Treatment of stomach cancer often requires a multi-disciplinary approach, having multiple expert specialists working together to achieve the best results and outcomes.
The gastrointestinal team at Saint John’s is highly experienced, treating thousands of patients each year. These specialists include GI surgeons, medical oncologists, and radiation oncologists, as well as on-site pathologists, geneticists, nutritionists, and immunologists.
Few patients with early-stage stomach cancer reveal symptoms. As the cancer progresses, so does the common symptoms associated with it, which tends to be later-stage diagnosis. Patients with symptomatic tumors may require several therapies to overcome the cancer. Those patients with disease localized to the stomach and nearby lymph nodes are generally offered chemotherapy and radiation followed by surgery. Frequently, this group of patients will receive immunotherapy after they have completed surgery. Patients with cancer that has spread through the blood generally are not candidates for surgery and are treated with a combination of chemotherapy, immunotherapy, and occasionally, radiation.
Surgery the primary treatment for stomach cancer and can be performed in a variety of ways including minimally invasive, robotic surgery. Understanding your surgery and post-surgical care will depend on how much of the stomach will need to be removed. The goal is to retain as much of the stomach as possible while ensuring the cancer has the smallest possible chance of returning. By preserving a portion of the stomach, it allows more patients to eat and function normally. The surgeon will also ensure that the edges (margins) of the portion of the stomach that remains is free from cancer cells.
Surgery (gastrectomy) offers the best chance for cure of stomach cancer. If part of the stomach is removed, it’s referred to a subtotal or partial gastrectomy. If the entire stomach is removed, it’s called a total gastrectomy. Both surgeries involve removal of surrounding lymph nodes, which are most likely affected by the cancer. The surgeons at the Saint John’s Health Center have extensive experience in performing this surgery using minimally invasive, robotic techniques. Robotic surgery affords patients quicker recovery, less pain, and shorter hospital stays. The team at the Saint John’s Cancer Health Center & Institute has some of the most experienced surgical oncologists in Southern California.
Partial, or Subtotal, Gastrectomy
A part of the stomach is removed leaving a portion of the stomach to be connected to the small intestine. If he cancer is closer to the esophagus, the front portion of the stomach may be removed. The surgeon will then reattach the esophagus to the stomach.
Total gastrectomy is the removal of the whole stomach. The esophagus is then directly connected to the small intestine. Despite having no stomach, patients can live a normal life. However, patients are instructed to eat smaller meals more frequently. In addition, the surrounding lymph nodes are removed (lymphadenectomy) and examined for signs of cancer.
Minimally-invasive surgery (laparoscopy or robotic) involves using smaller incisions and is associated with less postoperative pain and faster recovery. The robotics surgeon performs the entire surgery from a control console near the patient while the robot, which is positioned above the patient, executes all the delicate movements that the surgeon is making and with greater precision in a smaller space.
A laparoscope, a thin, lighted tube with a high definition video camera at its tip, is inserted through a tiny incision in the abdominal wall. Images are visible to the surgeon at the console and are projected onto a large viewing screen for members of the surgical team to follow. Guided by highly magnified images, the surgeon operates using specially designed surgical instruments that are also 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 for Stomach Cancer Treatment
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 site. Since radiation is used to destroy cancer cells and 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, thereby reducing the risk of injury to healthy tissues.
Chemotherapy for Stomach Cancer Treatment
Chemotherapy can be used to treat stomach cancer by itself or in combination with other treatments such as surgery and radiation therapy. It may be given to patients whose cancers have invaded the layers of the stomach wall, lymph nodes, and nearby organs. Chemotherapy can be used before surgery (neoadjuvant therapy) to shrink the tumor prior to surger. It may also 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 where surgery is not possible, chemotherapy may improve both the length and quality of life.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
HIPEC offers patients the opportunity for prolonged survival, an improvement in symptoms and even cure. It involves surgical removal of all visible tumors followed by the delivery of chemotherapy into the peritoneum. Because the chemotherapy is heated and delivered for 1-2 hours in the operating room, tumor cells can be destroyed that are not easily visible. This surgery requires specialist cancer surgeons working in close collaboration with medical oncologists.
IP Therapy to Treat Stomach Cancer
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 for Stomach Cancer
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.
Side Effects of Surgery
Though we aim to minimize side effects from stomach cancer surgury, particularlly with the use of minimally-invasive techniques, there is always a chance of complications as with any major surgery. These problems can include surgery-related bleeding, blood clots, and though extremely rare, harm to nearby organs.
Side effects after surgery can also include abdominal pain, heartburn, and nausea, particularly after consuming food. Part of the reason for these side effects is that once a portion or all of the stomach has been removed, food will pass into the small intestine more quickly, but tends to improve the more time has passed. To help with these side effects, your doctor may prescribe medicines to reduce symptoms.
After surgery, you will not be allowed to eat or drink anything for many hours after a total or subtotal gastrectomy. This is nessessafy for the digestive tract to heal and ensure the new surgical connected are working normally.
Diet and Nutrition
Changes in your diet will be needed after a partial or total gastrectomy which is why a nurtitionist may become involved with your care. The most significant change is adapting to eating smaller meals more frequently, which most patients do very well. How much you need to adapt will be based on the amount of stomach that was removed. Patients who have undergone partial or total gastrectomy can develop vitamin deficiencies. As such, vitamin supplements may be prescribed. In rare cases, liquid nutrition can be provided through a special tube directly into the intestine to help prevent malnutrition.
Call today to learn more about stomach cancer treatments or concerns you may have. Our multi-disciplinary team is ready to support you.