Diagnosis and Treatment
The choice of treatment largely depends on the stage of the cancer, which is determined by how much the tumor has grown, how deeply it has invaded the layers of the stomach, and whether it has spread to nearby organs, lymph nodes, or other parts of the body. The treatment plan may include surgery, chemotherapy, or radiation therapy.
Recent studies suggest that, for patients at high risk of recurrence for stomach cancer, chemotherapy before surgery or surgery followed by chemotherapy and radiation therapy may improve survival compared to surgery alone.
One approach is using chemotherapy both before and after surgery, and another is a combination treatment of radiation and chemotherapy after surgery. When the tumor cannot be removed, we may employ laser techniques or stenting, inserting a metal tube to hold the area open, in order to relieve areas of obstruction that can cause pain and disability.
Communication is key. We talk to you about what you’re facing because we believe that treating the whole person, not just the disease, is the best approach for patients and family members.
- Fecal occult blood test
This test checks for hidden blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested in the doctor's office or sent to a laboratory.
- Upper GI (gastrointestinal) series
Also called barium swallow, this test examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine).
A fluid called barium – a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray – is swallowed. X-rays are then taken to evaluate the digestive organs.
Also called EGD or upper endoscopy, this procedure allows us to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows us to view the inside of this area of your body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
- Endoscopic ultrasound
This imaging technique uses sound waves to create a computer image of the wall of the esophagus and stomach, as well as nearby lymph nodes. A small transducer that emits sound waves and receives their echoes is placed on the tip of an endoscope. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach so that we can see the inside of this area of the body, as well as insert instruments to remove a sample of tissue for biopsy.
- Computed tomography scan (CT or CAT scan)
This noninvasive diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Before we set up a specific treatment protocol for your diagnosis of stomach cancer, we will take the following into account:
- Your age, overall health, and medical history
- Extent or stage of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Depending on the stage of your stomach cancer, we may treat it with one or a combination of the following:
Surgery may be necessary to remove cancerous tissue, as well as nearby noncancerous tissue. The most common operation is called gastrectomy. If part of the stomach is removed, it’s called a subtotal or partial gastrectomy. If the entire stomach is removed, it’s called a total gastrectomy. Nearby lymph nodes are usually removed as well. The surgeon s have extensive experience in performing this surgery using minimally invasive techniques with shorter hospital stays and quicker recovery times.
- Partial, or subtotal, gastrectomy
This involves removing part of the stomach, as well as parts of other tissues or organs near the tumor like the small intestine or esophagus, depending on the location of the tumor.
- Total gastrectomy
This involves removing the entire stomach and parts of the esophagus, small intestine, and other tissue near the tumor. Following total gastrectomy, the esophagus is directly connected to the small intestine, to allow the patient to continue to eat and swallow normally. During the procedure, your surgeon will also remove nearby lymph nodes to examine them for cancer cells. This is called lymphadenectomy. Sometimes the spleen, an organ in the upper abdomen that filters blood and eliminates old blood cells, and part of the pancreas are also removed.
Minimally-invasive surgery is performed using smaller incisions than traditional surgery. This is called laparoscopy and often allows for fewer complications, less blood loss and postoperative pain, and shorter hospital stays.
During laparoscopy, a thin, lighted tube with a video camera at its tip – called a laparoscope – is inserted through a tiny incision in the abdominal wall, and the image is projected onto a large viewing screen. Guided by this highly magnified image, the surgeon can operate using specially designed surgical instruments that are inserted through additional small incisions.
In some patients, minimally invasive surgery can be used to remove stomach tumors or even the entire stomach.
Radiation therapy uses high-energy rays or particles to kill cancer cells. One standard of care for treating stomach cancer is surgery followed by a combination of radiation therapy and chemotherapy to destroy any remaining stomach cancer cells.
One of the radiation therapy techniques we use at Providence Saint John’s includes IMRT, a type of 3-D radiation therapy that targets tumors with greater precision than conventional radiation therapy. Using highly sophisticated computer software and 3-D images from CT scans, the radiation oncologist can develop an individualized treatment plan that delivers high doses of radiation to cancerous tissue while sparing surrounding organs and reducing the risk of injury to healthy tissues.
- External radiation
External radiation, also known as external beam therapy, sends high levels of radiation directly to the cancer cells. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. External radiation may be used after surgery to try to kill any remaining cancer cells or for more advanced stomach cancer to ease symptoms such as pain or blockage.
Chemotherapy uses anti-cancer drugs to treat cancerous cells, working by interfering with the cancer cells ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells.
Chemotherapy is used to treat stomach cancer, either by itself or in combination with surgery and/or radiation therapy. It may be given to patients whose cancers have invaded the layers of the stomach wall, lymph nodes, and nearby organs. Chemotherapy may be used before surgery (neoadjuvant therapy) to shrink the tumor, or it may be given after surgery (adjuvant therapy) to kill any remaining cancer cells.
When given alone or in combination with radiation therapy, chemotherapy may help alleviate symptoms related to stomach cancer. In patients with more advanced stomach cancer in whom surgery is not possible, chemotherapy may also improve both the length and quality of life.
Although used very rarely, another method used to treat stomach cancer is intraperitoneal (IP) chemotherapy. In IP therapy, chemotherapy drugs are placed directly into the internal lining of the abdominal area and are released through a surgically implanted catheter. This allows a high concentration of chemotherapy agents to reach the cancerous tissue, thereby increasing the effectiveness of treatment.
Some newer drugs work differently from standard chemotherapy drugs by targeting certain receptors on cancer cells and not normal cells. For example, in some stomach cancers, the cells have too much of a protein called HER2 on their surfaces. A drug called trastuzumab (Herceptin) may be helpful against these cancers by neutralizing this receptor. It is usually given along with standard chemotherapy drugs to help treat more advanced stomach cancers.
Depending on the stage of your stomach cancer, we may recommend a combination of treatments.