When it comes to diagnosing and treating stomach cancer, our team includes surgeons, gastroenterologists, radiologists, interventional radiologists, pathologists, medical oncologists, and radiation oncologists. These team members will confirm the diagnosis of gastric cancer and help you to select the best treatment plan. The choice of treatment largely depends on the stage of the cancer, which is determined by how much the tumor has grown, how deeply it has invaded the layers of the stomach, and whether it has spread to nearby organs, lymph nodes, or other parts of the body. The treatment plan may include surgery, chemotherapy, or radiation therapy.
Recent studies suggest that, for patients at high risk of recurrence for stomach cancer, chemotherapy before surgery or surgery followed by chemotherapy and radiation therapy may improve survival compared to surgery alone.
One approach is using chemotherapy both before and after surgery, and another is a combination treatment of radiation and chemotherapy after surgery. When the tumor cannot be removed, we may employ laser techniques or expandable devices or stents to relieve areas of obstruction that can cause pain and disability.
Communication is key because treating the whole person, not just the disease, is the best approach for patients and family members. An emphasis is placed on improving your quality of life through nutritional, exercise and psychosocial support programs.
What Are the Stages of Stomach Cancer?
Once a diagnosis of stomach cancer has been made, a number of tests may be performed to determine if and how far the cancer may have spread to the other layers of the stomach, nearby organs, and nearby lymph nodes. This process is called staging, and it is an important factor in deciding which treatment would be most beneficial to the patient.
CT scanning is often used for staging stomach cancer, as is PET scanning. A CT scan provides a roadmap and the PET scan looks at activity within the cancer cell. Both tests can be complementary to better define whether the cancer has spread or not.
Endoscopic ultrasound is another test that may be used during both diagnosis and staging.
A staging system is a way for your doctor to describe the extent of your cancer and then establish a treatment plan. The system most often used to stage stomach cancer in the United States is the American Joint Commission on Cancer (AJCC) TNM system. This divides cancer stages into 1 and 2 (early), 3 spread to surrounding lymph nodes and 4 to other organs (eg lung, liver and peritoneum)
TNM (tumor, node, metastasis) describes the stage of a cancer. This abbreviation summarizes the depth of penetration of the tumor into the stomach wall (T), whether it has spread to nearby lymph nodes (N), and whether it has metastasized, or spread, to other parts of the body (M).
- T describes the extent of the primary tumor (how far it has grown into the wall of the stomach and into nearby organs).
- N describes the spread to nearby (regional) lymph nodes.
- M indicates whether the cancer has metastasized (spread) to distant parts of the body. The most common sites of distant spread of stomach cancer are the liver, the peritoneum (the lining of the space around the digestive organs), and distant lymph nodes. Less common sites of spread include the lungs and brain.
Treating Stomach Cancer
Before a specific treatment protocol is established several factors are considered:
- Your age, overall health, and medical history
- Extent or stage of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Surgery
Surgery may be necessary to remove cancerous tissue, as well as nearby noncancerous tissue. The most common operation is called gastrectomy. If part of the stomach is removed, it’s called a subtotal or partial gastrectomy. If the entire stomach is removed, it’s called a total gastrectomy. Nearby lymph nodes are usually removed as well.
- Partial, or Subtotal, Gastrectomy
This involves removing part of the stomach, as well as parts of other tissues or organs near the tumor like the small intestine or esophagus, depending on the location of the tumor.
- Total Gastrectomy
This involves removing the entire stomach and parts of the esophagus, small intestine, and other tissue near the tumor. Following total gastrectomy, the esophagus is directly connected to the small intestine, to allow the patient to continue to eat and swallow normally. During the procedure, nearby lymph nodes are removed to examine them for cancer cells. This is called lymphadenectomy. Sometimes the spleen, an organ in the upper abdomen that filters blood and eliminates old blood cells, and part of the pancreas are also removed.
Minimally Invasive Surgery
Minimally invasive surgery is often performed using smaller incisions than traditional surgery. This is called laparoscopy and can be associated with fewer complications, less blood loss and postoperative pain, and shorter hospital stays.
During laparoscopy, a thin, lighted tube with a video camera at its tip – called a laparoscope – is inserted through a tiny incision in the abdominal wall, and the image is projected onto a large viewing screen. Guided by this highly magnified image, the surgeon can operate using specially designed surgical instruments that are inserted through additional small incisions.
In some patients, minimally invasive surgery can be used to remove stomach tumors or even the entire stomach.
Radiation Therapy
Radiation therapy uses high-energy rays or particles to kill cancer cells. One standard of care for treating stomach cancer is surgery followed by a combination of radiation therapy and chemotherapy to destroy any remaining stomach cancer cells.
- IMRT
One of the radiation therapy techniques we use includes IMRT, a type of 3-D radiation therapy that targets tumors with greater precision than conventional radiation therapy. Using highly sophisticated computer software and 3-D images from CT scans, the radiation oncologist can develop an individualized treatment plan that delivers high doses of radiation to cancerous tissue while sparing surrounding organs and reducing the risk of injury to healthy tissues.
- External radiation
External radiation, also known as external beam therapy, sends high levels of radiation directly to the cancer cells. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. External radiation may be used after surgery to try to kill any remaining cancer cells or for more advanced stomach cancer to ease symptoms such as pain or blockage.
Chemotherapy
Chemotherapy uses anti-cancer drugs to treat cancerous cells, working by interfering with the cancer cells ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells.
Chemotherapy is used to treat stomach cancer, either by itself or in combination with surgery and/or radiation therapy. It may be given to patients whose cancers have invaded the layers of the stomach wall, lymph nodes, and nearby organs. Chemotherapy may be used before surgery (neoadjuvant therapy) to shrink the tumor, or it may be given after surgery (adjuvant therapy) to kill any remaining cancer cells.
When given alone or in combination with radiation therapy, chemotherapy may help alleviate symptoms related to stomach cancer. In patients with more advanced stomach cancer in whom surgery is not possible, chemotherapy may also improve both the length and quality of life.
IP Therapy
Another method used to treat more advanced stomach cancer is intraperitoneal (IP) chemotherapy. In IP therapy, chemotherapy drugs are placed directly into the internal lining of the abdominal area and are released through a surgically implanted catheter. This allows a high concentration of chemotherapy agents to reach the cancerous tissue, thereby increasing the effectiveness of treatment.
Targeted Therapy
Some newer drugs work differently from standard chemotherapy drugs by targeting certain receptors on cancer cells and not normal cells. For example, in some stomach cancers, the cells have too much of a protein called HER2 on their surfaces. A drug called trastuzumab (Herceptin) may be helpful against these cancers by neutralizing this receptor. It is usually given along with standard chemotherapy drugs to help treat more advanced stomach cancers.
