The choice of treatment for patients with stomach cancer depends on several factors including their age, general state of health and their ability to withstand treatment. The degree of cancer spread is another important factor.
The different forms of treatment that may be administered include the following:
- Radiation therapy
- Targeted therapy
A patient may be offered one of these treatments or a combination of several, depending on their individual circumstances. The main aim of treatment is to remove as much of the cancer as possible and a complete cure for stomach cancer is achieved in around 20% to 30% of cases. In cases where the cancer cannot be cured, treatment is aimed at relieving the symptoms and improving quality of life.
Surgery is the most common treatment approach to stomach cancer that is in the early stages and is confined to the stomach. The aim is to remove as much of the tumor as possible. This may be achieved through endoscopy, a procedure where a thin flexible tube called an endoscope is passed down the esophagus and is used to remove the tumor. However, it is not always possible to remove all of the cancer from the stomach using endoscopy and instead a procedure to remove part or all of the stomach may be needed.
Surgery to remove a part of the stomach is termed partial gastrectomy, while the removal of the whole organ is called total gastrectomy. In both of these procedures, the nearby lymph nodes are also removed to reduce the risk of cancer recurrence. In some cases, part of the esophagus may also be removed, in which case the procedure is termed esophagogastrectomy. All surgeries performed to remove stomach cancer are major operations and the patient will need to stay in hospital while they recover, which usually takes around two weeks.
Chemotherapy refers to the use of anti-cancer agents to stop the multiplication and division of cancer cells. Chemotherapy may be prescribed before surgery to shrink the tumor as well as after surgery to destroy any remaining cancer cells and help prevent recurrence. Chemotherapy is often given in cycles that each last about three weeks. The most common combinations of chemotherapy drugs include ECF (epirubicin, cisplatin fluorouracil) and ECX (epirubicin, cisplatin and capecitabine [Xeloda])
In radiotherapy, high energy radiation beams are directed at the cancer. However, radiotherapy is not often used to treat stomach cancer since the beams of radiation may also damage other major organs that lie close to the stomach. Radiotherapy involves treatment sessions (lasting a few minutes) five days a week.
The cancer cells in some forms of stomach cancer express a cell surface protein called human epidermal growth factor receptor 2 (HER2). In these cancers, growth of the tumor is stimulated by activation of this receptor. A medication called trastuzumab (sold under the brand name Herceptin) blocks the effects of this protein and therefore prevents the growth of HER-2 positive cancers. Although trastuzumab does not eradicate the stomach cancer, it does slow the tumor growth and prolong survival.