Introduction

Stomach cancer, also referred to as gastric cancer, can be a life-altering diagnosis. The treatment process depends on several factors, including the stage of the cancer, its location in the stomach, the patient’s overall health, and personal preferences. Advancements in medical technology and oncology have led to more effective treatment strategies, improving survival rates and quality of life. Understanding the various treatment options available helps patients make informed decisions and actively participate in their care journey.

Surgical Treatments

Surgery is often the primary treatment for stomach cancer, especially when the disease is detected at an early stage and has not spread to other parts of the body. The goal of surgery is to remove the cancerous tissue and prevent the cancer from returning.

There are several types of surgical procedures, including:

  • Subtotal (Partial) Gastrectomy: This involves removing the part of the stomach affected by cancer. The remaining portion of the stomach is then connected to the small intestine. This procedure is typically used when cancer is located in the lower or middle parts of the stomach.

  • Total Gastrectomy: In this surgery, the entire stomach is removed, and the esophagus is directly connected to the small intestine. This is often done when cancer is widespread or located in the upper part of the stomach.

  • Lymph Node Dissection: Alongside stomach removal, nearby lymph nodes are also removed and examined to determine if the cancer has spread.

Minimally invasive techniques, such as laparoscopic surgery, may be used in certain cases. These approaches typically involve smaller incisions, less pain, and quicker recovery times compared to open surgery.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells or stop them from growing and dividing. It can be administered before surgery (neoadjuvant chemotherapy) to shrink the tumor and make it easier to remove, or after surgery (adjuvant chemotherapy) to eliminate any remaining cancer cells and reduce the risk of recurrence.

In cases where surgery is not an option due to the cancer being advanced or having spread, chemotherapy may be used as a primary treatment to manage symptoms and slow the disease’s progression.

Chemotherapy drugs are typically given intravenously, though some may be taken orally. Treatment is usually administered in cycles, allowing the body time to recover between sessions. Common side effects include nausea, fatigue, hair loss, and a lowered immune response, though these can often be managed with supportive care.

Radiation Therapy

Radiation therapy uses high-energy rays to target and destroy cancer cells. It is often combined with chemotherapy, a combination known as chemoradiation, especially for locally advanced stomach cancers.

Radiation therapy may be used:

  • Before surgery, to shrink the tumor

  • After surgery, to kill any remaining cancer cells

  • As a palliative treatment to relieve symptoms in advanced cases

Modern techniques like intensity-modulated radiation therapy (IMRT) help focus the radiation precisely, reducing damage to surrounding healthy tissues. Side effects may include skin irritation, nausea, fatigue, and digestive discomfort, which usually improve after treatment.

Targeted Therapy

Targeted therapies are drugs designed to attack specific molecules involved in the growth and spread of cancer cells. These treatments are often used in patients with advanced or metastatic stomach cancer whose tumors have certain genetic characteristics.

One of the most commonly used targeted therapies is trastuzumab, which targets the HER2 protein found in some stomach cancers. Other targeted drugs may focus on vascular growth factors or signaling pathways involved in cancer cell proliferation.

Before starting targeted therapy, patients typically undergo molecular testing to determine whether their cancer expresses the relevant targets. This ensures the treatment is tailored and more likely to be effective.

Immunotherapy

Immunotherapy is an emerging field in stomach cancer treatment that aims to stimulate the body’s immune system to recognize and attack cancer cells. Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, block proteins that prevent immune cells from attacking tumors.

Immunotherapy may be recommended for patients with advanced gastric cancer, especially if their tumors have specific biomarkers, such as PD-L1 expression or microsatellite instability (MSI-high). These therapies are often used when other treatments have not been successful.

While immunotherapy has shown promise, it does not work for everyone. Side effects can include inflammation in various organs, fatigue, and flu-like symptoms, which require close monitoring and management.

Palliative Care and Symptom Management

When stomach cancer is advanced and cannot be cured, the focus of treatment may shift toward palliative care. The goal is to improve quality of life by managing pain, controlling symptoms, and addressing emotional and psychological needs.

Palliative treatments may include:

  • Medications to reduce nausea, pain, and acid reflux

  • Nutritional support to maintain weight and energy

  • Procedures to relieve blockages in the stomach or intestines

  • Counseling and psychological support for patients and families

Palliative care can be provided alongside curative treatments or as a stand-alone approach in end-stage cancer. It plays a critical role in ensuring comfort and dignity for patients facing serious illness.

Clinical Trials and Experimental Treatments

Patients with stomach cancer may be eligible to participate in clinical trials that test new drugs, treatment combinations, or procedures. These trials contribute to the advancement of medical knowledge and may offer access to cutting-edge therapies not yet widely available.

Participation in a clinical trial is voluntary and requires careful consideration. Healthcare providers can help patients understand the potential risks and benefits and whether a trial is appropriate for their condition.

Complementary and Integrative Therapies

Some patients choose to explore complementary therapies alongside conventional treatments. These may include acupuncture, meditation, massage therapy, or herbal supplements. While not substitutes for medical treatment, such approaches may help reduce stress, improve sleep, and alleviate side effects.

It is essential to discuss any complementary therapies with a healthcare provider to avoid interactions with prescribed medications or treatments.

Conclusion

Stomach cancer treatment involves a range of options tailored to each patient’s unique condition. From surgery and chemotherapy to newer methods like targeted and immunotherapy, modern medicine offers multiple strategies to fight the disease. Early-stage cancers may be cured with surgery alone, while advanced cases often require a combination of treatments.

Palliative care and complementary approaches also play important roles in improving well-being and managing the emotional toll of cancer. Ultimately, a personalized treatment plan created by a multidisciplinary team offers the best chance for effective care and a better quality of life. By staying informed and engaged, patients can take an active role in navigating their treatment journey.