Stomach Cancer Treatment

Stomach Cancer - Treatments

There are a few effective treatment options for stomach cancer. In general, treatment for stomach cancer depends on the following factors:

Size, location and extent of the tumour
Stage of the disease when the cancer is found
Patient’s general state of health

The main and only curative treatment for stomach cancer is surgery. However, chemotherapy and radiotherapy may also be required for some patients. Endoscopic resection may be possible for very early cancers confined to the mucosa. In advanced stage disease, chemotherapy is generally used in combination with surgery, and radiotherapy may also be administered.

New treatment approaches such as immunotherapy have been shown in clinical trials to be effective for certain types of stomach cancer, either given as single agent or in combination with chemotherapy.

An individual with cancer should be assessed by a specialist to determine which treatment is best suited for them.

Surgery

The type of surgery for stomach cancer varies based on the stage of the cancer.

Upper endoscopy, which is also used to diagnose stomach cancer, can be used to treat early stomach cancer limited in spread to the stomach’s uppermost layers. As a part of this procedure an endoscopic submucosal dissection or endoscopic mucosal resection is performed, and the tumour is resected from the stomach and removed through the mouth.

When the cancer is more advanced, gastrectomy, or removal of the stomach is the recommended surgery.

Partial or subtotal gastrectomy is the removal of a part of the stomach. After a partial gastrectomy, the surgeon will connect the remaining portion of the stomach to the oesophagus or the small intestine, depending on which part of the stomach was removed.
Total gastrectomy is the removal of the entire stomach, suspicious lymph nodes near the stomach and other surrounding tissue. After a total gastrectomy, the surgeon will connect the oesophagus directly to the small intestine.

gastrectomy surgery, used to treat stomach cancer

When stomach cancer has metastasised and spread to the peritoneum, the inner lining of the abdomen, they are known as peritoneal surface malignancies (PSM). In these cases, they may be eligible for a complex and extensive surgery known as cytoreductive surgery (CRS) to remove all visible tumour implants within the abdomen. Following CRS, a high concentration of heated chemotherapy is instilled intra-abdominally to eradicate residual microscopic tumour cells, in a procedure called hyperthermic intraperitoneal chemotherapy (HIPEC).

Chemotherapy

Chemotherapy is sometimes recommended after surgery if there is a risk that the cancer might return. It may also be used before surgery to shrink the cancer, so that it is more likely to be removed completely during surgery.

In patients with advanced stomach cancer, chemotherapy may be used alone or with targeted drug therapy when resection is no longer meaningful or possible.

Radiotherapy

Radiotherapy uses powerful energy beams to kill cancer cells. It can also be used before surgery to shrink the cancer so that it is more easily removed during surgery. In some instances, the doctor may recommend radiotherapy to reduce the risk of a cancer recurrence after surgery, or in the palliative setting to stop bleeding.

Targeted therapy

Targeted drug treatments work by blocking specific weaknesses present within cancer cells, causing the cancer cells to die. Targeted drug therapy is usually combined with chemotherapy for treating advanced or recurrent stomach cancer.

Immunotherapy

Immunotherapy is a drug treatment that helps a patient’s immune system fight cancer. Immunotherapy may be recommended if the stomach cancer is advanced, recurs or spreads to other parts of the body.

Palliative surgery and care

As many advanced cancer patients may not be amenable to cure, palliative surgery or care may be a potential form of treatment. Patients can present with a wide variety of abdominal symptoms owing to tumour related complications such as pain, bleeding, intestinal obstruction, sepsis and jaundice which can substantially decrease their quality of life. Palliative surgery in selected patients has the potential to provide effective relief of symptoms, as can interventions from the supportive and palliative care team to decrease pain and provide comfort.

Stomach cancer – Complications

If stomach cancer is untreated it can lead to serious symptoms such as gastric outlet obstruction (which can present as intractable vomiting), bleeding from the primary tumour, and accumulation of fluid in the abdomen called ascites, which can lead to increased discomfort from bloating and difficulty to ingest food. Further spread of the disease to liver, lung and bones can also cause organ-specific complications.

If stomach cancer is treated with surgery there are also potential complications, especially if the stomach is removed:

Changes in bowel habits – The body may process food differently, resulting in in more frequent bowel movements or difficulty passing motion.
A feeling of fullness and change in appetite – Post-surgery a feeling of fullness may persist, making it difficult to eat full meals. As your stomach capacity and reserves would have changed, this will take some time and months to adjust to and it will slowly regain some normalcy. Small frequent meals are advised.
Increased bloating or gas – Post surgery, a feeling or bloating or gas may persist.
Vitamin deficiency - Nutrition absorption may be impacted, which may lead to conditions such as anaemia.). This should be discussed and addressed by your doctor and necessary deficiencies will be appropriately replaced
Dumping syndrome – The body may not be able to digest sugar and starch properly, which may cause sudden dips in blood pressure. This should be discussed and addressed by your doctor.