This information is an interpretation of various studies that have been published in medical journals. The information below represents various views of nurses and doctors who serve on the American Cancer Society’s Cancer Information Database Editorial Board. Keep in mind that the information provided in this article is not designed to be taken as medical advice or to replace the opinion and judgment of your personal cancer care team. It is simply designed to help you make informed decisions together with your doctor. The general treatment options that will be discussed may not be what your doctor recommends, and there may be various reasons why. You should take the time to find out what specific treatments doctors recommend for you.
Diagnosed with Stomach Cancer Late?
Schedule your free consultation today
There are different types of treatments available for stomach cancer. The type of treatment used depends on the severity of the cancer, its spread, and the general health of the patient. Some options may not be possible if a patient can no longer withstand the possible complications or lifestyle adjustments necessary after the treatment, especially surgery. In these cases, alternatives may be used.
When it is possible, surgeons will try to remove the cancer without taking out much of the stomach or the surrounding organs. Some lymph nodes and tissues that may later be infected will have to be taken out, but the goal is to spare as much tissue as possible.
If the disease is too advanced and removing the stomach is no longer a wise option, palliative surgery may be done to alleviate symptoms, although this type of surgery will not cure the cancer.
Surgery aims to achieve 'negative surgical margins,' which means that even when looking through the microscope, there should be no more cancer cells at the edges of the removed stomach parts.
For some very early-stage stomach cancers that are superficial and have an extremely low risk of spreading beyond the stomach, endoscopic procedures like endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) may be treatment options. These minimally invasive techniques involve passing an endoscope down the throat and into the stomach, allowing surgical tools to be inserted through the scope to carefully remove the tumor along with some surrounding normal stomach wall layers. ESD removes a deeper portion of the stomach wall than EMR.
While less commonly performed in the United States, where stomach cancer is less prevalent, these endoscopic resections are more frequently used in regions like East Asia, where early gastric cancers are more often detected through screening programs. Patients undergoing these procedures should have them done at experienced medical centers due to their technical complexity.
Partial or subtotal gastrectomy is a surgical procedure where only a portion of the stomach is removed, rather than the entire organ. It may be recommended when the cancer is confined to either the lower (distal gastrectomy) or upper (proximal gastrectomy) regions of the stomach. During the operation, the affected part of the stomach is excised, sometimes along with a section of the esophagus or the initial part of the small intestine. The remaining stomach is then reconnected.
Nearby lymph nodes and omental tissue are also typically removed, and any invaded surrounding organs like the spleen may require resection as well. Compared to total gastrectomy, preserving part of the stomach often allows for easier eating and digestion after surgery. Subtotal gastrectomies aim to remove the cancerous portion while sparing as much functional stomach as possible.
Total gastrectomy involves surgical removal of the entire stomach. It is commonly recommended when the cancer has extensively spread throughout the stomach or if the tumor is located in the upper part of the stomach near the esophagus.
During this procedure, the entire stomach is resected along with nearby lymph nodes, the omentum, and potentially the spleen or portions of other organs like the esophagus, intestines, or pancreas if they have been invaded by cancer. The remaining esophagus is then reconnected directly to a part of the small intestine to allow for continued food passage and digestion. However, without a stomach reservoir, patients can only consume small portions at a time and must eat frequently after a total gastrectomy to meet their nutritional needs. This lifestyle change can be difficult to adapt to and requires special care and attention.
During either a subtotal or total gastrectomy for stomach cancer, the surgeon also performs a lymph node dissection or lymphadenectomy, which involves the removal of nearby lymph nodes. This aspect is considered critically important, as the number of lymph nodes successfully removed is believed to directly impact the long-term outcomes of the surgery.
In the United States, the recommended standard is to remove at least 16 lymph nodes, a procedure termed a D1 lymphadenectomy. However, surgeons in countries like Japan and South Korea routinely perform more extensive D2 lymphadenectomies by extracting a greater number of regional lymph nodes, an approach that has been associated with higher success rates in those nations.
Palliative surgery is done when the cancer cannot effectively be cured, but symptom relief is still desired. A gastric bypass may be done if the tumor is large enough to block food from entering the stomach. A part of the small intestine will be attached to the upper part of the stomach to allow food to leave.
A subtotal gastrectomy will remove as much of the tumor as possible to relieve bleeding, blockages of food, and pain. The installation of a gastronomy tube or feeding tube can also be done when the patient can no longer ingest food or drink. The endoscope can also be used to place stents to keep the stomach open or perform ablations to reduce tumor size.
Possible side effects of surgery:
Chemotherapy may be given before surgery to shrink the cancer cells, this is known as neoadjuvant treatment. It may also be done after the surgery to remove any lingering cancer cells, this is adjuvant treatment. And it may be used as the primary treatment method as well, if cancer has spread to other parts of the body, or if surgery is not possible for the patient due to his conditions.
Chemo is given in cycles, with rest periods in between. These are powerful drugs that can severely wear down a person. Drugs are administered through an IV or orally and are usually given in combination. For stomach cancer, the following drugs are commonly used:
For early stomach cancers, the following drugs are used:
For advanced stomach cancer, the following drugs are combinations are used:
Chemotherapy is difficult and side effects can be expected after treatment. The following side effects may occur after or during chemotherapy for stomach cancer:
Constant monitoring is necessary after chemotherapy to prevent more serious side effects like Hand and foot syndrome, Nerve damage, and diarrhea.
Certain cell changes and proteins can be targeted by special drugs to inhibit cancer growth or even kill off cancer cells.
HER2 is a growth-promoting protein that allows cancer cells to develop faster. If the tests reveal that your cancer is HER2 positive, the following targeted drugs can be used for treatment:
Trastuzumab is a monoclonal antibody therapy that targets the HER2 protein. For patients with advanced stomach cancer that over-expresses the HER2 gene (HER2-positive), adding trastuzumab to chemotherapy has been shown to prolong survival compared to chemotherapy alone. However, trastuzumab is only effective for HER2-positive cancers, so tumor testing is required beforehand to determine HER2 status. The drug is given intravenously, typically every 2-3 weeks, alongside chemotherapy.
This drug causes mild side effects like chills, weakness, and headaches. But rarely, it may also cause heart damage, so it is important to study the conditions of your heart before this drug can be given.
Fam-trastuzumab deruxtecan is an antibody-drug conjugate (ADC) therapy for advanced HER2-positive stomach cancer. It consists of an anti-HER2 monoclonal antibody linked to a chemotherapy drug. The antibody component acts as a guided delivery system by binding to HER2 proteins on cancer cells, allowing the attached chemotherapy to be selectively transported and released into those cells. This ADC can be used as a single-agent treatment for HER2-positive metastatic gastric cancer, typically after prior trastuzumab therapy has been attempted. It is administered intravenously, usually once every 3 weeks.
Common side effects associated with fam-trastuzumab include low blood cell counts (increasing infection and bleeding risk), nausea, vomiting, diarrhea, constipation, appetite loss, fever, fatigue, and hair loss. Importantly, this drug can cause potentially life-threatening lung disease in some patients, so any new or worsening respiratory symptoms like coughing, wheezing, breathing difficulties, or fever should be promptly reported to the healthcare team. Rare but serious heart damage is also a risk, so cardiac function testing with an echocardiogram or MUGA scan may be performed before initiating therapy to establish a baseline. Careful monitoring and management of side effects is critical when receiving fam-trastuzumab deruxtecan treatment.
VEGEF proteins tell the cells in the blood to make more blood vessels. Blood vessel growth also increases cancer growth and spread. VEGEF proteins attach to cells' surface proteins called VEGEF receptors to accomplish this.
Ramucirumab is a monoclonal antibody therapy that targets the vascular endothelial growth factor (VEGF) pathway, which plays a key role in promoting new blood vessel formation for tumor growth and spread. By binding to the VEGF receptor, ramucirumab inhibits VEGF signaling and can help slow or stop the progression of certain cancers. It is approved for the treatment of advanced or metastatic gastric cancer, most commonly used after failure of prior chemotherapy regimens. Ramucirumab is administered as an intravenous infusion, typically every two weeks, either as a single agent or in combination with chemotherapy.
Common side effects associated with ramucirumab include hypertension, headaches, and diarrhea. However, some potentially serious adverse events require careful monitoring. These include an increased risk of blood clots, severe bleeding events, gastrointestinal perforations (holes forming in the stomach or intestines), and impaired wound healing. Gastrointestinal perforations are particularly concerning as they can lead to severe infections and may necessitate surgical intervention. Patients receiving ramucirumab should be closely observed for any signs or symptoms suggestive of these side effects and report them promptly to their healthcare provider for appropriate evaluation and management.
A few stomach cancers have changes in one of the NTRK genes which causes the production of abnormal TRK proteins, leading to cancer. Larotrectinib and entrectinib are pills taken once or twice daily that can target these TRK proteins. They may cause dizziness, fatigue, and diarrhea. But in rare, serious cases, they can also cause heart problems, brain fog, and liver complications. As with all targeted drugs, constant monitoring is needed.
The immune system has 'immune checkpoint proteins' in place that stop it from cannibalizing healthy cells and tissues. These are useful in preserving overall health, but cancer can sometimes hide behind the immune system checkpoints and make treatment less effective. Drugs called immune checkpoint inhibitors can turn these checkpoints off to help your immune system fight cancer more vigorously.
For stomach cancer, drugs called PD-1 inhibitors may be used for immunotherapy. Nivolumab and Pembrolizumab block PD-1 proteins in the T-cells and can boost immune response which shrinks cancer cells and slows tumor growth. Nivolumab is usually used for advanced cancer together with chemo, while pembrolizumab can be used as part of the first treatment for advanced stomach cancer with chemo if the cancer is negative for HER2 proteins or if high levels of MSI-H, dMMR, and TMB-H gene irregularities are found. These drugs are given once every 2-3 and 3-6 weeks respectively. Common side effects may include:
However, more serious side effects may happen when an autoimmune response is triggered. Because these drugs turn off your immune system checkpoints, it may result in the immune system targeting your organs and healthy tissue. This will require the doctor to give you immunosuppressants, usually in the form of corticosteroids.
Radiation therapy can be used in different ways to treat stomach cancer. For some earlier-stage cancers, radiation may be combined with chemotherapy (chemoradiation) before surgery in an attempt to shrink the tumor and facilitate surgical removal. Alternatively, after surgery, radiation can be administered along with chemotherapy to target any remaining cancer cells and help delay or prevent disease recurrence.
For stomach cancers that are inoperable or cannot be completely removed surgically, radiation therapy can be used to slow the growth of the cancer and alleviate symptoms such as pain, bleeding, or difficulties with eating.
When radiation is used to treat stomach cancer, it is delivered from an external machine that aims the radiation beams at the cancer site from multiple angles. Advanced techniques like 3D-conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) use computer guidance to precisely target the cancer while limiting exposure to surrounding healthy tissues. Before treatment, a simulation process maps out the optimal angles and radiation doses based on imaging studies like CT or MRI scans. Treatments are typically administered daily, 5 days per week over several weeks, with each treatment lasting only a few minutes.
Potential side effects from radiation for stomach cancer include skin irritation, nausea, vomiting, diarrhea, fatigue, and low blood cell counts. These effects are often worse when radiation is combined with chemotherapy. Some patients may experience difficulty eating and maintaining adequate nutrition during and after treatment, sometimes necessitating IV fluids or feeding tube placement. Radiation can also damage nearby organs like the heart and lungs, so careful treatment planning aims to minimize radiation exposure to these areas. Patients should report any side effects to their care team for appropriate management.
If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your stomach cancer, or from negligence during your treatment that caused you more harm, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.
