Stomach CancerLast Updated: October 04, 2011 This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/11 Overview
About the stomach The stomach is located in the upper abdomen and plays a central role in digesting food. When food is swallowed, it is pushed down the esophagus (the muscular tube that connects the throat with the stomach) and enters the stomach. The muscles in the stomach mix the food and release gastric juices that help break down and digest the food. The food then moves into the small intestine for further digestion. Types of stomach cancer Stomach cancer, also called gastric cancer, begins when cells in the stomach become abnormal and grow uncontrollably. These cells form a growth of tissue, called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Cancer can begin in any part of the stomach, and it can spread to nearby lymph nodes and other areas of the body, such as the liver, bones, lungs, and a woman’s ovaries. Most stomach cancers are a type called adenocarcinoma, which means that the cancer started in the glandular tissue that lines the inside of the stomach. Other types of cancerous tumors that form in the stomach include lymphoma, gastric sarcoma, and carcinoid tumors, but these are rare. Find out more about basic cancer terms used in this section. Looking for More of an Overview? If you would like additional introductory information, explore these related items on Cancer.Net:
Or, choose “Next” (below, right) to continue reading this detailed section. To select a specific topic within this section, use the icon panel located on the right side of your screen. Statistics
This year, an estimated 21,520 adults (13,120 men and 8,400 women) in the United States will be diagnosed with stomach cancer. It is estimated that 10,340 deaths (6,260 men and 4,080 women) from this disease will occur this year. The incidence of stomach cancer varies in different parts of the world. Although it is decreasing in the Western world, it is still one of the most common cancer types worldwide. The five-year survival rate (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of people with stomach cancer is about 28%. This statistic reflects the fact that most people with stomach cancer are diagnosed after the cancer has already spread to other parts of the body. If stomach cancer is found before it has spread, the five-year survival rate is generally higher but depends on the stage of the cancer found during surgery. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with stomach cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics. Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2011. Medical Illustrations
Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. The following factors may raise a person’s risk of developing stomach cancer: Age. Stomach cancer occurs most commonly in people older than age 55. Most people diagnosed with stomach cancer are in their 60s and 70s. Gender. Men have twice the risk of developing stomach cancer, compared with women. Family history. People who have a first-degree relative (a parent, child, or sibling) who has had stomach cancer are at increased risk for stomach cancer. Race. Black people are more likely than white people to develop stomach cancer. Diet. Eating foods preserved by drying, smoking, salting, or pickling may increase the risk of stomach cancer. Eating fresh fruits and vegetables may help lower the risk. Bacteria. A common bacterium called Helicobacter pylori, which causes stomach inflammation and ulcers, may increase the risk of stomach cancer. However, most people who are infected with this bacterium never develop stomach cancer. Previous surgery or health conditions. People who have had stomach surgery or have pernicious anemia (a severe decrease in red blood cells that occurs when the body does not have enough B12, which is usually due to the stomach’s inability to properly absorb the vitamin) or achlorhydria (the absence of hydrochloric acid in the gastric juices, which help digest food) have an increased risk of stomach cancer. Occupational exposure. Exposure to certain dusts and fumes may increase the risk of developing stomach cancer. Tobacco and alcohol. Tobacco use and excessive alcohol consumption may increase the risk of developing stomach cancer. Genetic mutations. Certain inherited genetic disorders, such as hereditary diffuse gastric cancer, Lynch syndrome, and familial adenomatous polyposis (FAP) may increase the risk of stomach cancer. Obesity. Excess body weight increases a man’s risk of developing stomach cancer. It is not clear whether obesity increases a woman’s risk of stomach cancer. Symptoms and Signs
People with stomach cancer may experience the following symptoms or signs. Sometimes, people with stomach cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor. Stomach cancer is usually not found at an early stage because it often does not cause specific symptoms. When symptoms do occur, they may be vague and can include:
Symptoms of advanced stomach cancer may include:
It is important to remember that these symptoms can also be caused by many other illnesses, such as a stomach virus or an ulcer. People with any of the symptoms listed above should talk with their doctor. Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
In addition to a physical examination, the following tests may be used to diagnose stomach cancer: Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Endoscopy. This test allows the doctor to see the inside of the body. The person may be sedated, and the doctor inserts a thin, lighted, flexible tube called a gastroscope or endoscope through the mouth, down the esophagus, and into the stomach and small bowel. The doctor can remove a sample of tissue during an endoscopy and check it for evidence of cancer. Endoscopic ultrasound. This test is similar to an endoscopy, but the gastroscope has a small ultrasound probe on the end that produces a detailed image of the stomach wall. An ultrasound uses sound waves to create a picture of the internal organs. The ultrasound image helps doctors determine how far the cancer has spread into the stomach and nearby lymph nodes, tissue, and organs, such as the liver. X-ray. An x-ray is a way to create a picture of the structures inside of your body, using a small amount of radiation. Barium swallow. In a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray. Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Laparoscopy. A laparoscopy is a minimally invasive surgery in which the surgeon inserts a scope into the abdominal cavity to evaluate spread of the stomach cancer to the lining of the abdominal cavity or liver. This pattern of cancer spread is not detected by CT or PET scan. Learn more about what to expect when having common tests, procedures, and scans. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer. Staging
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. This section covers staging of adenocarcinoma, the most common type of stomach cancer. Staging is different for gastric lymphoma, sarcoma, and carcinoid tumors. One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
Tumor. Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the how far the tumor has extended into the stomach. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below: TX: The primary tumor cannot be evaluated. T0 (T plus zero): There is no evidence of a primary tumor in the stomach. Tis: This stage describes a condition called carcinoma (cancer) in situ. The cancer is found only in cells on the surface of the epithelium (the inner lining of the stomach) and has not spread to any other layers of the stomach. T1: The tumor has invaded the lamina propria, muscularis mucosae, or the submucosa (the inner layers of the wall of the stomach). T1a: The tumor has invaded the lamina propria or muscularis mucosae. T1b: The tumor has invaded the submucosa. T2: The tumor has invaded the muscularis propria (the muscle layer of the stomach). T3: The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach, but it has not penetrated the peritoneal lining or serosa. T4: The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach and has penetrated the peritoneal lining or serosa or the organs surrounding the stomach. T4a: The tumor has invaded the serosa. T4b: The tumor has invaded organs surrounding the stomach. Node. The “N” in the TNM staging system is for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes inside the abdomen are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. The overall prognosis for patients with stomach cancer is based on how many regional lymph nodes show evidence of cancer. If six lymph nodes or fewer are involved, the prognosis is better than if more than 15 lymph nodes contain cancer cells. NX: Regional lymph nodes cannot be evaluated. N0 (N plus zero): The cancer has not spread into the regional lymph nodes. N1: The cancer has spread to one to two regional lymph nodes. N2: The cancer has spread to three to six regional lymph nodes. N3: The cancer has spread to seven or more regional lymph nodes. N3a: The cancer has spread to seven to 15 regional lymph nodes. N3b: The cancer has spread to more than 16 regional lymph nodes. Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body. MX: Distant metastasis cannot be evaluated. M0 (M plus zero): The cancer has not metastasized. M1: The cancer has spread to another part or parts of the body. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. Stage 0: This is also called carcinoma in situ. The cancer is found only on the surface of the epithelium. The cancer has not invaded any other layers of the stomach and is considered an early cancer (Tis, N0, M0). Stage IA: The cancer has invaded the inner layer of the wall of the stomach, but it has not spread to any lymph nodes or other organs (T1, N0, M0). Stage IB: Stomach cancer is called stage IB in either of these two conditions:
Stage IIA: Stomach cancer is called stage IIA for any one of these conditions:
Stage IIB: Stomach cancer is called stage IIB for any one of these conditions:
Stage IIIA: Stomach cancer is called stage IIIA for any one of these conditions:
Stage IIIB: Stomach cancer is called stage IIIB for any of these conditions:
Stage IV: Stage IV stomach cancer describes a cancer of any size that has spread to distant parts of the body besides the area around the stomach (any T, any N, M1). Recurrent cancer. Recurrent cancer is cancer that comes back after treatment. It may be a localized recurrence (comes back in the place where it started), or it may be a distant metastasis (comes back in another part of the body). If there is a recurrence, the cancer may need to be staged again (re-staging) using the system above. Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net. The Japanese system for staging stomach cancer Stomach cancer is much more common in Japan (and other parts of Asia and South America) than in the United States. Japan has a different method of staging stomach cancer, based on where the affected lymph nodes are located around the stomach. This is different from the U.S. system, which uses the number of lymph nodes and not their location. Surgery for stomach cancer may be described using the Japanese system. The type of surgery is identified by which lymph nodes are removed in addition to the stomach. Learn more about surgery for stomach cancer in the Treatment section.
Treatment
This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections. Treatment overview In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For stomach cancer, the team of doctors may include a gastroenterologist (a doctor who specializes in the gastrointestinal tract, including the stomach and intestines), a surgeon, a medical oncologist, and a radiation oncologist. Stomach cancer may be treated with surgery, radiation therapy, or chemotherapy. Descriptions of these common treatment options for stomach cancer are listed below. Often, a combination of these treatments is used. It can be difficult to cure stomach cancer because it is often not detected until it is at an advanced stage. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Learn more about making treatment decisions. Surgery Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The type of surgery will depend on the stage of the cancer (see Staging). In early stages (stages 0 or I), when the cancer is still contained within the stomach, treatment usually consists of surgery to remove the affected part of the stomach and nearby lymph nodes. For a very early stage (T1a) cancer, some doctors may recommend a non-surgical treatment called endoscopic mucosal resection (removal of the tumor with an endoscope; see Diagnosis). If the cancer has spread to the outer stomach wall or to more than three lymph nodes (stages II or III), surgery plus either chemotherapy or radiation therapy may be used. The surgeon can perform a subtotal or partial gastrectomy (removal of part of the stomach) or a total gastrectomy (removal of all of the stomach). During a gastrectomy, the surgeon attaches the esophagus directly to the small intestine. In a partial gastrectomy, the surgeon connects the remaining part of the stomach to the esophagus or small intestine. After this surgery, the patient will only be able to eat a small amount of food at a time. Gastrectomy is major surgery and can have serious complications or side effects. One common side effect is a group of symptoms known as dumping syndrome, which includes cramps, nausea, diarrhea, and dizziness after eating. This happens when food enters the small intestine too fast. The doctor can suggest ways to avoid this and can prescribe medication to help control these symptoms. The symptoms usually disappear in a few months, but in some cases, they may be permanent. Patients who have their entire stomach removed will need regular injections of vitamin B12 because they will no longer be able to absorb this essential vitamin through their stomach. Regional lymph nodes are often removed during surgery (lymphadenectomy) because the cancer may have spread to those lymph nodes. There is still debate as to how extensive the lymphadenectomy should be. In Europe and especially in Japan, more lymph nodes are routinely removed than in the United States. When the cancer is diagnosed as Stage IV, surgery is typically not a primary treatment recommendation (see metastatic stomach cancer below). Learn more about cancer surgery. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Patients with stomach cancer usually receive external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells. Side effects from radiation therapy include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Chemotherapy can be given by mouth (orally) or injection. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce cancer-related symptoms. It also may be combined with radiation therapy. Currently, there is no standard chemotherapy treatment plan that is accepted worldwide. However, most chemotherapy treatments are based on the combination of at least two drugs, fluorouracil (5-FU, Adrucil) and cisplatin (Platinol). Newer drugs similar to 5-FU (such as capecitabine or Xeloda) and similar to cisplatin (such as oxaliplatin or Eloxatin) appear to be equivalent. Other drugs commonly used include docetaxel (Taxotere), paclitaxel (Taxol), irinotecan (Camptosar), and epirubicin (Ellence). In addition, patients whose stomach tumors have too much of the protein HER2 (called HER2-positive cancer) may benefit from the addition of trastuzumab (Herceptin) to chemotherapy in advanced stomach cancer. For more information about targeted therapies, such as trastuzumab, see the Current Research section. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Recurrent stomach cancer Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence. Metastatic stomach cancer If cancer has spread to another location in the body (called Stage IV), it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials. In addition to treatment to slow or stop growth of the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs. The goal of treatment at this stage is typically to prolong life and increase the patient’s comfort since metastatic stomach cancer is not considered curable. Any treatment, including chemotherapy or radiation therapy, is considered palliative therapy. The role of surgery is limited, and the primary treatment is usually chemotherapy. It is important to note that studies indicate that the use of palliative chemotherapy can improve both the length and quality of life. Given the inability to cure metastatic stomach cancer, this diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with stomach cancer. To make scientific advances, doctors create research studies involving people, called clinical trials. Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating stomach cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with stomach cancer. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for stomach cancer, learn more in the Current Research section. Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with stomach cancer. Learn more about caregiving. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of stomach cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care. A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
After treatment for stomach cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. People who have had their entire stomach removed can feed themselves and live normally, but it is important for them to learn how to eat and take food in after this major surgery. Talk with your doctor about this type of rehabilitation. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed. People recovering from stomach cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes. Find out more about common terms used after cancer treatment is complete. Current Research
Doctors are working to learn more about stomach cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you. Chemoprevention. This is the use of drugs or nutrients to lower a person’s risk of developing cancer. Preliminary research indicates that using antibiotics to treat people infected with Helicobacter pylori (see Risk Factors) can prevent changes to stomach cells that may lead to cancer. Combination therapy. The combination of chemotherapy, radiation therapy, and surgery may reduce the chance that stomach cancer will return. Doctors may give chemotherapy before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy). In addition, doctors may give combined radiation therapy and chemotherapy after surgery. Doctors are also exploring the possibility of giving both radiation therapy and chemotherapy before surgery, but this approach is usually given after surgery. Newer chemotherapy treatments. Multidrug chemotherapy combinations are being increasingly used for people with stomach cancer and may modestly improve effectiveness. As outlined in Treatment, taxanes (a group of drugs that includes paclitaxel [Taxol] and docetaxel [Taxotere]), irinotecan (Camptosar), oxaliplatin (Eloxatin), and oral medications such as S-1 and capecitabine (Xeloda) are drugs that are being combined with other types of chemotherapy. Targeted therapies. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells, usually leading to fewer side effects than other cancer medications. Anti-angiogenesis therapy is a type of targeted therapy. It is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients found in blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Drugs that block the growth of new blood vessels are called antiangiogenic drugs. Other new drugs function by blocking important growth promoting pathways in stomach cancer, including the epidermal growth factor receptor (EGFR). Examples of targeted therapies under large scale investigation include cetuximab (Erbitux) and panitumumab (Vectibix). As discussed in Treatment, trastuzumab, which targets HER2 (a specialized protein that controls cancer growth and spread), is approved for use in metastatic stomach cancer patients whose tumors test HER2 positive. Bevacizumab (Avastin) failed to improve survival when combined with chemotherapy in a recently completed clinical trial. Learn more about targeted treatments. Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current stomach cancer treatments in order to improve patients’ comfort and quality of life. Learn more about common statistical terms used in cancer research. To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now. Questions to Ask the Doctor
Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
