Treatment Options
When first diagnosed with stomach cancer, it can bring up many emotions — fear, sadness, uncertainty — and raise questions about what life will look like in the future. Learning about the available treatment options can help patients feel more prepared, empowering them to assist their care team with making the best decisions for their health. Knowing what each treatment is, why it is used, and what to expect during recovery may also lessen any anxiety that could occur.
Gastric cancer treatment varies based on stage and individual factors. But it typically includes surgery to remove the cancer, chemotherapy (sometimes combined with surgery), radiation therapy, targeted drug therapy, and immunotherapy. With advances in minimally invasive and robotic techniques, surgery incisions are now smaller, which may mean a faster recovery and fewer complications. Dietitians can even be involved in the care of gastric cancer patients to give nutritional recommendations.
Understanding the most common treatment options:
Surgery
Gastrectomy surgery is one of the primary treatments for stomach cancer. This is a surgical procedure that removes all or part of the stomach. The goal when stomach cancer is present is to remove what has been affected by cancer and the nearby lymph nodes, while still allowing the patient’s digestive system to work. Doctors can use different techniques when performing gastrectomy surgery. The surgeon will recommend the best approach based on the patient’s condition. Depending on the method, there will be one large incision or several smaller ones on the abdomen.
There are two main types of gastrectomy surgery:
- Subtotal (or partial) gastrectomy. A subtotal gastrectomy is a surgery where the lower part of the stomach and the nearby lymph nodes are removed while leaving the rest in place. After removing the diseased section, the surgeon reconnects the remaining stomach to the small intestine so food can still pass through the digestive system normally. This procedure leaves many people with a smaller stomach, sometimes making it necessary for them to eat smaller, more frequent meals. Though some foods may be harder to digest initially, most patients will adapt over time. Also, some patients may need to start taking vitamin supplements such as vitamin B12.
- Total gastrectomy. A total gastrectomy is a surgery that removes the entire stomach along with the nearby lymph nodes. Sometimes, small portions of the esophagus (the food pipe) are also removed. The surgeon then connects the esophagus directly to the small intestine, allowing the patient to continue eating and swallowing even though the stomach has been removed. But it will become necessary to eat smaller, more frequent meals following surgery. Since the stomach absorbs certain vitamins, a dietitian will offer guidance on nutrition and supplements. However, vitamin B12 is known not to be absorbed naturally after the procedure, so that will need to be taken as a lifelong supplement.
- Lymph nodes. It is important to note that during any gastrectomy surgery, the surgeon will also remove some lymph nodes near the stomach. Lymph nodes are small, bean-shaped glands found throughout the body that act like tiny filters for a fluid called lymph, which moves between cells in the body. They help trap germs, waste, and other unwanted substances before the fluid returns to the bloodstream. Most people notice them in their neck or under their arms when they swell during a sore throat or infection. Because they filter so much, lymph nodes are often one of the first places where cancer cells can travel and get trapped. Removing them helps doctors check if the cancer has spread, and this continues to guide the best treatment for their patients.
There are two main types of surgical techniques:
- Open. When one long incision is made (see diagram), it is called an open surgery. Though this technique causes more pain and will result in a longer recovery process, it is the better method for complicated stomach cancer cases, large tumors, or in any other instance where wider access to the area is needed. The entire surgery could take several hours, depending on the complexity of the case. Typically, patients who receive an open gastrectomy stay in the hospital for 7-14 days and make a full recovery in 6-8 weeks.
- Robotic. Robotic surgery is a minimally invasive method where the surgeon uses a robotic system to perform the gastrectomy through a few small incisions in the abdomen. The exact location and number of port sites may vary according to the procedure and surgeon. This procedure is more suitable for early to midstage stomach cancer, as it allows for better visualization of the surgical area, greater precision when navigating critical vessels and nerves, less blood loss, and fewer complications. The entire operation could take several hours, depending on the complexity of the case. The hospital stay will vary, but most patients average about 5-7 days and make a full recovery in 2-4 weeks.
Chemotherapy
Chemotherapy, or “chemo,” is a type of treatment that uses special medicines to kill cancer cells or stop them from growing and spreading. They are most often given through an IV or a port into a vein or as pills to swallow. These medicines travel through the bloodstream, so they can reach cancer cells almost anywhere in the body.Chemotherapy can be given at various times in cancer treatment to address issues that are specific to an individual’s cancer case. Chemo can be used before stomach surgery along with radiation (known as chemoradiation) to enhance the outcome of the procedure. This is considered to be neoadjuvant treatment (chemo and/or radiation treatment before surgery), as the therapy can shrink the tumor and allow for an easier surgery.
Chemotherapy can be given after surgery (adjuvant) with the goal of killing any cancer that may have been missed during the procedure. This is to prevent the cancer from coming back.
But chemotherapy can also be used as the sole treatment if the cancer has already spread to other parts of the body, or it is unable to be surgically removed.
At whatever point patients receive chemo in their cancer journey, it will be given in cycles. These cycles usually last for several weeks and are then followed by a rest period before starting the next cycle. This is to give the body a chance to recover.
Chemo can also affect some healthy cells, and it does come with some side effects that can vary from person to person. These include hair loss, fatigue, nausea, vomiting, diarrhea, a weakened immune system, and/or numbness/tingling in the hands/feet. Good nutrition, rest, hydration, and antinausea medicines (if necessary) will be helpful while undergoing this treatment.
Radiation Therapy
This is a cancer treatment that uses high-energy beams (similar to X-rays) to kill cancer cells or stop them from growing. For this treatment, doctors carefully aim the radiation beams at the exact area of the stomach where the cancer is located. This is so the beams can focus on damaging the cancer cells while trying to protect as much healthy surrounding tissue as possible.
Radiation therapy can be used to address cancer cases that are in various stages. Before stomach surgery, radiation can be used along with chemotherapy (known as chemoradiation) to shrink the cancerous tumor, making it easier to remove. Chemoradiation can also be used after surgery to kill any cancer that may have been missed during surgery, which is meant to prevent the cancer from coming back.
If a patient has cancer that can’t be removed by surgery, radiation therapy can sometimes be used as an option to slow the growth of the cancer and relieve any resulting symptoms like bleeding, pain, or trouble eating/swallowing.
Radiation is a painless treatment that is typically given in short, daily sessions over several days or weeks. It does come with some side effects that are usually temporary. These include fatigue, nausea, diarrhea, and/or skin irritation near the treated area.
Targeted Drug Therapy
Some stomach cancers have unique features that can be attacked with “smart” drugs. Researchers have discovered information about the changes in cells that cause cancer, which has allowed them to develop drugs to specifically target these changes.
Targeted drug therapy is a type of cancer treatment that uses medicines designed to find and attack specific features of cancer cells — such as certain proteins like HER2 or abnormal gene changes — that help them grow or survive. By focusing on these “targets,” the treatment aims to affect mostly the cancer cells and cause less harm to healthy cells.
Targeted drugs are different from existing chemo drugs, often proving to be more effective with milder side effects (such as diarrhea, high blood pressure, and/or skin changes). Targeted therapy can be given as pills, injections, or through an IV. Sometimes, targeted drug therapy can be used alone to treat gastric cancer. But it is often used along with other treatments, like chemotherapy or immunotherapy, to improve results. It all depends on the patient’s individual case. Doctors usually run special tests on the patient’s cancer to see if it has the right target for this treatment to work.
Immunotherapy
The immune system is the body’s natural defense army, normally acting as a protection from germs and illnesses. But sometimes, cancer cells find ways to hide from it. Immunotherapy is a type of cancer treatment that helps the body’s immune system find those hidden cancer cells and attack them.
When the immune system is functioning well, it uses “checkpoint” proteins to signal whether to start an immune response, or kick into protection mode. But in instances when cancer cells use these checkpoints to avoid being attacked, immunotherapy can be used to “wake up” the immune system or give it extra tools to recognize and destroy those cancer cells more effectively.
Immunotherapy drugs (also called immune checkpoint inhibitors) are usually given as an IV infusion once every 2-3 weeks. They have been known to be used along with chemotherapy in patients who have advanced stomach cancer and specific gene markers such as HER2 or PD-L1.
Because it boosts the body’s immune response, immunotherapy can sometimes cause side effects that mimic an infection, such as fatigue, fever, or skin changes. The patient’s care team can help to manage any side effects.
Endoscopic Stenting
Often, there are advanced gastric cancer cases where surgery isn’t possible and the cancer blocks food from passing through the stomach or intestine. In those instances, a surgeon can place an endoscopic stent (a small tube) in the narrowed sections of the digestive tract during an endoscopy. This can improve the passage of food and reduce blockages, allowing the patient to eat more comfortably.
Patients who decide to receive an endoscopic stent will be sedated for this short procedure. They will spend at least two hours at the designated medical center, which allows for check-in, preparation, and recovery after sedation. However, the actual procedure will only take about 30-60 minutes.
When it comes to gastric cancer, every person’s treatment plan will be unique. Some people may need a combination of treatments, not just one.