Treatment
Treatment depends entirely on the stage stomach cancer has reached at the time of diagnosis. The majority of people - about 80% - will have advanced stomach cancer at diagnosis. These people will not be able to have curative treatment but there are many palliative treatment options available for them and many of them may have surgery as part of their treatment. More detailed staging information is provided for stomach cancers than for other cancers because the Tumor Nodes Metastasis (TNM) staging system rather than the number grading system will often be used in correspondence about people with stomach cancer.
Early disease
This may be treated by curative surgery and is any stage from 1-3 using the number staging system. The table below shows how the stages are described using both systems and where only Tumor Node Metastasis TNM staging is given in the correspondence can be used to give a number stage to the case. Number staging is used throughout malignancies guidance.
| Number stage | TNM staging system |
|---|---|
|
Stage 1 |
T1 N1 M0 T2 N0 M0 |
|
Stage 2 |
T1 N2 M0 T2 N1 M0 T3 N0 M0 |
|
Stage 3 |
T2 N2 M0 T3 N1 M0 T3 N2 M0 T4 N0 M0 |
Treatment of localised (early stage) stomach cancer
This type of cancer can be removed by surgery and the aim of treatment is to cure the cancer. Five year survival in this group varies depending on the stage of the tumour at operation.
Curative surgical operations for stomach cancer include:
- Radical or total gastrectomy – removal of all of the stomach
- Partial or subtotal gastrectomy – removal of part of the stomach
- Oesophagogastrectomy – removal of the stomach and part of the oesophagus
These are all major operations; recovery time is a minimum of three months. People will often have gastro-intestinal symptoms up to a year afterwards, particularly those who have undergone Total Gastrectomy or Oesophago-gastrectomy. Common gastro-intestinal problems for someone after this type of surgery include coping with adjusted eating pattern. Most people will need to adjust their diet to eating 6 small meals a day as opposed to 3 and will only be able to tolerate a small volume of food without feeling painfully full. Also rapid gastric emptying known as “Dumping Syndrome” can have either an immediate or delayed effect on the person after eating and can manifest itself as symptoms of nausea, bloating, pain and diarrhoea. This can improve with time. Someone who has all their stomach removed will need vitamin B12 injections every three months for life.
Chemotherapy
Most people with early stomach cancer will have a course of chemotherapy as well as surgery. Chemotherapy may be given before surgery to shrink the tumour – ‘neo-adjuvant treatment’ or afterwards as ‘adjuvant treatment’. A common drug combination is ‘ECF’. This consists of three separate chemotherapy drugs called:
- Epirubicin
- Cisplatin
- 5-FU (fluorouracil)
The 5FU is given continuously via a pump into a central line in the neck and the two other drugs are given as injections once every three weeks. More recently, capecitabine (otherwise known as Xeloda) tablets have been used to replace the continuous 5FU infusion (ECX). For the majority of the three weeks a person will be at home and only go into hospital to have injections of the two other drugs. 6-8 three week cycles are usually given if there is a good response to the treatment. Total treatment tine is 18-24 weeks. See general notes for side effects.
Radiotherapy
This is not used in the treatment of early stomach cancer except in clinical trials.
Advanced disease
80% of people diagnosed with stomach cancer will be in this group and they will be having palliative treatment which may include surgery. Staging information in the medical correspondence may use either the TNM or number staging system. This table shows the different way in which advanced disease may be described using the two different systems:
| Number stage | TNM staging system |
|---|---|
|
Stage 4 |
T1 T2 or T3 AND N3 M0 T4 and N1 N2 OR N3 M0 Any T any N AND M1 |
Treatment of advanced stomach cancer
Advanced stomach cancer is not curable at all; treatments are palliative and aimed at reducing symptoms and improving quality of life. Most people will die within two years of getting this diagnosis and will be terminally ill.
Surgery
Palliative surgery may be used to prevent ‘gastric outflow obstruction’ or severe bleeding from the tumour. The names of the operations performed for this are:
- Gastrectomy
- Sub-total or partial gastrectomy
- ‘Gastroenterostomy’, ‘ Gastrojejunostomy’ or ‘bypass’
This type of operation does not remove enough of the cancer to cure it or sometimes any of the cancer at all; it re-plumbs the bowel so that the stomach contents can get past the blockage caused by the growing tumour. This is called bypass surgery
Recovery time from these operations takes several weeks and can dramatically improve quality of life for people with stomach cancer. This does not improve survival.
Chemotherapy
Chemotherapy in advanced stomach cancer does not improve survival but it can reduce symptoms of the disease. A common drug combination is ‘ECF’. This consists of three separate chemotherapy drugs called:
- Epirubicin
- Cisplatin
- 5-FU (fluorouracil)
The 5FU is given continuously via a pump into a central line in the neck and the two other drugs are given as injections once every three weeks. More recently, capecitabine (otherwise known as Xeloda) tablets have been used to replace the continuous 5FU infusion (‘ECX’ is the name given to this drug combination). For the majority of the three weeks a person will be at home and only go into hospital to have injections of the two other drugs. 6-8 three week cycles are usually given if there is a good response to the treatment. Total treatment tine is 18-24 weeks. Other treatments may be given at the same time as the chemotherapy.
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Radiotherapy
This is not used very often but can be used to help with symptoms like pain and bleeding.
Amended November 2008
