Once your doctor confirms a diagnosis of gastric cancer, your treatment will begin immediately. The specific course of treatment will depend on the tumor’s location and stage, your current and past health conditions and your personal preferences.
Treatment Approaches for Gastric Cancer
The main approaches to treat gastric cancer are endoscopic therapy, surgery and chemotherapy. Your medical team will work with you to design a course of treatment using one of these approaches or a combination, depending on your specific conditions and preferences.
Main treatment options for gastric cancer:
- Endoscopic therapy
A: Total gastrectomy; B: Subtotal gastrectomy. (Click to enlarge.)
Gastric Cancer Treatment: Endoscopic Therapy
Early stage gastric cancer has not spread beyond the two innermost layers of the stomach. When gastric cancer is in its early stage, endoscopic therapies may treat it completely. Even in later stages, endoscopic therapies can be useful for relieving cancer-related symptoms. Your medical team will decide whether to use endoscopic therapy or surgery. This decision will be based on a number of factors, including the stage and location of the tumor.
Endoscopic mucosal resection is a type of endoscopic therapy in which the innermost lining (mucosa) is peeled off with a small blade at the tip of the endoscope. It is an option when tumors are confined to the mucosa and have not metastasized (spread). With this endoscopic procedure, multiple small lesions and cancerous areas can be removed without requiring surgery.
During an endoscopic therapy:
- You receive anesthesia and will be asleep during the procedure.
- 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, stomach and small intestine, respectively.
- The endoscope acts like a pathway to the inside of your body. Your doctor passes therapeutic instruments through the endoscope in order to remove the lesions.
Endoscopic palliative techniques. (Click to enlarge.)
Gastric Cancer Treatment: Surgery
Surgery offers the best chance for curing gastric cancer. The success of surgery mainly depends on the stage and extent of the cancer. When the cancer is in an early stage (confined to the inner lining of the stomach) and the tumor has not spread beyond the stomach, the chance of a cure is higher. If the disease has already spread beyond the lining to the lymph nodes or to other organs, the chance of a complete cure is lower. In later stages of the disease, surgery can still be used to relieve cancer-related symptoms.
There are two types of surgical procedures for gastric cancer:
- Partial (subtotal) gastrectomy: This procedure is an option when the tumor is located in the lower part of the stomach. Your surgeon removes only the lower part of the stomach where the cancer is located and keeps the upper part. Your surgeon then attaches the upper remaining part to the free end of the small intestine.
- 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 if present. Your surgeon then connects the esophagus directly to the free end of the small intestine.
You will probably need to make some lifestyle adjustments until you fully recover from surgery. Dietary changes may be especially required, as your digestive tract adjusts. A nutrition specialist as a member of your care team can help you manage this.
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. Chemotherapy is used with surgery or alone in gastric cancer. If the disease is past the early stage, you will receive chemotherapy. Usually chemotherapy consists of a combination of powerful drugs, delivered through an IV line or port.
You usually receive chemotherapy in cycles. That means you undergo a session of chemotherapy treatment for a few days or weeks, and 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, it may affect non-cancerous, healthy cells and may cause you to 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 beginning of the small intestine. Gastric outlet obstruction often occurs with gastric cancer. Your doctor can diagnose this with 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 into the narrowed area. Then, your doctor inflates the balloon to dilate the stricture. If the obstruction is malignant, your doctor may place a hollow tube, called a stent, in the area to treat it.
- Surgery: The goal of surgery for gastric outlet obstruction is to relieve the obstruction even though the cancer may not be completely curable. 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.)