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Blog, Gastric Cancer

Gastric Cancer-Treatment


The gastric cancer treatment mainly depends on the stage, location of the tumor, performance status of the patient, the presence of certain genetic abnormalities, along with other factors. Following are the preferred treatment approaches for different stages of gastric cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

treatment - non metastatic stomach cancer

treatment - metastatic stomach cancer

TNM Score

(clinical)

Preferred Treatment
Tis-1a Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is considered preferred treatment approach depending on the extent of disease.
T1b Surgical removal of partial (subtotal gastrectomy) or entire stomach (total gastrectomy) depending on the involvement.

Chemotherapy with/without radiotherapy if surgically unresectable or inoperable.

T2-T4 Any N Surgical resection in combination with chemotherapy with/without radiotherapy is the preferred treatment.

Chemotherapy with/without radiotherapy if surgically unresectable or inoperable.

Any T Any N M1

(Metastatic disease)

Chemotherapy is the mainstay of treatment.

Radiotherapy, surgery, or other palliative treatment may be employed to relieve the symptoms.

 

Following is the brief description of various treatment types employed for gastric cancer:

1.Surgery: Surgery is the treatment of choice for some earlier stage cancers that can be completely removed. Surgery can also be employed for some higher stages of cancers that have not spread to distant parts and if the patient is medically fit. Sometimes, surgery is combined with other treatments such as chemotherapy and/or radiation therapy as per physician discretion and patient’s condition. Surgery for gastric cancer may be partial or total gastrectomy. It may be a D1 resection or D2 resection depending upon number and stations of lymph nodes removed.

2.Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy).  Radiotherapy is commonly combined with other treatment options such as surgery and/or chemotherapy for higher stage disease. Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.

 

3.Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.

4. Targeted Therapy Targeted drugs are designed to target a specific gene or protein characteristic of the gastric cancer cells. With the advancement in diagnostic techniques, genetic abnormalities for gastric cancer have been identified that can be targeted with the help of targeted drugs. Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy.  For example, trastuzumab targets the HER2 protein and Ramucirumab targets receptor for VEGF. They are generally used alone or in combination with chemotherapy for the treatment of higher stage disease.

5.Endoscopic Treatments: Several types of endoscopic treatment can be employed for very early stage gastric cancers. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) is alternative to surgery with similar efficacy and safety for early-stage gastric cancer confined to gastric mucosa. Other treatments like endoscopic tumor ablation and endoscopic stent placement aim mainly to relieve symptoms of more advanced staged gastric cancers.

6.Palliative Treatments: These may help in improving the overall quality of life by providing relief from the symptoms caused by gastric cancer. However, they do not directly treat gastric cancer. They are generally given as supportive care for advanced stage cancer. These include but are not limited to placing stent or feeding tube in the gastric, using drugs to reduce pain and other symptoms such as vomiting, external-beam radiation therapy for bleeding or pain, etc.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes a patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals of treating gastric cancer:

  • Prolongation of life.
  • Reduction of symptoms.
  • Improvement of overall quality of life.

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