Stomach Cancer: Treatment Options Explained

Over the last two decades, stomach cancer cases have reduced significantly. Also known as gastric cancer, it has a five-year survival rate of 32.4%¹. As such, it still poses a significant threat, and seeking treatment early is essential.

What is stomach cancer?

In general, cancer occurs when abnormal cells begin growing uncontrollably. With stomach cancer, these cells are those along the stomach lining.

While it's not possible to pinpoint its actual cause, there are several known contributory factors. The highest among these are family history and a specific gut bacteria called Helicobacter pylori, leading to increased stomach acid and cancer.

High salt diets with minimal vegetables, smoking, and alcohol consumption are also linked to stomach cancer.

Learn more about the causes and risk factors of stomach cancer.

In its early stages, you may not experience any symptoms. However, they include a sense of fullness (satiety), fatigue, weight loss, and mild central belly pain when they do emerge. As you may notice, these are common with many other conditions.

Some of the more alarming stomach cancer symptoms include:

• Severe abdominal pain

• Loss of appetite

• Vomiting and nausea

• Painful or difficulty swallowing

• Dark or sticky stool

• Vomiting blood

If you experience these symptoms, book an appointment with your doctor or a gastroenterologist.

Is stomach cancer curable?

Many factors influence the outlook of stomach cancer patients. These include age, location, patient's overall health, and most importantly, the type and stage. If found early, before it spreads to other areas of the body, stomach cancer is curable.

However, at an advanced stage, it can only be managed but not cured. Unfortunately, about 50% of stomach cancers have spread by the time they’re diagnosed.

Stomach cancer stages

While different factors help determine the appropriate stomach cancer treatment, the stage is the primary one. So, here's a breakdown of stomach cancer stages:

• Stage I- These are early-stage cancers that only affect the top layers of the stomach.

• Stage II- Cancer has progressed to deeper layers of the stomach wall and possibly to nearby lymph nodes but not distant parts. Such cancers are resectable (able to be removed) through surgery.

• Stage III- Such cancers are present in deeper layers of the stomach lining or even have invaded through the stomach wall into nearby organs. Cancer has been detected in nearby lymph nodes but not distant parts. 

• Stage IV- These cancers have spread to distant parts of the body and are known as metastatic cancers. 

Treating early-stage cancer (stage 1)

As these cancers are only present in the top layers of the stomach wall, they're the easiest to treat, most often through surgical interventions.

If it's detected at the onset, surgery may not be necessary as an endoscopic resection will do. This procedure involves the removal of some layers of the stomach. To achieve this, your doctor will pass an endoscope down your throat and into the stomach. The endoscope contains a camera for visibility and a sharp end to scrape off the cancerous parts.

It's rare for stomach cancer to be detected in the earliest stage in the US. This is why surgical interventions are more common. This may involve removing part (subtotal gastrectomy) or the entire stomach (total gastrectomy). During the procedure, the lymph nodes near the affected area are also removed.

If the results of surgery and endoscopic resection show that cancer has been completely removed, you may not need further treatment. Even still, you will remain under close observation.

On the other hand, if it's not clear whether it has been removed completely, more treatment will be necessary. For example, your doctor may recommend radiation and chemotherapy or extensive surgery.

Treating stage II cancer (potentially resectable)

With potentially resectable cancer, surgery is the best first treatment option. However, before any surgery is attempted, it's vital that staging is done accurately. This is because surgical intervention will not be helpful if cancer has spread too far. Moreover, surgery comes with serious side effects, which may outweigh the potential benefits.

Some of the tests that are used for stomach cancer staging include:

• CT scans

• PET scans

• Staging laparoscopy

• Endoscopic ultrasound (EUS)

Once accurate staging is done, the location of the cancer will determine the best first treatment. For some, it may be a subtotal or total gastrectomy. If so, the surgeon may also remove some lymph nodes and parts of nearby organs.

If starting with surgery is not an option or seems too risky, treatment may begin with shrinking cancer. This can be achieved through chemotherapy or chemoradiation (a combination of chemotherapy and radiation). Once the tumor shrinks to an ideal size, surgery may be performed to remove it.

Post-surgery treatment may involve chemotherapy or chemoradiation to kill any remnant cancer cells. Chemoradiation would only be an option if it was not used before the surgery. If a significant portion of the cancer is not removed, you may also have to undergo another extensive operation.

Treating stage III cancer/unresectable

A key characteristic of these cancers is that they have not spread to distant body parts. However, complete removal (resection) using surgery is not possible. For this, the first treatment option may come in various forms such as:

• Chemotherapy

• A combination of chemotherapy and immunotherapy along with the targeted drug trastuzumab for HER2-positive cancer

• Chemoradiation

After treatment, cancer staging will then be performed. It's essential to determine the true extent of cancer for doctors to choose the appropriate treatment. The options may include:

• Surgery to remove cancer if it has shrunk enough to allow this

• Further treatment to relieve any problems caused or controlling the growth of cancer

There are situations where potentially resectable cancer remains. This may be due to the patient's overall health or preference. If so, treatment after that will focus on controlling its growth.

Treating stage IV cancer

Once stomach cancer reaches stage IV, it becomes very difficult to cure. This is because it has become metastatic, meaning it has spread to distant body parts. However, treatment can help relieve the symptoms and keep them under control.

At this stage, treatment may involve:

• Chemotherapy

• Chemotherapy plus immunotherapy. Immunotherapy involves medications to stimulate your immune system to seek out and break down the cancer cells. 

• Chemoradiation (only for those who are healthy enough)

If the cancer is HER2-positive (where cancer cells have too much of a growth-promoting protein), your doctors may also recommend the targeted drug trastuzumab to boost the effect of chemotherapy.

Unfortunately, it's common for chemotherapy to stop working. When this happens, your doctor will use another form of chemotherapy treatment. This may also include an immunotherapy drug. There is no one size fits all approach. Side effects of the medication (for example, nausea, vomiting, extreme lethargy, autoimmune disease) may limit their use.

In order to relieve symptoms, several other procedures are also possible, including an endoscopy to destroy tumors that block the passage of food.

Those who cannot or do not want surgery often choose this procedure, which may involve placing a stent. This hollow tube helps keep the junction between the esophagus and stomach open, making it easy for food to pass through. It can also be used to keep the meeting point between the small intestines and stomach open.

If your stomach or intestines begin blocking, palliative surgery may be necessary. This may be gastric bypass surgery or subtotal gastrectomy. Other than unblocking, these procedures can also help control bleeding.

Stomach cancer post-treatment

The results of cancer treatment vary from one patient to the next, depending on the stage and the patient’s overall health. For some, it may be destroyed or removed completely. Even still, you may be monitored after treatment as cancer can reemerge.

For others, it's not possible to eradicate cancer. This means continued treatment to keep cancer in check will be necessary. In this case, it can be stressful and difficult. This is why post-treatment care is essential. This will involve:

• Follow-up care - To monitor and manage cancer and the side effects of the treatment. It is recommended to go for follow-up visits every 3-6 months, even if you're done with treatment. 

• Nutrition support - Stomach cancer can impact your eating habits and ability to absorb nutrients. If left unchecked, this can significantly affect your health. To assist, doctors may refer you to a dietician to help ensure your nutritional needs are met. 

What to do if treatment is not successful

In some cases, curing or controlling stomach cancer is not possible. When it gets to this point, it is referred to as terminal or advanced gastric cancer.

Such a diagnosis is extremely stressful to the patient and their family. Fortunately, cancer healthcare professionals have the knowledge, skills, and experience to offer the necessary support. This helps free the patient from any pain and keeps them physically comfortable and emotionally uplifted.

If the patient has a life expectancy of six months or less, hospice care is highly recommended. Hospice care is designed to provide the highest quality of life for people approaching the end of life.

Role of clinical trials in the treatment

While cancer treatment is progressing, there's still a long way to go. Scientists and doctors are continually researching and seeking better treatment options. A key part of this involves performing clinical trials.

Clinical trials are studies using volunteers to test for the effectiveness of new drugs and treatments. This is a step that every drug must go through to receive FDA approval.

Stomach cancer specialists

Cancer care is vast, and the treatment plan may be multi-dimensional. As such, your stomach cancer care team may include professionals such as:

• Surgeon or surgical oncologist- Medical professionals specialized in surgical removals of cancer and its complications

• Gastroenterologist- Doctors whose area of specialty is the stomach, liver, and intestines

• Medical oncologists- These are specialists who use medical interventions to treat cancer (e.g., chemotherapy, immunotherapy)

• Radiologist- Medical professionals who diagnose diseases using imaging tests

• Radiation oncologist- Doctors who treat cancer using radiation therapy

• Pathologist- Doctors who diagnose diseases by interpreting lab results and evaluating organs, tissues, and cells

Along with such medical professionals, your cancer care team may include nurse practitioners, physician assistants, social workers, oncology nurses, counselors, dieticians, pharmacists, and others.

It can be easy to feel overwhelmed, but there is a lot of support for patients and their families going through these difficult situations.

The lowdown

While stomach cancer is treatable, the late emergence of symptoms is a primary challenge. As such, early diagnosis or prevention can significantly improve outcomes.

Universal screening is still questionable in terms of its cost-effectiveness and long-term benefits on the outcomes of the disease.

In certain countries with a higher rate of stomach cancer, such as Japan and Chile, they recommend a yearly contrast X-ray of the stomach or 1-2 yearly endoscopies for everyone over the age of 50. This is only done for patients with a previous history or family history of gastric cancers in most other countries.

More importantly, try and reduce risk factors - treatment of the common reflux causing bacteria H. pylori; reducing salt intake; and, increasing vegetable intake has all been shown to help reduce the risk of gastric cancer.

While being diagnosed with the condition is intimidating, it's not a death sentence. There are treatment options available that can help cure it or keep it under control so you can manage your symptoms.