Gastrointestinal (GI) Oncology Program

Stomach Cancer

Stages and Treatment Options

If the doctor finds cancer, he or she will do more tests to find out if cancer cells have spread to other parts of the body. This process is called staging.

The doctor needs to know whether and where the cancer has spread in order to plan treatment. Stomach cancer can spread to the liver, the pancreas, and the lungs, and the doctor may want to do other tests, such as a computerized tomography (CT) scan or additional biopsies, to examine these areas.

Based on the results of these tests, the doctor will stage the disease and create a treatment plan to meet the patient's needs.

The following stages (and common treatments) are used for cancer of the stomach:

Stage 0: Stage 0 cancer is very early cancer. Cancer is found only in the innermost layer of the stomach wall.

At this stage the typical treatment is surgery. The doctor may recommend removing part of the stomach (subtotal gastrectomy) or the entire stomach and some of the tissue around it (total gastrectomy). Lymph nodes around the stomach might also be removed (lymph node dissection).

Stage I: At Stage I, cancer is in the second or third layer of the stomach wall but has not spread to lymph nodes near the cancer, or it may be in the second layer of the stomach wall and the lymph nodes very close to the tumor. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)

At this stage, one of the following surgeries is usually recommended:

Surgery to remove part of the stomach (subtotal gastrectomy) and associated lymph nodes (lymphadenectomy).
Surgery to remove the entire stomach and some of the tissue around it (total gastrectomy) as well as associated lymph nodes (lymphadenectomy).

Stage II: At Stage II, cancer may be situated in the following areas:

The second layer of the stomach wall and the lymph nodes farther away from the tumor.
The muscle layer (the third layer) of the stomach and the lymph nodes close to the tumor.
All four layers of the stomach wall but not the lymph nodes or other organs.

Treatment for Stage II stomach cancer is likely to be one of the following:

Surgery to remove part of the stomach (subtotal gastrectomy).
Surgery to remove the entire stomach and some of the tissue around it (total gastrectomy).
A clinical trial of surgery followed by adjuvant radiation therapy and/or chemotherapy.
Surgery to remove the lymph nodes around the stomach (lymph node dissection).

Stage III: Cancer in any of the following locations in the stomach is called a Stage III cancer:

The third layer of the stomach wall and the lymph nodes farther away from the tumor.
All four layers of the stomach wall and the lymph nodes either very close to the tumor or farther away from the tumor.
All four layers of the stomach wall and nearby tissues (the cancer may or may not have spread to lymph nodes very close to the tumor).

A doctor is likely to recommend one of the following treatments for Stage III cancer:

Surgery to remove the entire stomach and some of the tissue around it (total gastrectomy). Lymph nodes may also be removed.
A clinical trial of surgery followed by adjuvant radiation therapy and/or chemotherapy.
A clinical trial of chemotherapy with or without radiation therapy.

Stage IV: At Stage IV, cancer has spread to nearby tissues and to lymph nodes farther away from the tumor or has spread to other parts of the body.

Stage IV cancer is usually treated with surgery to relieve symptoms, reduce bleeding, or remove a tumor that is blocking the stomach or with chemotherapy to relieve symptoms.

Recurrent: Recurrent cancer is cancer that has come back (recurred) after treatment. It may come back in the stomach or in another part of the body such as the liver or lymph nodes. Chemotherapy is usually given to relieve symptoms. Clinical trials are testing new chemotherapy drugs and biological therapy.

About the Treatments and Side Effects

The two primary treatment options for patients with cancer of the stomach are surgery and radiation therapy. Chemotherapy and biological therapy are being tested in clinical trials. Because it is very difficult to destroy cancer cells without also damaging healthy cells, nearly all treatments have side effects. The treatments and their side effects are described below:

Surgery

Surgery is the most common treatment for cancer of the stomach. The doctor may remove the cancer using one of the following operations:

Subtotal gastrectomy removes the part of the stomach that contains cancer and parts of other tissues and organs near the tumor. The surgeon might also remove nearby lymph nodes (lymph node dissection) and/or the spleen (an organ in the upper abdomen that filters the blood and removes old blood cells). The remaining part of the stomach is then connected to the esophagus or small intestine.
Total gastrectomy removes the entire stomach and parts of the esophagus, the small intestine, and other tissue near the tumor. The surgeon might also remove the spleen and/or nearby lymph nodes (lymph node dissection). The esophagus is connected to the small intestine so the patient can continue to eat and swallow.

Side effects of surgery: Recovery from a gastrectomy takes time. While the patient is healing, he or she will initially be fed intravenously and, after several days, will be gradually reintroduced to liquids, soft foods, and solid foods. Many patients who have had a subtotal gastrectomy are eventually able to eat fairly normally, although they may have to make some adjustments in their diet (such as eating smaller meals) to avoid discomfort and indigestion.

Patients recovering from a total gastrectomy may need to make more substantial changes in their diet and will receive guidance on how to do so from their doctor or nutritionist. Total gastrectomy patients can anticipate the following:

They will need to receive injections of vitamin B₁₂because they will no longer be able to absorb it from their foods. The body needs Vitamin B₁₂ for healthy blood and nerves.
Patient may continue to experience symptoms of an upset stomach because bile can easily back up from the small intestine into the esophagus. These symptoms can be alleviated with medications.
Patients may experience temporary or permanent discomfort -- cramps, nausea, dizziness, discomfort -- shortly after eating when food and liquid enter the small intestine. These symptoms (called the "dumping syndrome") can often be relieved if the patient eats smaller, more frequent meals and if he or she eats a diet low in sugar (sugar exacerbates this problem) and high in fats and protein. Medicines may also help. Often the problem disappears over a period of several months, but in some patients it is permanent. Most patients, however, are able to adjust with dietary changes.

Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) in the areas where the cancer cells are found (internal radiation therapy). External radiation therapy treatments are usually given to patients five days a week for five to six weeks.

Radiation therapy is sometimes used as adjuvant therapy -- that is, it is given after surgery to destroy any remaining cancer cells. It is also used to relieve pain. Studies are under way to determine whether radiation given during surgery will improve treatment effectiveness.

Side effects of radiation therapy: Radiation to the abdomen can cause nausea, vomiting, and diarrhea. Patients usually find relief from these symptoms with medication and changes in their diet. Other common side effects of radiation include tiredness and skin reactions (dry, red, or irritated skin) in the treated areas. Patients may have a lowered number of white blood cells (the cells that help the body fight infection) and may feel especially tired in the later weeks of therapy. Doctors usually advise getting plenty of rest while also staying active during treatment. To avoid and relieve skin irritation patients should wear loose-fitting cotton clothing and avoid the use of lotions and creams except as recommended by their doctor.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein or a muscle, but some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

Chemotherapy is sometimes given before surgery in an effort to shrink the tumor and sometimes after surgery to destroy any remaining cancer cells. Studies are being done to determine the effectiveness of combining chemotherapy with radiation therapy and to test the effectiveness of putting chemotherapy drugs directly into the abdomen.

Side effects of chemotherapy: Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

Biological Therapy

Biological therapy (or immunotherapy) is treatment to help the body's own immune system fight cancer. Materials made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy. Doctors are studying ways to use biological therapy along with other treatments to prevent the recurrence of stomach cancer.

Side effects of biological therapy: Depending on the type of treatment used, biological therapy can cause symptoms resembling those that occur following other forms of therapy: rashes, susceptibility to bruising and bleeding, or flu-like symptoms such as nausea, vomiting, diarrhea, and fever. Because these symptoms may be severe, patients may be hospitalized during treatment.

This page was last updated on: March 3, 2008.

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