Once your doctor confirms a diagnosis of gastric cancer, you will begin treatment immediately. Your specific course of treatment will depend on the severity and location of the tumor, your general health and personal preferences.
Treatment Approaches for Gastric Cancer
There are three approaches to treating gastric cancer: surgery, endoscopic therapy and chemotherapy. Your doctor may choose one approach or a combination of these treatments, depending on your specific condition.
Your Johns Hopkins medical team will work with you to design a course of treatment tailored specifically to you.
Treatment options for gastric cancer:
The success of gastric cancer surgery depends on the stage of the cancer. When the cancer is caught early and the tumor has not spread beyond the stomach lining, the chance of a cure is higher. If the disease has spread beyond the lining or to the lymph nodes, the chance of a complete cure is lower.
There are two types of surgical procedures for gastric cancer:
Total gastrectomy. When tumors are located in the upper part of the stomach, your surgeon needs to remove the entire stomach. He or she will also remove lymph nodes, parts of the esophagus and small intestine, and any other cancerous tissues near the tumor. Your surgeon then connects the esophagus directly to the small intestine.
You will probably need to make dietary changes following surgery, as your body recovers and adjusts. A nutrition specialist can help you manage your dietary needs.
A: Total gastrectomy; B: Subtotal gastrectomy. (Click to Enlarge)
When gastric cancer is in its early stages, endoscopic therapy may be able to cure it completely. In later stages, endoscopic therapy can be palliative and help relieve symptoms. Your doctor will decide whether to use endoscopic therapy or surgery. He or she will base the decision on a number of factors, including the stage and location of the tumor.
Endoscopic mucosal resection is an option when tumors did not metastasize (spread) and are confined to the mucous lining. Your doctor performs an endoscopic procedure and removes small lesions and cancerous areas.
During an endoscopy:
You receive anesthesia and will be asleep during the procedure.
You lie on your left side.
The doctor uses an endoscope, which is a thin, lighted tube. Your doctor passes the endoscope through your mouth and pharynx and into the esophagus.
The endoscope acts like a pathway to the inside of your body. Your doctor passes instruments through the endoscope in order to remove the lesions.
Endoscopic palliative techniques. (Click to Enlarge)
Chemotherapy is the use of powerful drugs to destroy cancer cells. Adenocarcinoma of the stomach is sensitive to chemotherapy, meaning the drugs are able to kill the cancer cells. You will receive a combination of drugs through an intravenous (IV) line. You usually receive chemotherapy in cycles. You undergo a session of chemotherapy treatments for a few days or weeks. Then, you have a period without treatment to let your body recover.
Chemotherapy is a systemic (body-wide) treatment. Since the medications affect the entire body, you will experience unpleasant side effects, including nausea, hair loss and increased risk of infection. Your medical team at Johns Hopkins will work with you to manage your pain and other symptoms during your treatment.
Gastric Outlet Obstruction
Gastric outlet obstruction, or pyloric stenosis, occurs when the pylorus narrows. The pylorus is the opening from the stomach into the small intestine. Gastric outlet obstruction often occurs with gastric cancer. Your doctor can diagnose this with computed tomography (CT) scans and oral contrast radiographs.
Your doctor may perform endoscopic therapy or surgery to treat gastric outlet obstruction
Endoscopic therapy. Your doctor will perform an endoscopy to open the obstructed area. One method is to pass a well-lubricated balloon through the endoscope and position it in the stricture (the narrowed area). Your doctor inflates the balloon to dilate the stricture. If the obstruction is malignant, your doctor may place a self-expanding stent in the area to treat it.
Surgery. The goal of surgery for gastric outlet obstruction is to remove the obstruction. When gastric cancer is causing the gastric outlet obstruction, the treatment may be a surgical procedure similar to that for cancer, during which your doctor will remove part of the stomach.
Endoscopic palliation of gastric outlet obstruction with an expandable metal stent; A: Gastric obstruction; B: Placement of the stent; B: Endoscopic view. (Click to Enlarge)