, drugs and doses used) but can commonly include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually improve once treatment is finished, but may take months to resolve completely. 

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.  For information about the side effects of chemotherapy, click here. 

Radiation Therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Patients with stomach cancer sometimes receive external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.

Side effects from radiation therapy include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.  For information about the side effects of radiation, click here.  

Advanced Stomach Cancer

Advanced stomach cancer has spread to other areas of the body and is generally treated the same way as earlier stages of the disease, with surgery, chemotherapy, or radiation therapy. Doctors may also use surgery to relieve symptoms and prevent intestinal or stomach blockages. Chemotherapy or radiation therapy can also help relieve symptoms.