Stomach Cancer Treatment
At MD Anderson, we customize your stomach cancer treatment to ensure the highest chances for successful treatment while focusing on your quality of life. Our treatments include targeted therapy, immunotherapy, chemotherapy, advanced radiation therapy and state-of-the-art surgery.
A stomach cancer patient¡¯s treatment plan often involves more than one type of therapy. A group of experts including oncologists, radiation oncologists and surgeons work together to determine the best treatment plan for you. This team approach ¨C coupled with extraordinary skill and the latest technology ¨C means you receive the best possible care with the least impact on your body.
Stomach cancer treatment options
If you are diagnosed with stomach cancer, your doctor will discuss the best options to treat it. This will depend on several factors, including the type and stage of the cancer, the location of the tumor and your general health.
One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Stomach cancer surgery
Surgery is the most common treatment for stomach cancer. Sometimes surgery is performed to cure the cancer. However, in some cases of advanced stomach cancer, surgery may be performed to treat symptoms and not necessarily cure the disease. This is known as palliative surgery.
Surgical techniques for stomach cancer may include:
Endoscopic mucosal resection: A thin tube (an endoscope) equipped with surgical tools is inserted down the throat and into the stomach, allowing doctors to remove certain types of early, non-invasive stomach cancers.
Gastrectomy: The goal of a gastrectomy is to completely remove the stomach cancer and affected nearby lymph nodes (tissues that filter infection and disease) while preserving as much stomach function as possible. There are several types of gastrectomy including:
- Partial (wedge) gastrectomy: The cancerous part of the stomach is locally removed. This method is typically used to treat stomach cancers with low likelihood of lymph node spread.
- Subtotal (distal) gastrectomy: The cancerous part of the stomach, nearby lymph nodes and a margin of healthy tissue is removed. In some cases, parts of the esophagus or small intestine that are near the tumor may also be removed.
- Total gastrectomy: The entire stomach, nearby lymph nodes and sometimes the spleen, parts of the esophagus, intestines, pancreas and other organs where the cancer has spread, are removed. The esophagus is reconnected to the small intestine allowing patients to continue to eat and swallow.
- Robotic gastrectomy: Surgeons use surgical robots to perform a minimally-invasive gastrectomy through small abdominal incisions. Robotic gastrectomy can be used to perform partial, subtotal or total gastrectomy with minimized pain and quicker recovery.
Endoluminal stent placement: When a stomach cancer tumor is blocking the stomach but cannot be removed completely, an endoluminal stent placement may help a patient eat normally. A thin, expandable tube is placed between the stomach and esophagus or small intestine to keep the passageway open.
Many times, surgery is combined with chemotherapy and radiation. If all three therapies are needed, MD Anderson's standard approach is to give chemotherapy and radiation before surgery (neoadjuvant chemoradiation therapy). This helps kill cancer cells and shrink the stomach tumor before surgery, and it is often better tolerated and more successful.
Stomach cancer surgery is delicate and challenging. Studies have shown that patients do better when their surgeons have a higher level of experience, and MD Anderson surgeons are among the most experienced in the country. MD Anderson's skilled surgeons use specialized procedures to treat stomach cancer while helping you retain as much of the stomach as possible. However, if surgical removal of part of all of the stomach is unavoidable, we have the skill and staff to help you adjust to life after surgery.
Life after stomach cancer surgery
Gastrectomy surgery may require you to change how you get nutrients. Some patients may have a feeding tube inserted directly into the small intestine; others may need to take vitamin supplements as pills or shots (injections). MD Anderson dieticians will support you in meeting your nutritional requirements after stomach cancer surgery.
Following stomach cancer surgery, you may need to eat smaller, more frequent meals and avoid sugar. Abdominal discomfort, lack of appetite and diarrhea may also occur; these are usually temporary.
Chemotherapy for stomach cancer
Chemotherapy works by killing fast-growing cells, including cancer cells.
At MD Anderson, chemotherapy for stomach cancer is often given before surgery to shrink the tumor. It can also be given after surgery to kill any remaining cancer cells that were not visible during the operation. Chemotherapy may also be used (often in conjunction with other therapies) to treat more advanced stomach cancer, especially if the cancer has spread to other parts of the body. MD Anderson offers the most advanced chemotherapy regimens with the fewest side effects.
These methods include:
- Intravenous (IV) chemotherapy: Chemotherapy drugs are inserted into a vein using a needle or catheter. This is the most common type of chemotherapy.
- Intraperitoneal (IP) chemotherapy: Chemotherapy drugs are inserted into the abdominal cavity using a port.
- Hyperthermic Intraperitoneal Chemotherapy (HIPEC): In this treatment, also known as hot chemotherapy, heated chemotherapy drugs are inserted into the abdominal cavity after the tumor is removed.
Radiation therapy for stomach cancer
Radiation therapy uses focused, high-energy beams to kill cancer cells.
We use the most precise methods of radiation therapy to target the stomach cancer while limiting damage to surrounding areas. These methods include:
- Intensity-modulated radiation therapy (IMRT): Treatment is tailored to the specific shape of the stomach, while avoiding other organs.
- Stereotactic body radiation therapy (SBRT): Very high doses of radiation are targeted at the tumor using beams. SBRT is typically used in cases when stomach cancer has spread to other sites.
Immunotherapy and targeted therapies for stomach cancer
Immunotherapy
Immunotherapy recruits the patient¡¯s own immune system in the fight against cancer. For stomach cancer, patients may be given an immunotherapy known as a checkpoint inhibitor. Immune checkpoint inhibitors stop the immune system from turning off before cancer is completely eliminated.
Targeted therapy
Targeted therapy works by stopping or slowing the growth or spread of cancer on a cellular level.
Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.
Genetic/molecular profiling
This type of testing classifies cancerous tumors by their genetic makeup and can help your doctor identify specific immunotherapies, targeted therapies, or clinical trials that might best treat that specific cancer.
Stomach cancer clinical trials
Since MD Anderson is one of the nation¡¯s leading research centers, we¡¯re able to offer top-quality, innovative treatment including clinical trials (research studies) of new treatments for every type and stage of stomach cancer.
Learn more about stomach cancer.
¡®How I knew I had stomach cancer¡¯: Six survivors share their symptoms
Abdominal pain, heartburn and fatigue can sometimes be symptoms of stomach cancer. But they can also be the result of overeating, untreated acid reflux or insomnia.
So, how do you know which category your symptoms fall into and when to see a doctor?
¡°Most stomach cancers don¡¯t cause any symptoms until they¡¯re more advanced, and they can mimic indigestion or reflux,¡± says , a surgical oncologist who specializes in stomach cancer and other gastrointestinal cancers. ¡°So, it¡¯s easy to dismiss the signs of stomach cancer as having overeaten or eaten the wrong foods or putting on too much weight. However, anything that changes and persists is usually something to get checked out, especially if it lasts for more than two or three weeks.¡±
Here¡¯s how six of our patients knew they had stomach cancer, in their own words.?
Abdominal pain
¡°I started having a burning, gnawing pain in the center of my stomach,¡± says Janine Somma, a stay-at-home mom from New York who was only 28 when she was diagnosed with early-stage stomach cancer. ¡°I went to my GI doctor, but he brushed it off as acid reflux and prescribed an antacid.¡±
¡°I had some really weird abdominal pains that stretched up and across my chest,¡± adds Erica Hunkin, a psychiatric nurse practitioner from Georgia who was 35 when she was diagnosed with stage I stomach cancer. ¡°I thought it was heart-related, but a stress test and EKG didn¡¯t find anything.¡±
Heartburn and indigestion
¡°I started getting really bad heartburn after eating almost anything,¡± recalls Craig Galati, an architect from Nevada who was 62 when he was diagnosed with stage III stomach cancer. ¡°That was really surprising because I don¡¯t usually have heartburn. Sometimes, I¡¯d also develop this really weird hiccup when I¡¯d eat too much or too quickly. It turned out I had a golf-ball-sized tumor at the very top of my stomach, right near the flap.¡±
Fatigue
¡°I was under a lot of stress right before I was diagnosed,¡± remembers Sylvia Coe, a retired art gallery director in Florida who was 54 at the time. ¡°So, I attributed my fatigue, shortness of breath and dizziness to that. But when I walked into a restaurant for brunch on Easter Sunday and swooned, I knew something was wrong. It turned out to be a tumor that was bleeding heavily.¡±
¡°Fatigue is what finally drove me to the doctor,¡± adds Ralph Lilja, a rancher and realtor from Kansas who was 57 when he was diagnosed with stage IV stomach cancer. ¡°It got to where I couldn¡¯t hardly go up the stairs. My local physician discovered I was anemic due to blood loss from the tumor. Once he started giving me transfusions, I felt better.¡±
Unusual hunger pangs
¡°I remember trying to catch some sleep between my shifts at the hospital and feeling hungry, even though I knew I shouldn¡¯t be,¡± says Joe Einspahr, M.D., a hospitalist from Nebraska who was 55 when he was diagnosed with stage II stomach cancer. ¡°I¡¯d only notice it during those quiet times, but it was a nagging sensation, just a gnawing hunger, and eating never seemed to impact it.¡±
Watch for these red-flag stomach cancer symptoms
Other stomach cancer symptoms include unintentional weight loss, feeling full quickly, and losing your appetite. But if you experience any of the following, seek medical attention right away.
- Vomiting blood: Any amount is considered too much.
- Bloody stools: These are often described as looking black or tarry and smelling like steel or metal.?
- Severe abdominal pain: Anything you might rank as an ¡°8,¡± ¡°9¡± or higher on a scale of 1 to 10 is considered severe.
¡°Throwing up can also be a sign of an obstruction or blockage, which is usually associated with advanced disease,¡± notes Mansfield. ¡°So, if you can¡¯t keep anything down or you vomit and see something you ate three days ago, go to the emergency room immediately.¡±
The key to early detection: listening to your body
Most patients Mansfield sees in his practice don¡¯t have any symptoms of stomach cancer. That¡¯s because they usually come to him only for risk-reducing stomach surgery after having learned they carry the CDH1 genetic mutation.?
¡°But a big part of early detection is just listening to your body,¡± he notes. ¡°Some people will have symptoms and ignore them. Others are very in tune with themselves and seek help right away at the first signs of trouble. A study out of England showed that just being curious and checking out patients with an endoscopic exam the first time they have symptoms can significantly increase the percentage of patients found with early gastric cancer.¡±
or call 1-877-632-6789.
After my stomach removal, I've never looked back
In 2014, I learned that I carry a genetic mutation called CDH1, which markedly increases my risk of developing breast and stomach cancers. I was only 25 when I found out, so my original plan was to monitor myself carefully. I¡¯d have my stomach examined annually with a scope and get mammograms twice a year.
I knew that a prophylactic total gastrectomy ¡ª the complete removal of my stomach as a preventive measure ¡ª was the current recommendation for people with this gene. But I was still a newlywed at the time, and my husband and I wanted to wait until after we¡¯d had children to take such a drastic step.
Despite having two endoscopies that showed no evidence of disease, the risk of developing stomach cancer was always in the back of my mind. One day, at age 27, I finally decided I¡¯d worried enough.
Why I chose MD Anderson for my preventive stomach cancer surgery
Anyone who hears they should have their stomach removed because there¡¯s a good chance they¡¯ll develop cancer in it one day is going to be a bit shocked. It definitely makes you want to find the best doctor to do it!
The first genetic counselor we met with recommended we choose a surgeon who treats lots of families with CDH1. She gave us a list of physicians and hospitals to consider, so we did some research and made some phone calls.
MD Anderson surgeon was one of the surgeons on that list. MD Anderson is the No. 1 hospital for cancer care. And because Dr. Mansfield had performed the same procedure on my mother, having him perform my surgery just made sense. My mom received such amazing care from him that I knew MD Anderson was where I wanted to go, too.
Dr. Mansfield removed my stomach on May 16, 2017.
Life after my total gastrectomy
During a total gastrectomy, the stomach is completely removed from the body and the esophagus is reattached directly to the small intestine. So, there was a lot of trial and error in figuring out which foods I could eat comfortably in the first few months after surgery.
Eating too much or too quickly now makes me feel really sick. I also have to avoid sugary and fried foods. Mostly, I just eat a high-protein diet, but with much smaller portions. I also eat frequently throughout the day.
The hardest and most surprising parts of not having a stomach
The hardest part of not having a stomach is probably that I rarely feel thirsty. So, I don't have that visceral cue anymore to prompt me to drink. I have to make a conscious effort to hydrate myself now. In the first few months after my surgery, I had a water bottle marked by the hour, just for the visual reminder.
The most surprising aspect of not having a stomach was discovering how hard it is to drink plain water. It literally feels like it¡¯s stuck in my esophagus ¡ª and a lot of the other gastrectomy survivors I¡¯ve talked to say the same.
Apparently, it has something to do with high surface tension, so drinking fluids with lower surface tension ¡ª like watered-down juices or sugar-free sports drinks ¡ª makes it easier. Finding the right cup, bottle and straw also helps.
Why I¡¯ve never looked back after my gastrectomy
In the years since my surgery, the biggest lesson I¡¯ve learned is that you don¡¯t need a stomach to live a healthy life.
I¡¯ve developed and maintained a new normal since 2017, even without a stomach. I do still feel ¡°hungry¡± sometimes, but it¡¯s more of a sense of emptiness (and a sign that my blood sugar is low) than anything else. I¡¯ve regained all eight pounds I lost after surgery and have been working out and running again, which is great.
Today, I¡¯m pregnant with my first child. And, other than a few modifications to my vitamin regimen and glucose monitoring methods, my pregnancy has been pretty normal. I even dodged the morning sickness bullet ¡ª so that was an unexpected benefit of not having a stomach!
At first, I wondered if I might¡¯ve jumped the gun in having my stomach removed. But a few weeks after my surgery, the pathology report came back. It showed that there was already signet ring cell carcinoma in the lining of my stomach, which is consistent with the CDH1 gene mutation.
So, technically, I already had stomach cancer; I just didn¡¯t know it yet. When I got that news, I knew I¡¯d made the right decision. And I have never looked back.
or by calling 1-877-632-6789.
No stomach, no problem! Gastrectomy patient another step ahead after marathon
Marne Shafer thought her running days were behind her after she received a total gastrectomy, a surgical removal of the stomach and nearby lymph nodes. She braced herself for the worst.
At age 33, the mother of two and experienced marathoner, learned she has a CDH1 gene mutation, which is associated with high-risk of a rare type of stomach cancer called hereditary diffuse gastric cancer, as well as lobular breast cancer.
Marne came to MD Anderson for genetic testing after several family members passed away from stomach cancer, including her father, grandmother and aunt. Since screening isn¡¯t successful in identifying the disease in its early stages, the recommended treatment plan was for Marne to undergo the prophylactic total gastrectomy. But the surgery revealed she already had stage I cancer, which was removed during the procedure.
¡°It seems counterintuitive to feel in full health and then go out and get your stomach removed,¡± she says. ¡°People ask, ¡®how are you still alive?¡¯¡±
Life without a stomach
While she had a feeding tube for nearly two months and worked hard to get enough nutrients post-surgery, Marne credits her quick recovery to the expert care provided by her surgeon, in addition to her history of running.
¡°I thought I was supposed to still feel horrible two weeks after my surgery. I didn¡¯t have a lot of strength, but I didn¡¯t think I would feel that much better,¡± she says. ¡°At the end of the day, Dr. Mansfield is just awesome. He is very personable in addition to being one of the best doctors in the world. He is extremely knowledgeable, and he put me at ease about the surgery.¡±
After her stomach removal, Marne resolved to help others facing similar situations. She started a blog, , to share her experiences, including challenges with eating.
Because Marne¡¯s esophagus is connected to her small intestine as a result of the gastrectomy, she can eat and swallow, but it¡¯s a slower process. She focuses on eating several small meals packed with protein and nutrients. ¡°It¡¯s like a forced, healthy diet,¡± she says.
In addition to blogging, Shafer raises awareness and funds for stomach cancer research.
¡°I think I was meant to have this so I can help other people,¡± she says.
The stomachless runner
Marne¡¯s return to running is another way that she¡¯s inspiring others, including Dr. Mansfield. Just months after her gastrectomy, she began training for a half marathon in Houston. Three years later, on Jan. 15, 2017, she completed the full Chevron Houston Marathon, coming in just one minute shy of her 3:21 personal record.
¡°It felt doubly important to run a marathon without a stomach,¡± Marne says. ¡°Look what you can do!¡±
Running the marathon wasn¡¯t without its unique challenges. Marne experimented during training to see if her body could process sugar gels used by long-distance runners to boost energy. Throughout the race, she couldn¡¯t gulp water or sports drinks to remain hydrated. Instead, she had to pinch the top of the cups and slowly sip while she ran.
She had never been so excited to cross a finish line.
¡°I had so many people supporting me because they knew what a milestone it was. Everyone has a meaning for the marathon. For me, not having a stomach is something that I deal with. Only through your trials do you understand your strength.¡±
or by calling 1-877-632-6789.