Treatment Options

Multimodality treatment (surgery, chemotherapy and radiation) is often used to treat patients with esophageal and gastric (stomach) cancer. Sequencing of treatment is determined by the stage, size and location of the tumor. If the tumor cannot be removed, we may employ laser techniques or stenting, inserting a metal tube to hold the area open, in order to relieve areas of obstruction that can cause pain and disability.

Communication is key. We talk to you about what you’re facing because we believe that treating the whole person, not just the disease, is the best approach for patients and family members.

Before we set up a specific treatment protocol for your diagnosis of stomach cancer, we will take the following into account:

  • 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
Human Digestive System (Stomach Anatomy)

Depending on the stage and location of your stomach cancer, we may treat it with one or a combination of the following:

Surgery

Surgery offers the best chance for cure and is known as a gastrectomy. If part of the stomach is removed, it’s called a subtotal or partial gastrectomy and if the entire stomach is removed, it’s called a total gastrectomy. Both surgeries involve removal of surrounding lymph nodes. The surgeons at the John Wayne Cancer Institute have extensive experience in performing this surgery using minimally invasive techniques resulting in shorter hospital stays and quicker recovery times.

  • Partial, or subtotal, gastrectomy: A part of the stomach is removed leaving a portion of the stomach to be connected to the small intestine
  • Total gastrectomy: The whole stomach is removed and the esophagus is directly connected to the small intestine. Despite having no stomach patients eat smaller meals and can live a normal life. The surrounding lymph nodes are removed (lymphadenectomy) and examined for cancer.

Minimally-Invasive Surgery

Minimally-invasive surgery (laparoscopy or robotic) involves using small incisions and is associated with less postoperative pain, shorter hospital stays and quicker return to work.

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. There are several ways to deliver radiation therapy.

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. 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.

Blockage IMRT is 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.

man Receiving Radiation Therapy Treatments for Breast Cancer

Chemotherapy

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

Although used very rarely, another method used to treat 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

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) destroys these cancers by neutralizing this receptor. It is usually given along with standard chemotherapy drugs to help treat more advanced stomach cancers.