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Treatment decisions

A team of health professionals decides what treatment you need. This depends on factors such as your cancer stage and grade. You might have one or more treatments, including surgery, radiotherapy, chemotherapy or targeted cancer drugs. 

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a specialist MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.

The team usually includes:

  • a specialist surgeon
  • cancer specialists (oncologists) who specialise in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
  • a specialist cancer nurse (also called clinical nurse specialist)
  • a pathologist (an expert who examines any cancer or tissue the surgeon removes)
  • a radiologist (who looks at your scans and x-rays)
  • an endoscopist (a specialist who looks inside your food pipe and stomach using a flexible tube)
  • a dietician  (who offers support and advice about eating and drinking)
  • a palliative care doctor ( who specialises in controlling cancer symptoms)

Your treatment depends on:

  • where your cancer is in your stomach
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your MDT will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

The main treatments are:

  • surgery    
  • radiotherapy   
  • chemotherapy
  • targeted cancer drugs 

You might have one or more of these treatments depending on the stage of your cancer.


You might have surgery if your stomach cancer hasn't spread. Doctors remove:

  • cancer from the lining of the stomach (an endoscopic mucosal resection or EMR)
  • all or part of your stomach (a partial or total gastrectomy)

You might have surgery with other treatments. 


Radiotherapy uses high energy rays to destroy cancer cells.

You might have radiotherapy combined with chemotherapy (chemoradiotherapy) as part of a clinical trial.  Or you might have radiotherapy to control symptoms of advanced cancer. 


Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

You might have chemotherapy before and after surgery.  Or you might have chemotherapy as your main treatment if your cancer has spread and you can't have surgery. 

Targeted cancer drugs

Targeted cancer drugs can change the way that cells work and help the body control the growth of cancer.

You might have a targeted drug called trastuzumab (Herceptin) if you have advanced stomach cancer which is HER2 positive. HER2 stands for human epidermal growth factor receptor 2 which is a protein that makes cells grow and divide.

Clinical trials to improve treatment

Your doctor may ask if you’d like to take part in a clinical trial.

Doctors and researchers do trials to:

  • improve treatment
  • make existing treatments better
  • develop new treatments

Treatment by stage

Stage 0

The main treatment is surgery to remove the lining of your stomach. You have the abnormal areas in the lining of your stomach removed through a tube called an endoscope. This is called an endoscopic mucosal resection (EMR). 

Stage 1

Surgery is the main treatment. 

You might have surgery to remove all or part of the stomach.

For very early, small stage cancers you might be able to have surgery through a thin flexible tube (endoscope) to remove cancer from the lining of the stomach. This is called an endoscopic mucosal resection or EMR. You don't usually need any other treatment.

Stage 2 and 3 

You usually have surgery to remove all of or a part of your stomach. And have chemotherapy before and after surgery. 

If you haven't had chemotherapy before surgery then you might have:

  • chemotherapy combined with radiotherapy  (chemoradiotherapy) after surgery
  • chemotherapy on its own after surgery 

Your doctor discusses your options with you. 

Stage 4

Treatment aims to control the cancer and maintain a good quality of life. You might have:

  • chemotherapy
  • radiotherapy
  • symptom control, for example treatment to help you swallow food
  • trastuzumab (Herceptin) targeted cancer drug for cancers that have the HER2 protein
Last reviewed: 
30 Aug 2019
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    M Amin and S Edge.
    Springer, 2017

  • Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up 
    E Smyth and others, 
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  • Gastric cancer
    Custem and others
    The Lancet, 2016.

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    Izuishi and J Mori
    Gastrointestin Liver Disease, 2016. Volume 25

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    NICE technology appraisal guidance [TA208], 2010

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    National Institute for Health and Clinical Excellence (NICE)
    Published January 2018