Stomach Cancer Treatment

It's helpful to understand the possible treatments for stomach cancer. The following are overviews of the most common treatments. Reading these should help you know what to expect, what the potential side effects are, and what the advantages are to each.

The most common treatments for stomach cancer include:

  • Gastrectomy
  • Chemotherapy
  • Radiation

You can read more about each treatment types in the following sections.

Stomach cancer treatment depends on where the cancer started in the stomach and how far it spread. The treatment for each stage is different.

Stage 0- Stomach Cancer

Stage 0 cancers are only in the inner lining of the stomach. They have not spread to deeper layers. Stage 0 cancers can be treated by surgery alone. Chemotherapy and radiation are usually not needed. The most common surgeries for this stage are:

  • Gastrectomy (surgical removal of part or all of the stomach).
  • Lymphadenectomy (removal of the nearby lymph nodes).

If the tumors in this stage are small, they can sometimes be treated by endoscopic mucosal resection. In this procedure the cancer is removed through an endoscope passed down your throat.

Stage I- Stomach Cancer

In Stage I stomach cancers, surgery removes:

  • All or part of the stomach
  • The omentum (a layer of fatty tissue in your abdomen)
  • Some nearby lymph nodes

As with stage 0 stomach cancer, endoscopic mucosal resection may be an option. Chemotherapy may be given before surgery. Your doctor might recommend chemotherapy

with radiation or chemotherapy alone after surgery.

The chemotherapy drugs used most often for stomach cancer are:

  • 5-FU or
  • Capecitabine (Xeloda)

If you have chemotherapy before surgery, you may be given the same chemotherapy after surgery. In this case, the most common chemo drugs are:

  • Etoposide
  • Cisplatin
  • 5-FU

Stage II- Stomach Cancer

The main treatment for stage II stomach cancer is surgery to remove all or part of the stomach, the omentum, and nearby lymph nodes. Some patients are treated with chemo before surgery. Treatment after surgery may include chemo alone or chemotherapy and radiation therapy.

Stage III- Stomach Cancer

Surgery is the main treatment for stage III stomach cancer. The purpose of the surgery may be to either:

  • Cure the cancer or
  • Relieve the symptoms.

If your doctor recommends chemo before surgery, you will probably have it afterwards as well. It is common to have radiation at the same time.

Stage IV- Stomach Cancer

Stage IV is stomach cancer that has spread to distant parts of the body. Although a cure is usually not possible, you may receive palliative surgery to:

  • Keep your stomach and/or intestines from becoming blocked
  • Control bleeding.

Sometimes, endoscopy is helpful. This is a laser beam directed through an endoscope (a long, flexible tube passed down the throat). It can vaporize most of the tumor and relieve the blockage without surgery. If necessary, a hollow metal tube called a stent can be placed where your esophagus and stomach meet. This helps maintain the opening so that food can pass. This can also be done where your stomach and small intestine meet.

Chemotherapy and/or radiation therapy can often help shrink the cancer. These treatments can also relieve some symptoms. Chemotherapy drugs typically used in Stage IV include:

  • 5-FU.
  • Cisplatin.
  • Either epirubicin or etoposide.
  • Docetaxel.
  • Oxaliplatin.
  • Capecitabine
  • Irinotecan.
  • Trastuzumab (Herceptin).

Combinations of these drugs are most commonly used.

Nutrition is another concern for many patients with stomach cancer. You may need a tube placed into your small intestine to provide nutrition if you are having trouble eating.

What is a gastrectomy?

The most common treatment for stomach cancer is surgery. A gastrectomy is the removal of some or all of your stomach that holds food at the beginning of digestion. During a gastrectomy, nearby lymph nodes, tissues, and organs near the tumor may also be removed depending on the stage of the cancer. If the entire stomach is removed, the surgeon will connect the esophagus to the small intestine so you can continue to swallow and eat. You will be given general anesthesia so you will be asleep during the procedure.

Preparing for Surgery

Your healthcare team will give you specific instructions to follow before your surgery. Some of these instructions may include altering your diet, medication, or physical activity in the days leading up to surgery.

Make sure you follow these instructions so your surgery and healing will go smoothly.

After Surgery

After surgery you will probably spend a few days recovering in the hospital. When it is time for you to go home, you will need a caregiver, family member, or friend to drive you home. You’ll also probably need help at home for the first few days after the procedure.

Your doctor may prescribe medications to prevent infection or to help with pain. Take all medications as instructed by your doctor.

You will need to change the way you eat after stomach surgery. Your healthcare team may ask you to follow soft food diet or to eat many small meals instead of two or three large ones daily.

Surgery Risks

Any surgery carries a risk of infection. Ask your healthcare team how to care for your incision and check for signs of infection. Some signs of infection include:

  • Fever
  • Pain
  • Swelling
  • Heat
  • Cloudy discharge or pus

If you notice and signs of infection, alert your healthcare team immediately.

A common side effect of a gastrectomy is “dumping syndrome.” Dumping syndrome is a condition where food leaves the stomach or moves through the digestive tract too quickly causing symptoms such as diarrhea and nausea. If dumping syndrome continues, it can lead to malnutrition and dangerous weight loss.

If you experience diarrhea or vomiting for more than 24 hours, contact your healthcare team immediately. If you are losing weight at a rate of 1-2lbs per week, tell your healthcare team. Rapid weight loss can be very dangerous and lead to malnutrition.

  • What will my surgery entail?
  • What do I need to do to prepare for surgery?
  • What do I need to do after surgery?
  • Can you refer me to a registered dietitian?
  • What are the possible side effects of my surgery, and how can I manage these?
  • Who should I call if I have any additional questions or notice any unsuspected changes after surgery?

Chemotherapy treatment (usually called “chemo”) is the use of drugs that prevent cancer cells from growing and spreading. Chemotherapy medicines either destroy cancer cells altogether or stop them from dividing. Chemo affects your whole body because it goes through your bloodstream. Chemo doesn’t refer to one treatment but many, because there are lots of different chemotherapy medicines.

When is chemotherapy used?

Chemotherapy may be given either alone or along with radiation therapy. When given alone, it is given in a higher dose designed to kill off cancer cells. When given along with radiation therapy, it is delivered at a lower dose. This is designed to make the cancer more sensitive to the radiation.

Chemotherapy is usually given by vein, but some forms can be given by mouth. Your medical oncologist will tell you how many cycles or courses of chemotherapy are best for you.

The number of cycles of chemotherapy needed vary. Different oncologists used different schedules. The type of chemo drug being used is another factor. You may also want to ask your doctor if you are a good candidate for chemotherapy research trials.

What to Expect

Chemotherapy not only weakens and destroys cancer cells at the site of the tumor, but throughout the body as well. Unfortunately, this means that chemo can unintentionally harm the development of normal cells like your hair, nails, mouth, and digestive tract.

The side effects chemo causes depend on the type of chemotherapy you receive and how many cycles you receive. The most common side effects of chemo are:

  • Nausea and vomiting
  • Fatigue or tiredness
  • Confusion, forgetfulness (“chemo brain”)
  • Decreased blood counts, sometimes with bruising, bleeding, or infection
  • Sores inside your mouth
  • Numbness in your hands and feet
  • Diarrhea, loose stool
  • Increased urgency to have a bowel movement or urinate

When chemotherapy is given at a lower dose, these side effects are less common. This sometimes happens when radiation is necessary too. If you experience side effects, call your physician right away. It is better to address side effects right away, and there are numerous drugs available to help manage side effects.

How You Receive Chemo

Chemo medicines come in different forms and can be given in different ways:

  • Intravenously (IV): As an infusion, the medicine comes through a thin needle (IV) in a vein, such as in your hand or lower arm. An oncology nurse will insert the needle before each infusion and take it out afterwards.
  • Injection: As a single shot into a muscle in your leg, arm, hip, or under the skin in the fatty part of your stomach, leg or arm.
  • By mouth: As a pill or capsule. You may take this yourself at home.
  • Through a port: This is inserted in your chest during a short outpatient surgery. It is about the size of a quarter and sits right under your skin. A port is a small disc made of plastic or metal. A catheter (soft thin tube) connects the port to a large vein. The chemo

medicines are delivered through a thin needle right into the port. You can also get your blood drawn through the port. Once you have finished chemo, the port is removed in a brief outpatient procedure.

  • Through a catheter in your chest or arm. This is a soft thin tube that is inserted into a large vein. This is done in a short outpatient surgery. The other end of the catheter stays outside your body. This is similar to having a port.

If you have a catheter or port, your medical team will tell you signs of infection to look for.

Port vs. Catheter

Many doctors recommend getting a catheter or port. It makes chemotherapy easier and more comfortable each time, as you don’t have to be restuck each time, like with an IV or injection. Some stomach cancer patients have a portable pump attached to the port or catheter. This controls how much and how fast the chemotherapy medicine goes in. The pump can either be internal (implanted under the skin during a short outpatient procedure) or external (carried with you). Once your rounds of chemo are done, the pump is taken out.

Setting Your Schedule

Your oncologist will set your treatment regimen. Every chemo regimen is made up of cycles. This means a period of treatment followed by a period of recovery. For example, you may get chemo one day and then have a few weeks of recovery with no treatment. That would be one cycle. Or you may get chemo for several days in a row and then have a recovery period. Several cycles make up a complete chemotherapy regimen.

The number of cycles in a regimen and the length of each regimen vary from patient to patient. A lot depends on the medicines used.

You can get chemotherapy in a variety of settings: at a hospital, in a doctor’s office, or in a clinic. You may even get chemo at home if you are taking chemo in a pill form or you have a portable pump.

If you take chemo in a clinic, hospital or doctor’s office, you usually go home between treatments. In some cases, you may stay in the hospital to be monitored. This is especially true if your immune system isn’t working as well as it should be. Your doctor will explain where you'll be getting your treatment.

Passing Time During Chemotherapy

A chemotherapy treatment at a hospital or clinic can take anywhere from one to several hours. Although many chemo treatment areas have televisions and magazines, you may want to bring something to help pass the time. Ideas include:

  • A laptop
  • Knitting, needlepoint or crochet
  • A thick novel
  • Crossword or other puzzle book
  • Sketchbook and pencils
  • Cards or board games (if you have someone to play with)
  • MP3 player or portable CD player to listen to music
  • Paper and pens to keep a journal or write letters

Planning Ahead for Chemotherapy

Chemotherapy treatment can drain most of your energy. This is a major process your body is going through. There are some things you should take care of before you start chemo:

  • Get your teeth cleaned and get a dental check-up. Chemo weakens your immune system, so you may be more vulnerable to infections caused by bacteria that are dislodged during teeth cleaning.
  • Get any heart tests (like an EKG) that your doctor recommends.
  • If you’re a woman, get a Pap smear. Chemo can alter the results of your Pap smear, so get one beforehand.
  • Find someone to help around the house. Chemo causes extreme fatigue. Line up someone to help with your daily chores: cleaning, grocery shopping, carpooling, and cooking to name a few. Don't be too proud or stoic to ask for help. Friends and family members will be happy to do something that helps you during this treatment phase. Ask  yourself: wouldn’t you be willing to do it for someone else?

    • Join a support group if that sounds helpful.
    • Find out ahead of time what you should and shouldn’t eat or drink on treatment days.
    • Tell your doctor all the vitamins, supplements, over-the-counter and prescription medicines you take.
    • Talk to your doctor about hair loss. Most chemo medicines cause some amount of hair loss. If you plan on wearing a wig, you might want to go ahead and get it so you can match it to your hair color and style.

Radiation therapy is also called radiotherapy or radiation. This is a very effective way to destroy cancer cells that may remain after your stomach surgery.

Your doctor may recommend radiation in combination with chemotherapy and surgery. Radiation can pinpoint the cancer cells very well. In addition, radiation therapy is relatively easy to tolerate, because its side effects are limited to the treated area.

A radiation oncologist will oversee your radiation treatments.

What to Expect

The goal of radiation is to kill as much cancer as possible while preserving normal tissue. Your radiation oncologist will determine how many treatments you will receive. Sometimes treatments are given once a day and sometimes twice a day. A treatment usually only takes a few minutes.

The most common side effects of radiation for stomach cancer are gastrointestinal symptoms, like nausea, diarrhea, fatigue, cramping and irritation.