Stomach Cancer Treatment

Stomach cancer is also known as gastric cancer. Both terms refer to cancers that arise anywhere between the point where the stomach joins the esophagus (the gastroesophageal junction) and the duodenum (the first portion of the small intestine).

In the U.S., stomach cancer represents about 1.5% of all cancer diagnoses in the U.S. annually. Men get stomach cancer at higher rates than women, and most people diagnosed with the disease are age 65 or older.

Overall, the five-year survival rate for stomach cancer is about 36% (cancer.gov). That rate can vary depending on the type of stomach cancer, its stage at diagnosis, individual health factors and response to treatment.

• Localized (has not spread beyond the stomach): 75%
• Regional (spread to lymph nodes or organs nearby): 35%
• Distant (spread outside of the stomach to distant parts of the body): 7% 

Causes of Stomach Cancer

In most cases, the cause of stomach cancer is unknown. However, some genetic conditions increase the chance of developing stomach cancer. 

Risk Factors for Stomach Cancer 

Known risk factors are having untreated helicobacter pylori bacteria in the stomach and a diet that includes large amounts of smoked foods or foods preserved with salt. Using tobacco and drinking alcohol are other factors that can increase the chances of developing stomach cancer.

Signs and Symptoms of Stomach Cancer

Stomach cancer tends to develop slowly over a number of years and rarely have symptoms in early stages of development. If you have any concerning symptoms, see your doctor. Symptoms of stomach cancer can include:

• Problems swallowing
• Abdominal pain
• Unexplained weight loss
• Feeling full after eating only a little
• Nausea
• Vomiting
• Blood in the stool or vomit

Types of Stomach Cancer

The majority of stomach cancers (90 to 95%) are adenocarcinomas that begin in glandular cells in the stomach lining.

Adenocarcinomas 

Adenocarcinomas can be intestinal, meaning the cancer cells look much like normal cells when viewed under a microscope.

They can also be diffuse, meaning they don’t look like normal cells under the microscope. Diffuse adenocarcinomas tend to be more aggressive, growing and spreading faster than intestinal adenocarcinomas. They can also be more challenging to treat.

There are two main classes of adenocarcinoma.

1. Gastric cardia cancer starts in the top of the stomach near where it joins the esophagus.
2. Non-cardia cancer starts in other parts of the stomach.

Neuroendocrine Tumors

Neuroendocrine tumors of the stomach are rare, representing about 5% (netrf.org) of cancers that develop within the gastrointestinal system. These are typically slow-growing tumors. They have the potential to spread to other parts of the body. 

Lymphomas 

Lymphomas are cancers that develop in cells within the immune system, and although they usually start in other parts of the body, they can start within immune cells in the stomach wall. There are different types, and they can grow slowly (indolent), or they can grow and spread quickly (aggressive). No matter where they start, they all have the potential to spread to different parts of the lymph system and throughout the body. 

Gastrointestinal Stromal Tumors (GISTs)

Gastrointestinal stromal tumors (GISTs) are not common. Most of them (more than 50%) start in cells in the wall of the stomach, although they can start anywhere in the digestive tract. 

Other Types of Stomach Cancer 

Some very rare types of cancer can start in the stomach:

• Squamous cell carcinomas represent only .04% to .07% of all stomach cancers reported globally. (pmc.ncbi.nlm.nih.gov)
• Small cell carcinomas of the stomach represent only .04% to .05% of stomach cancers in the world.
• Leiomyosarcoma is a soft tissue cancer. Leiomyosarcomas that start in the stomach are extremely rare, with the most common site for this disease being the uterus. 

Diagnosing Stomach Cancer

If your care team suspects stomach cancer, they will order tests to find out if you have cancer. If a tumor is detected, tests will also determine how far any cancer may have spread.

The first step is often an esophagogastroduodenoscopy (EGD). During this procedure, a physician uses a small camera mounted on a flexible tube to examine the lining of the stomach and other nearby tissues. If cancer is found, patients have more imaging with computed tomography (CT) or positron emission tomography/computed tomography (PET/CT) scans to determine how far the disease has spread. Some patients also receive an endoscopic ultrasound, which helps physicians determine how deeply cancer has invaded the wall of the stomach.

CT and PET scans do not always find cancer that has spread to the lining of the abdomen. When imaging does not find evidence of the cancer having spread within the abdominal, you may have a diagnostic laparoscopy to confirm that the abdomen is truly free from cancer. This minimally invasive procedure is done under anesthesia, so the patient is asleep. A surgeon makes a small incision in the abdomen and inserts a thin, flexible tube with a camera inside (laparoscope) to look at the abdominal cavity.

Treatment for Stomach Cancer

Physicians develop an individualized treatment plan based on the type and stage of the stomach cancer. The patient’s overall health and goals for treatment are also important considerations.

Earlier-Stage Disease

When all tests confirm that the cancer has not spread beyond the stomach and nearby lymph nodes, treatment can focus on curing the cancer. Treatment usually includes chemotherapy, radiation therapy and surgery.

Advanced Stomach Cancer

Stomach cancer can spread to organs such as the liver or the lungs. For patients whose stomach cancer has spread to other organs, the treatment plan includes chemotherapy. Treatment with immunotherapy drugs may be available through a clinical trial.

Advanced Cancer Confined to the Stomach and Abdominal Cavity

For some patients with advanced stomach cancer, cancer cells have spread to the lining of the abdominal cavity, but it has not spread to any other organs. These patients may be eligible for a newer treatment option that combines cancer surgery with drug therapy.

The patient first receives two to four months of intravenous (IV) chemotherapy with the goal of shrinking the cancer that spread to the abdominal lining. If the amount of cancer in the abdomen is reduced enough, the patient may then have a procedure called HIPEC. During this surgery, surgeons remove as much tumor tissue as possible. Then, they circulate a heated chemotherapy solution throughout the abdominal cavity to destroy any remaining cancer cells. For eligible patients, this treatment approach can significantly extend survival.

Clinical Trials

Our physicians are actively investigating new treatments for stomach cancer. One of the most promising areas of research today is immunotherapy. This treatment approach boosts the patient’s own immune system to better fight cancer cells. Many stomach cancer patients can access immunotherapy drugs and other options through our clinical trials program.