Treatment
Treatment for stomach cancer depends on the form, stage, location, and if the cancer has spread to other parts of the body. Stomach cancer treatment may involve a combination of surgery followed by chemotherapy and radiation therapy. Here are some types of treatment your doctor may recommend:
Surgery
Surgery represents the best chance for long term survival from gastric cancer, but it is not appropriate for cases where the tumor has spread to other places in the body such as the liver, distant lymph nodes, or the lining of the abdominal cavity. If your stomach cancer is caught early, your doctor may be able to perform an endoscopic mucosal resection, using only an endoscope to remove the tumor. More severe cases of stomach cancer may require a subtotal (partial) gastrectomy, in which only part of the stomach and nearby lymph nodes are removed. Or, it may require a total gastrectomy where the entire stomach, nearby lymph nodes, and sometimes parts of the esophagus and small intestine may be removed, depending on the location of the tumor. The doctor then connects the esophagus or remnant of the stomach to the small intestine.
Chemotherapy
Chemotherapy are drugs that kill rapidly growing cancer cells. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Doctors may give chemotherapy to shrink the tumor before surgery (neoadjuvant) and/or to destroy any traces of cancer left after surgery (adjuvant). In more advanced stages in which the cancer has spread, chemotherapy may be the best treatment option to relieve symptoms.
Radiation Therapy
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. Doctors may give radiation therapy before surgery to shrink the tumor or after surgery to lower the chance of the cancer returning. In external beam radiation, a large machine delivers radiation to your tumor from outside. It is almost always given with chemotherapy, which is commonly called chemoradiation.
Chemoradiation:
Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both. Chemoradiation may be given after surgery (adjuvant therapy) to lower the risk that cancer will come back. Chemoradiation may be given before surgery (neoadjuvant therapy) to shrink the tumor so the surgery is easier.
Immunotherapy:
Immunotherapy is a new type of cancer treatment that stimulates the body's immune system to attack cancer cells. The most common type of immunotherapy is a group of drugs called immune checkpoint inhibitors. These drugs are monoclonal antibodies that target the “checkpoints” of the immune system. Cancer cells can express checkpoint proteins that bind to the immune cells and tell them to ignore the cancer cells. Immune checkpoint inhibitors block these checkpoints and signal the immune system to attack the cancer cells. Immune checkpoint inhibitors can be used in combination with chemotherapy or by itself. Another type of immunotherapy is cancer vaccines. These are uncommon, but they are currently being studied in clinical trials.
Targeted Therapy:
About one in every five cases of stomach cancer contain cells that overexpress the HER2 protein, which causes the cancer to grow more aggressively. Because the HER2 protein is the main driver for cancer growth, therapy that specifically targets these cells is very effective in stopping the cancer. HER2 targeted therapy is used in combination with chemotherapy and immunotherapy for patients with cancer that has spread. Recently, another target called Claudin 18.2 was found to be an important driver in stomach cancer. Claudin 18.2 targeted therapy is used in combination with chemotherapy for patients with cancer that has spread.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
