Treating gastric cancer

The main treatments for stomach cancer are surgery, chemotherapy and radiotherapy. You may have one of these treatments or a combination, depending on your individual circumstances.

Surgery is used if gastric cancer is diagnosed at an early stage, before it has spread, whereas chemotherapy and radiotherapy tend to be used when the condition is diagnosed at a later stage.

The primary aim of treatment, where possible, is to completely remove the tumour and any other cancerous cells in your body. It is estimated that a cure is possible in 20-30% of gastric cancer cases.

In some cases your doctors will focus on trying to prevent your tumour from getting any bigger and causing any further harm to your body. This may be done using chemotherapy or radiotherapy.

It is not always possible to cure the cancer or slow it down. In this case, your treatment will aim to relieve your symptoms and make you as comfortable as possible.

Your healthcare team will talk to you about which treatments are most suitable for you.

If you are diagnosed with a gastric cancer that the surgeons feel is operable, it may be possible for the cancer to be completely removed during surgery.

This is normally done through a big opening in your abdomen, although in some cases this may instead involve passing a thin, flexible tube (endoscope) down your oesophagus, rather than incisions in your abdomen. This is known as endoscopic surgery, and can be used to remove a sample of the tumour for testing (biopsy). It can also be used to remove the tumour completely if stomach cancer is diagnosed at an early stage. 

If your cancer has spread beyond your stomach, it may not be possible to remove it completely through surgery. If this is the case, you may still have surgery to bypass the block or to remove any cancer blocking your stomach, to ease your symptoms. This will depend on whether your symptoms can be controlled, and the risks and side effects of undertaking a major surgical procedure.

Any kind of surgery for stomach cancer will involve a large operation and a long recovery time. If you have stomach cancer surgery, you will usually stay in hospital for around a week. You will also need several weeks at home to recover.

If you have surgery to remove the cancer in your stomach, you will probably need to have part or all of your stomach removed.

Surgery to remove part of your stomach is known as a partial/subtotal gastrectomy, and surgery to remove all of your stomach is known as a total gastrectomy. In some cases, your surgeon may also remove part of your oesophagus (gullet), as well as the whole of your stomach, which is known as an oesophagogastrectomy.

This operation may be carried out using either an incision in your abdomen, or a number of smaller incisions through which surgical tools can be passed (known as ‘laparoscopic’ or ‘keyhole’ surgery. The type of surgery used will be dependent on you and your surgeon. Both these techniques are carried out under general anaesthetic, which means you will be asleep throughout the procedure.

During your operation, your surgeon will also remove the lymph nodes nearest to the cancer. These will be sent to the laboratory and checked to see if they contain cancer cells.

If your cancer is in the lower part of your stomach, you may have a partial gastrectomy to remove this.

After the operation, your stomach will be smaller than it was before surgery. However, the operation will not affect the top part of your stomach, where your oesophagus (gullet) feeds into it.

If your cancer is in the middle or at the top of your stomach, you may need to have a total gastrectomy to remove the whole of your stomach. If the cancer is close to the end of your oesophagus (gullet), where it meets your stomach, you may need to have an oesophagogastrectomy to remove part of your gullet.

If you have a total gastrectomy, your stomach will be removed, and the end of your gullet will be joined to the top of your jejunum (the top part of your small intestine). If you have an oesophagogastrectomy, your stomach and the end of your gullet will be removed, and the remaining part of your gullet will be joined to your jejunum.

If your stomach cancer has spread beyond your stomach, it may not be possible to remove it through surgery.

However, if you have a large amount of cancer in your stomach, it can cause a blockage, which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting and feeling very full after eating.

If you have a blocked stomach, there are a few options:

• Stenting – a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic; after insertion, it will expand and open up the bottom part of the stomach.
• Bypass surgery – an operation where part of your stomach above the blockage is joined to your small intestine, leaving the blocked part of your stomach out of your digestive system; this allows food to move through the unblocked part of your stomach and into your intestines, without coming into contact with the blockage.

Chemotherapy is a specialist treatment for cancer that uses medicines, called cytotoxic medicines, to stop cancer cells dividing and multiplying. As it circulates through your body, the medicine can target cancer cells in your stomach and any that may have spread to other parts of your body.

You may have chemotherapy for stomach cancer before surgery. You may also have chemotherapy after surgery to treat any remaining cancer cells and prevent the cancer from coming back.

Chemotherapy can also be used to slow the progression of cancer and ease the symptoms of more advanced stomach cancer, which may not be suitable for surgery.

If you do require chemotherapy, it may be given as tablets or intravenously (by injection or a drip through a vein directly into your bloodstream), or a combination of both.

Chemotherapy is often given in cycles, each usually lasting about three weeks.

Alternatively, chemotherapy may be administered through a small pump, which gives you a constant low dose over a few weeks or months. The pumps are portable and can be worn at home, which means fewer trips to hospital.

Radiotherapy uses beams of high energy radiation to destroy cancer cells. It is not often used to treat stomach cancer because there is a risk that other organs close to your stomach might be affected by the treatment.

However, if your cancer is advanced and causing bleeding or pain, you may need to have radiotherapy.

In some cases, prior to or following surgery, you may have chemotherapy and/or radiotherapy, to help prevent the stomach cancer from recurring.

Trastuzumab (sold under the brand name Herceptin) is a medication that was first used to treat breast cancer. It is also useful in treating some cases of advanced stomach cancers.

Some stomach cancers are stimulated by a type of protein called human epidermal growth factor receptor 2 (HER2). Trastuzumab works by blocking the effects of this protein.

This does not cure stomach cancer, but can slow its growth and increase survival time.

If you are diagnosed with advanced stomach cancer and testing shows you have high levels of the HER2 protein in the cancerous cells, your doctors may recommend treatment with a combination of chemotherapy and trastuzumab.