Depending on your overall health and the stage and location of your cancer, you will likely be treated with a surgical procedure to remove the tumor and then several weeks or months of chemotherapy and/or radiation therapy. In some cases, chemotherapy may be administered before surgery and then again following the surgery. For patients with cancer that has spread outside of the stomach to other organs or regions of the body, surgery is not generally a treatment optionl; in these cases, chemotherapy can be given to try to control and slow the progress of the cancer.
Treatment of stomach cancer depends on the tumor's location, how far the tumor has spread, and the health of the patient. Currently, there are three primary options: surgery (taking out the cancer in an operation), radiation therapy (using high-energy rays to kill cancer cells), and/or chemotherapy (using drugs to kill cancer cells).
Chemotherapy uses drugs to kill cancer cells. It may also be administered before surgery to shrink the size of the tumor, or after surgery to prevent or delay recurrence of the cancer. Chemotherapy for stomach cancer may use a combination of several anticancer drugs. For patients with stomach cancer, a combination of chemotherapy and radiation therapy can delay or prevent cancer recurrence after surgery, and may help these patients live longer.
Surgery is the only way to possibly cure stomach cancer. Even when the cancer has spread beyond the stomach, and a cure is impossible, surgery may give the patient relief by helping to prevent bleeding from the tumor or helping to prevent the stomach from being blocked. Surgery for stomach cancer is best performed by a specialized surgeon who may remove either some or all of the stomach using one of these two procedures:
- Subtotal (or Partial) Gastrectomy Removal of the part of the stomach that contains cancer, and parts of other tissues or organs that may be involved, such as the esophagus, or the duodenum (the first part of the small intestine).
- Total Gastrectomy Removal of the entire stomach and parts of the esophagus, small intestine, and other tissues near the tumor. After the stomach is removed, a surgeon will connect the remaining part of the stomach to the esophagus or to the small intestine. The surgeon will try to leave behind as much healthy stomach as possible, or try to make a new stomach out of intestinal tissue. Regardless, once a total gastrectomy is performed, the patient will only be able to eat a small amount of food.
During either form of surgery, the surgeon may also remove nearby lymph nodes, the spleen, and the omentum (an area of fatty tissue near the stomach and the intestines). Surgery for stomach cancer is difficult and may cause bleeding, blood clots, and damage to nearby organs, such as the gallbladder and pancreas. Therefore, it is important to have a skilled surgeon who has experience in this type of surgical procedure, especially with removal of lymph nodes.
Radiation therapy treatment uses high-energy X-rays to kill cancer cells; it can be used to kill very small remnants of the cancer that cannot be seen, or that were not removed during surgery. Studies have shows that using a combination of radiation therapy and chemotherapy drugs, such as 5-fluorouracil (5-FU), can delay or prevent cancer recurrence after surgery, and may help patients live longer. Radiation therapy is also useful for relieving pain. Typically, radiation treatments are given five days a week for five to six weeks.
Proton therapy is a form of radiation treatment that targets protons at tumors to kill cancer cells. It delivers higher, more effective doses of radiation than traditional X-ray radiation therapy with great precision, significantly limiting radiation exposure to surrounding healthy tissue near the stomach, such as the bowel, liver, kidneys, and spinal cord. This may reduce side effects from treatment and allow for a shorter course of treatment compared with X-ray radiation therapy.
Seattle Cancer Care Alliance (SCCA) patients receive proton therapy atthe SCCA Proton Therapy Center, located on UW Medicine’s Northwest Hospital & Medical Center campus (view map and directions). A complete proton therapy session can range from 15 to 60 minutes; the time spent delivering protons to the tumor is only about one minute. Most patients receive therapy five days a week for four to eight weeks. If your doctors recommend proton therapy for you, they will talk with you about this option. Learn more about proton therapy.