Stomach cancer is cancer that arises from the inner lining of the stomach. Stomach cancer is classified into different stages depending on tumor size, extent of spread, lymph node involvement and the presence of distant metastases or recurrence.
According to the American Cancer Society, treatment plans for stomach cancer depend on the site of the cancer, the extent of spread, the health status of the patient and the patient's personal preferences. Treatment modalities follow the staging system.
Stages of Stomach Cancer
Stomach cancer in stage 0 is limited to the inner lining of the stomach. Stage I cancer has grown into the wall of the stomach, up to the muscular outer wall, but not beyond it, with or without lymph node involvement. According to the ACS, stage II cancers have grown right through the walls of the stomach, with or without lymph node spread and without distant spread. These are the early stages of the stomach cancer.
The advanced stages of stomach cancer are stage III, where the cancer has spread to surrounding structures like the liver, spleen, pancreas or major blood vessels, and stage IV, with spread to distant organs like the lungs, brain and bones.
According to the ACS, for practical purposes, stomach cancers are divided into resectable and non-resectable cancers, based on the ability to remove the entire cancer by surgery.
Types of Treatment
Surgery is the mainstay of treatment in the early stages. The earliest stages of stomach cancer can be treated by surgery alone. Surgical removal of part or all of the stomach is called gastrectomy. Lymphadenectomy or removal of surrounding lymph nodes is also carried out at the same time to check the extent of spread. Cancers limited to the lining of the stomach are sometimes removed by endoscopic mucosal resection.
Radiation therapy is treatment with high-powered radiation. External beam radiation therapy is the type used in stomach cancer treatment, according to the ACS. Radiation therapy is used in addition to surgery in advanced cases of cancer where there is a risk that some cancer cells were missed or there is a risk of recurrence. When combined with chemotherapy, it is more effective, says the ACS. Radiation therapy is also used to relieve pain in terminal cases of stomach cancer.
Drugs that kill cancer cells or stop them from growing are used in chemotherapy for stomach cancer. Chemotherapy is used in stomach cancer that has spread to distant sites or to relieve distressing symptoms of terminal cases.
Chemotherapy, says the ACS, is also used after surgery, as adjuvant therapy in advanced cases. Drugs commonly used in stomach cancer are 5-fluorouracil, etoposide, doxorubicin, cisplatin, methotrexate and epirubicin.
Special Considerations
According to the ACS, a treatment plan based on the patient's state of health and personal preferences is formulated to include a combination of two types of treatment for best results. A team approach to the treatment of stomach cancer that includes a surgeon, a radiation oncologist and/or a medical oncologist, is recommended.
The aim of treatment is best outlined at the onset of treatment based on expectations of successful treatment or symptom relief. Education on side effects and possible complications of the different modes of treatment are better explained at the onset of treatment.
Side Effects of Treatment
Complications of bleeding, blood clots and damage to nearby organs may follow surgery, says the ACS. Other adverse effects include heartburn, abdominal pains and vitamin deficiencies.
According to the ACS, diarrhea, fatigue, nausea and vomiting may follow radiation therapy for stomach cancer. Other adverse effects of radiation therapy include low blood counts and skin problems at the site of the radiation.
Short term side effects common to most chemotherapy drugs, according to the ACS, are loss of appetite, hair loss, diarrhea, low blood counts, nausea and vomiting and mouth sores. Adverse effects from the suppression of blood cell production in the bone marrow by chemotherapy are increased chances of infection, shortness of breath and bleeding tendencies.
Outlook
The overall five-year survival rate in the U.S. according to the ACS, is a dismal 28 percent. This is the percentage of patients still alive five years after first diagnosis of stomach cancer. The general outlook for stomach cancer in the U.S., according to the ACS, is poor, because they are usually discovered at advanced stages.
