Treatment Goals
If you have gastric cancer, there are several key factors your doctor will consider before deciding on the best treatment approach. This involves reviewing your diagnosis and identifying the outcomes that matter most to you. By discussing these goals together, you and your care team can create a personalized plan that guides your decisions at every stage of treatment.
Cancer Stage
When determining treatment goals, the most important factor to consider is the stage of the cancer. Early stages may have a goal of using endoscopy or surgery to cure the cancer, and later stages may focus on controlling its spread or managing symptoms. For gastric cancer, the stages will correspond with how far the cancer has grown into the layers of the stomach wall and whether it has spread to nearby lymph nodes and other organs. Doctors will use biopsy, imaging, and sometimes diagnostic laparoscopy to determine the correct staging.
- Early stage cancer (Stage I): This stage is often confined to the stomach lining, making it potentially curable with surgery or endoscopic procedures.
- Locally advanced cancer (Stages II-III): At this point, the cancer has grown deeper into the stomach wall or spread to multiple lymph nodes, which usually requires a combination of surgery, chemotherapy, and/or radiation.
- Metastatic or advanced cancer (Stage IV): When the cancer has spread beyond the stomach into other organs, a cure is not the goal. Controlling the disease and its symptoms becomes the primary focus of treatment.
Location of Tumor
The location of the cancer influences whether surgery is possible. The tumor’s position determines both the type of surgery that can be performed and whether normal digestive function can be preserved. This will affect how well a patient can eat after treatment or if reconstructive techniques will be needed to help with adequate digestion.
- Upper stomach tumors: These are near the esophagus and may require part of the stomach and esophagus to be removed
- Middle stomach tumors: These generally require part of the stomach to be removed (subtotal gastrectomy).
- Lower stomach tumors: With these tumors, part of the stomach sometimes can be preserved, which may allow for more limited resections.
Overall Health and Fitness
Having surgery may be too risky for some, and chemotherapy can be taxing on the body. So, a patient’s overall health may place limitations on intended treatment goals.
It is important to consider the patient’s age, general strength, pre-existing health conditions (such as diabetes or heart disease), and nutritional status when creating a treatment plan. Patients in stronger health may be able to tolerate more aggressive treatments, while those who are more frail may respond better to supportive care or less-invasive treatments.
Personal Preferences and Values
Each patient will have priorities, and these will help to shape the treatment plan. One person may want to use aggressive treatments despite the risk of side effects. Another may value the ability to remain independent and comfortable without using too many treatments. When health care providers share the decision-making process with patients, it increases the likelihood that the treatment will align with the patient’s goals and expectations. Keeping the lines of communication open between patients and the care team will be essential for creating the best treatment plan.
Treatment Approach
Depending on the stage of cancer, your doctor will discuss different treatment goals with you.
1. Cure. When gastric cancer is diagnosed at an early or localized stage, the primary goal is to completely eradicate the cancer. Complete eradication will offer the best chance for long-term survival or remission. Curative treatment often includes:
- Endoscopic therapy: removal of the cancer is possible for very early stage gastric or gastroesophageal junction cancers.
- Gastrectomy surgery: to remove the cancer and surrounding tissue.
- Neoadjuvant therapy (chemotherapy or chemoradiation): to shrink the tumor before surgery and improve surgical outcomes.
- Adjuvant therapy: to kill remaining microscopic cancer cells after surgery.
2. Control. If the patient has an advanced cancer and a complete cure is not possible, the goal is to control the disease. Strategies to control the cancer include focusing on slowing tumor growth, reducing complication risks, and prolonging life in the most comfortable way. This approach manages the cancer like a chronic condition, monitoring the patient’s side effects and making adjustments as necessary. Treatment options may include chemotherapy, targeted drug therapy, and immunotherapy, which are all meant to target rapidly growing cancer cells and relieve symptoms.
3. Palliative Care. If a patient has an advanced case of stomach cancer and the ability to cure or control it is limited, palliative care is essential. Palliative care is designed to relieve pain, nausea, eating difficulties, or any other symptoms that may be causing discomfort. If appropriate, this care may be combined with other treatments. With palliative care, patients receive the medical, nutritional, and emotional support needed to maximize their quality of life.
Overall, patients who are facing a stomach cancer diagnosis need to know there is more than one way to treat it. High-quality, accessible care is available, and it can be personalized.