Stomach Cancer: Treatments

The treatment of stomach cancer requires close coordination between a multi-disciplinary team that includes surgical and medical oncologists, gastroenterologists, radiation oncologists, radiologists, and pathologists. This team meets regularly to develop a personalized approach towards treating each patient with stomach cancer.

The only curative treatment for gastric cancer is to surgically remove the tumor within the stomach. That option is available if the cancer is found in early stages and in more advanced stages if it is confined to a limited area.

Chemotherapy and radiation may be used in conjunction with surgery to shrink the tumor or reduce symptoms and increase the chances of undergoing a curative surgery.

In the U.S., more than 60 percent of all cases are diagnosed when it is too late for surgery, making early screening and detection of the utmost importance, especially for patients who fall into high-risk categories.

Surgery

Endoscopic Mucosal Resection (EMR)

Some patients may be eligible for nonsurgical removal of their tumor using Endoscopic Mucosal Resection (EMR). This is similar to upper endoscopy, in that the surgeon uses an endoscope, or long flexible tube with a small video camera attached, to view the area and identify the tumor. Next, small surgical tools are passed through the endoscope to remove the tumor and a small area surrounding it.

EMR for gastric cancer was developed in Japan where the disease is far more prevalent. Doctors at the Center for Global Excellence in Gastric Cancer Care were among the world’s leading experts in this approach.

Open Surgery

A partial gastrectomy removes the portion of the stomach that is affected the cancer and may also take a part of the esophagus of the first section of the small intestine. Some of the omentum, a layer of fat tissue covering the stomach and intestines, may be removed as well, along with the nearby lymph nodes. Eating is much easier after surgery if only part of the stomach is removed instead of the entire stomach.

A total gastrectomy is performed if the cancer has spread throughout the stomach. Then the entire organ is removed along with the nearby lymph nodes, the omentum, and often part of the esophagus.

After this surgery, patients can only eat a small amount of food at a time. Because of this, they must eat more often. To address this problem, a tube may be placed to the intestine during surgery. One end is attached to the intestine while the other remains outside the body. This is called a jejunostomy tube or J tube and allows patient to receive liquid nutrition.

Traditionally both partial and total gastrectomies have done through a large incision (cut) in the skin of the abdomen. However, our experts have pioneered a new minimally invasive approach that may have fewer complications, and faster recovery time.

Minimally Invasive Robotic Surgery

With specialized training in robotic surgery for gastric cancer with the world's foremost experts, Dr. Yanghee Woo has brought robotically assisted gastrectomy and lymph node dissection to NYP/Columbia, where it is now a standard of care.

Instead of making a large abdominal incision, surgeons the use robotic technology to excise cancerous tissue. This approach allows for greater precision and control. It is particularly valuable in cases when the surgeon must operate near blood vessels. Dr. Woo has researched and published extensively on its benefits to patients.

Compared to open surgery, laparoscopic surgery benefits patients with decreased pain, fewer pulmonary complications, and a faster recovery.

More information can be found here.

Radiation Therapy

With advanced radiation therapy techniques doctors can better target tumors while reducing the radiation to nearby healthy tissues. Here at HICCC our radiation oncology experts have the ability to provide “state of the art” treatments for stomach disease.

Your radiation oncologist will design the optimal treatment plan with you to ensure you achieve the best outcomes. Treatment delivery can be daily, weekly, every other day, and or single fraction.

If radiation treatment is recommended, a radiation oncologist will work with our radiation oncology team to create a course of treatment. At Columbia University Irving Medical Center treatment modalities available and most commonly used for this cancer are External Beam Radiation Therapy, 3D Conformal Radiotherapy, Image Guided Radiation Therapy (IGRT), Intensity modulated radiation therapy (IMRT), Stereotactic Body Radiotherapy (SBRT) and Brachytherapy.

Chemotherapy

Chemotherapy drugs are given to kill cancer cells and can be given by mouth (orally) or injection. Chemotherapy may be given prior to surgery to kill cancer cells and make surgery more likely to be successful, and following surgery to destroy cancer remaining after surgery. If the cancer is advanced chemotherapy may slow the tumor’s growth, or reduce cancer-related symptoms.

Chemotherapy treatments for gastric cancer are based on the combination of fluorouracil (5-FU, Adrucil) and cisplatin (Platinol). Newer, similar drugs such as capecitabine (Xeloda), and oxaliplatin (Eloxatin), seem to be equally effective.Other commonly prescribed drugs include docetaxel (Docefrez, Taxotere), paclitaxel (Taxol), irinotecan (Camptosar), and epirubicin (Ellence).

Combination Therapy

For stomach tumors that arise in the proximal stomach or the GE junction, the optimal therapy is a combination of chemotherapy, radiation therapy, and surgery. For stomach tumors in other locations chemotherapy may be used prior to and following surgery. If someone has not had chemotherapy before surgery they should be evaluated for this therapy following the surgery.

Novel Therapies

Recently, it was shown that up to 20% of all stomach tumors contain too much of the protein HER2 (called HER2-positive cancer). Patients with these tumors may benefit from a targeted therapy called trastuzumab (Herceptin) which added to chemotherapy if patients have advanced stomach cancer.

Another new targeted therapy is called ramucirumab (Cyramza) and works by blocking the formation of blood vessels that may be necessary for feeding tumor growth. It is given intravenously for patients who have had tumor growth after traditional chemotherapy.