Types of treatment for stomach cancer

As with many cancers, the main treatment options are surgery, chemotherapy and radiotherapy. You may have surgery with chemotherapy or radiotherapy, or on its own. Your doctors will plan your treatment taking into account

• How far your cancer has grown or spread (the stage)
• Your general health
• Your age and level of fitness

As with many types of cancer, the earlier your cancer is diagnosed, the easier it is to get it under control and possibly cure it. If your cancer is diagnosed before it has spread, you will almost certainly have surgery. The surgery for stomach cancer is very major. So it is important for your doctor to make sure you are fit enough for a big operation.

The amount of surgery you have will depend on the stage of your cancer. You are likely to have a CT scan and laparoscopy to help your specialist decide if surgery is an option for you. But your doctor may not be able to tell you exactly what stage your cancer is until after surgery. After surgery, specimens from the operation are sent to the lab where a pathologist looks at them under a microscope. This gives the most accurate measure of the cancer stage. Depending on the stage of the cancer, you might have

• Surgery to remove the cancer
• Surgery to relieve symptoms

Surgery to remove the cancer

If it is possible to try to cure your stomach cancer, you will have all or part of your stomach removed. How much is removed will depend on where in the stomach the cancer is. During your operation, your surgeon will examine the stomach and surrounding area. The lymph nodes around your stomach and part of the omentum (sheet of connective tissue that holds the stomach in place) will be removed. These will be sent to the laboratory and checked to see if they contain cancer cells.

Surgery to relieve symptoms

Even if your stomach cancer cannot be cured with surgery, you may need an operation to relieve symptoms and try to give you a better quality of life for longer. If the tumour is blocking the entrance or exit to your stomach you are likely to have a tube (called a stent) into the area, along with chemotherapy. Or you may have bypass surgery, where part of the stomach above the blockage is attached directly to the small bowel. Sometimes laser surgery is used to reduce the size of a tumour that is blocking the entrance to the stomach.

There is more about surgery for stomach cancer in this section.

You may have chemotherapy on its own or with surgery to treat stomach cancer. You are most likely to have chemotherapy on its own if your cancer is advanced and has already spread. This treatment can often relieve symptoms and may shrink a cancer or slow its growth.

A stomach cancer that has grown into nearby tissues but hasn't spread to another organ is called a locally advanced cancer. Sometimes locally advanced cancers have grown so far that it isn't possible to completely remove them. In this situation, you may have chemotherapy before surgery to try to shrink the cancer. In some cases, this can shrink it far enough for your surgeon to be able to remove it.

If you have a stage 2 or 3 cancer, you will usually be offered chemotherapy before and after surgery. The chemotherapy helps to lower the risk of the cancer coming back later. There is information about chemotherapy for stomach cancer in this section.

Radiotherapy is not routinely used to treat stomach cancer. In some cases, you may have radiotherapy after surgery to help stop your cancer coming back. This may be given as part of a clinical trial.

Radiotherapy is not used for advanced stomach cancer as often as chemotherapy. But radiotherapy may be used to try to shrink the tumour. It can also help to control pain or bleeding.

There is more about radiotherapy for stomach cancer in this section.

Trastuzumab (Herceptin) is a biological therapy sometimes used for people with adenocarcinoma of the stomach that has spread. It only works if their cancer cells have receptors for Herceptin (HER2 positive cancer). You have Herceptin in combination with chemotherapy such as capecitabine or fluorouracil and cisplatin.

There is information about Herceptin on the page about biological therapy for stomach cancer.