Understanding Different Treatment Options for Stomach Cancer by Stage

When deciding on the best treatment options for you, your doctors will take several factors into consideration, one of them being the stage of your stomach (or gastric) cancer. Let’s take a look at how gastric adenocarcinomas, the most common type of gastric cancer, are treated according to their stage.

Stage 0

Also called carcinoma in situ (which means in its original place), the cancer is found only in the epithelial cells of the mucosa, where it first started, and has not grown into the deeper layers of the stomach wall. These are considered pre- or early-stage gastric cancers and are typically treated with surgery.

Stage 0 cancers, especially those with smaller tumors, can be treated by endoscopic resection. Minimally-invasive procedures of this kind involve inserting a thin, tube-like instrument called an endoscope down the esophagus and into the stomach. Surgical cutting tools passed through the tube are then used to remove the tumor tissue.

Endoscopic resection is usually done in countries, like Japan and South Korea, where gastric cancers are often detected early through screening. In the United States, early detection of gastric cancer is rare, which means that this type of treatment is not frequently used. However, if your gastric cancer is discovered early and your doctors recommend endoscopic resection, it should be performed at a high-volume cancer center with surgical oncologists experienced in this technique.

If all of the cancerous tissue is successfully removed, you may not need further treatment and simply require close monitoring by your doctors. If your doctors are unsure whether all the tumor tissue has been removed, they may recommend follow-up treatment with chemotherapy or radiation therapy to kill any remaining cancer cells.

Stage 1 (Stage I)

Surgery is the main form of treatment for stage 1 gastric cancers. Some smaller, early-stage tumors can be treated with endoscopic resection. However, most cases need to be treated with a gastrectomy.

A gastrectomy is a surgical procedure where all or part of the stomach is removed. Depending on the location of the cancer in your stomach and how far it has spread, your doctors will decide if you are due for a partial or total gastrectomy. The former involves removing part of the stomach whereas in the latter, the entire organ is resected. During these procedures, nearby lymph nodes and surrounding tissue may also be removed. A lymph node dissection, which refers to the removal of nearby lymph nodes, is generally done with a gastrectomy for full staging of the cancer. Surrounding tissue may also be removed.

If you’ve been diagnosed with stage IB gastric cancer, you may require chemotherapy, radiation therapy or a combination of the two known as chemoradiation. Treatments given before surgery are known as neoadjuvant therapy, which aims to shrink the gastric tumor so that it’s easier to remove during the operation.

On the other hand, treatments given after surgery are referred to as adjuvant therapy. The goal of adjuvant therapy is to kill any remaining cancer cells that were not visible during the operation and subsequently left behind and increase the chance of long-term cure. This can happen if the cancer has grown deep into the stomach wall or spread to nearby lymph nodes. Adjuvant therapy therefore lowers the chances of the cancer coming back, which is known as cancer recurrence. If the lymph node dissection reveals a positive lymph node, i.e. that lymph node contains cancer, adjuvant therapy would typically be recommended.

Stage 2 and 3 (Stage II and III)

Most gastric cancer cases in the United States are discovered at stage 2 or 3. These cancers are primarily treated with a gastrectomy. On top of that, chemotherapy or chemoradiation is almost always offered with surgery for stage II or III tumors, be it in the form of neoadjuvant and/or adjuvant therapy. This is because of the high risk of cancer recurrence at these stages.

Not all tumors are created equal – some can be removed with surgery (resectable) while others can’t (unresectable). If you’ve been diagnosed with a stage II or III tumor that is potentially resectable, your treatment options will first include chemotherapy and radiation therapy. After the first round of treatment, your doctors will likely reassess the extent of your cancer using imaging tests. If results show that the cancer has shrunk after initial treatment, you may be eligible for surgery. This could be a partial or total gastrectomy.

On the other hand, if the tumor is unresectable, you will likely receive treatment with the intention of controlling cancer growth, relieving any symptoms and maintaining your quality of life. This is known as palliative therapy. Palliative therapy is also applicable for people whose cancer is potentially resectable but are not healthy enough for or decide against surgery.

Unresectable gastric tumors are usually treated in the same way as metastatic (stage 4) gastric cancer. Apart from chemotherapy and radiation therapy, targeted therapy or immunotherapy will be considered if you have the right tumor markers.

Some types of palliative surgery can also be helpful in relieving any blockage and controlling symptoms such as bleeding. Examples of such medical procedures are a subtotal gastrectomy, endoluminal laser therapy and gastrojejunostomy.

> Learn more about palliative surgery here

Stage 4 (Stage IV)

Stage 4 gastric cancer cases are those that have spread (metastasized) to other parts of the body such as the liver. More often than not, the aim of treatment for metastatic tumors is not to cure the cancer. Instead, it is palliative.

Treatment options include chemotherapy, radiation therapy, targeted therapy and immunotherapy. Your doctors may also combine any of these treatments to help them work better. Palliative surgery may also be useful in relieving blockages and controlling symptoms, such as bleeding.

Stage 4 cancers are generally treatable, but not curable. At this stage, the effectiveness of each treatment may vary significantly from patient to patient, which makes it difficult to predict the outcome for any single case. Currently, many cancer therapies are being tested in clinical trials to see if they are safe and effective or better than the standard types of treatment. These trials can offer groundbreaking new treatments or improve on current treatments for gastric cancer. To see if you may benefit from a clinical trial, please consult your doctors and care team before participating.