Stomach Cancer Treatment

Stomach cancer, also known as gastric cancer, occurs when abnormal cells grow uncontrollably in the lining of the stomach to form a tumor. Because the early signs of the disease are often subtle, it is very common for stomach cancer to be diagnosed at a more advanced stage.

Whether your cancer was caught early or has already spread, getting the best possible outcome requires a customized treatment plan. Depending on the type, size, and location of the tumor, along with your age and overall health, stomach cancer is typically treated with a combination of therapies. Your care team will work together to build a plan that might include surgery, chemotherapy, radiation therapy, targeted molecular therapies, or a mix of these approaches.

Preparing for Stomach Cancer Treatment

Preparing for stomach cancer treatment may be the most difficult thing you have faced up to this point in your life. You are likely feeling sad, scared, or confused about how you got cancer, and there is probably much uncertainty about what your new normal will be. One of the best ways to relieve some of that initial fear is to learn as much as you can. Do not hesitate to ask your doctor clinical questions, as understanding your plan will help you physically and mentally prepare.

Because you will be frequenting the hospital for surgery or chemotherapy, preparing a "travel bag" can help keep you comfortable and relaxed. Consider packing a sweatshirt or comfortable clothes, a pillow and blanket, books, an iPod and headphones, cards or crossword puzzles, a journal and pen, and crackers or other snacks as tolerated. Most importantly, lean on your support system. Some find it very helpful to talk to friends, family, or a counselor about the way they are feeling.

Surgical Options for Stomach Cancer

Surgery is the primary treatment for early-stage stomach cancer, particularly when the tumor is small and remains confined to the area where it originated. The goal is to remove the tumor and any affected tissues, helping to prevent the cancer from progressing.

Depending on the specifics of the tumor, your surgical oncologist may perform traditional open surgery or a robotic-assisted surgery. With robotic procedures, surgeons use an advanced computer console like the da Vinci® Surgical System to maneuver robotic instruments. This allows for smaller incisions, greater dexterity, a more detailed view, less blood loss, and a faster recovery. A surgeon may use robotic assistance for partial gastrectomies, total gastrectomies, wedge gastric resections (excising a small localized section), and transgastric tumor resections (removing a tumor directly through the stomach wall).

Surgical Options for Stomach Cancer

What to Expect After Stomach Cancer Surgery

If you are feeling uneasy about your upcoming surgery, one of the best ways to reassure yourself is to have your procedure performed by an experienced surgeon at a reputable cancer center. Educating yourself on what to expect will also help you go into the procedure prepared.

As with all surgeries, stomach cancer surgery can have a number of potential side effects. Commonly reported temporary effects include post-operative pain, nausea, heartburn, diarrhea, and fatigue. For most patients, these side effects are not serious and subside in the days and weeks following their surgery. Your physician can prescribe medications to help manage them, so be sure to speak up if your symptoms are not improving. Depending on the procedure, you may also need to make lifestyle changes, such as adjusting your diet or taking vitamin supplements to ensure your nutritional needs are met.

Advanced & Supportive Interventions for Stomach Cancer

If a stomach tumor is inoperable due to its size, location, or advanced stage, surgical treatment may be considered to improve your comfort and quality of life. The goal is to address tumor-related complications like digestive obstruction, bleeding, and difficulty swallowing.

For some patients, especially those who have an aggressive or difficult-to-treat type of cancer, CRS/HIPEC may lead to a better outcome and enhanced quality of life.

Sean Dineen, MD

• Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

  HIPEC for stomach cancer is a specialized treatment that combines cytoreductive surgery to remove all visible cancer cells with a concentrated dose of heated chemotherapy. Immediately after the tumor is removed, the heated chemo solution is circulated within the abdominal cavity for 60 to 90 minutes. Heat enhances the effectiveness of chemotherapy by increasing its penetration into the tissues, improving its ability to target microscopic tumor cells left behind. It can be effective in controlling peritoneal spread when systemic chemotherapy has shown limited success.

  • Recovery: This intensive procedure requires a 1-to-2-week hospital stay. Full recovery can take several months. It involves wound care for incisions, managing temporary changes in appetite and bowel function with a special diet, and working with a dietitian for nutritional support. Because chemotherapy weakens the immune system, you will be monitored for infection. The physical toll can impact your emotional well-being, making counseling and support groups highly beneficial. You can engage in light activities like walking, but must avoid strenuous activities for six to eight weeks.
  • Risks: Complications can include infection, significant bleeding requiring transfusion, inadvertent damage to nearby organs (intestines, liver, kidneys), chemo toxicity (nausea/vomiting), fluid imbalances causing dehydration or swelling, blood clots (DVT/PE), intestinal blockage from scar tissue, severe fatigue, and cancer recurrence.
• Stent Placement for Unresectable Stomach Cancer

  If an advanced or nonresectable tumor is causing a blockage, stent placement for unresectable stomach cancer can help. A surgeon endoscopically inserts a self-expanding metal into the obstructed area to reopen the passage. This minimally invasive technique restores normal digestion and offers immediate relief from nausea, vomiting, and difficulty eating. It does not treat the cancer itself, but acts as a supportive care plan.

  • Recovery: Most patients go home the same day after a short observation period. You will transition from liquids and soft foods to solid foods as tolerated. You can resume normal activities within a few days, but should avoid strenuous activities for a few weeks. Mild soreness can be managed with over-the-counter pain relievers.
  • Risks: The stent may drift from its original position (requiring repositioning) or become blocked by tumor growth or food debris. Other risks include minor bleeding, persistent pain, acid reflux or heartburn (indigestion), infection requiring antibiotics, and rarely, tissue perforation.
• Endoscopic Tumor Ablation for Unresectable Stomach Cancer

  Endoscopic tumor ablation for unresectable stomach cancer is a minimally invasive technique used to reduce the size of a tumor that is interfering with digestion. Using an endoscope, a surgeon delivers heat, cold, or laser energy directly to the tumor to destroy cancerous cells. This alleviates symptoms like obstruction, bleeding, and difficulty swallowing. It can be repeated if necessary.

  • Recovery: Patients typically go home the same day. Soft foods and liquids are recommended initially. Mild abdominal bloating or discomfort can be managed with over-the-counter pain relievers. Light activities like walking can be resumed quickly, avoiding strenuous activities for a few days.
  • Risks: Risks include excessive bleeding requiring intervention, abdominal pain and bloating, infection requiring antibiotics, stricture formation (scar tissue narrowing the tract), symptom recurrence, and tissue perforation leading to serious complications that necessitate surgical repair.

Radiation Therapy for Stomach Cancer

Radiation therapy uses high-energy beams to destroy cancer cells. It might be used on its own, alongside surgery to ensure no cells are left behind, or as a way to relieve pain and bleeding in advanced cases. Depending on the size, location, and stage of your tumor, your care team may recommend one of three primary ways to deliver this treatment.

• External Beam Radiation Therapy (EBRT)

  EBRT for stomach cancer directs high-energy beams at the tumor from outside the body. Advanced imaging techniques are used to map the tumor, ensuring beams focus precisely on the cancerous cells while sparing nearby structures like the liver and intestines.

  • Types of EBRT include:
    • Three-dimensional conformal radiation therapy (3D-CRT): Shapes the radiation beams to the exact dimensions of the tumor.
    • Intensity-modulated radiation therapy (IMRT): Modulates the intensity of the beam for greater control over the dose delivered.
    • Image-guided radiation therapy (IGRT): Continually adjusts for any movement or changes in the tumor's position.
    • Stereotactic radiosurgery (SRS): A nonsurgical procedure delivering high-dose, precisely targeted radiation to a small, well-defined tumor in a few sessions.
  • Benefits: EBRT can shrink a tumor to make it easier to remove, eliminate residual cells after surgery, enhance the impact of concurrent chemotherapy, or provide a noninvasive way to relieve symptoms.
  • Side Effects: Fatigue that increases as treatment progresses, nausea and vomiting, diarrhea (loose or frequent stools), skin changes similar to a mild sunburn, loss of appetite, emotional impact (stress or anxiety), and over the long term, minor scarring or stiffness affecting digestive function. Rarely, it may impact nearby organs like the liver, kidneys, or intestines.
• Internal Radiation Therapy

  Internal radiation therapy, also known as brachytherapy, for stomach cancer involves the temporary or permanent placement of a small radioactive device directly inside or near the tumor.

  • Benefits: High-dose-rate brachytherapy is highly precise, minimizing exposure to surrounding organs and tissues. It offers a higher concentrated dose, shorter treatment durations (fewer sessions), and improved comfort by relieving pain and bleeding.
  • Side Effects: Patients may experience localized discomfort at the insertion site, nausea and vomiting, bowel changes like diarrhea or constipation, fatigue, and minor bleeding if the tumor is located near blood vessels. Rarely, the insertion site can become infected, or minor scarring can occur.
• Systemic Radiation Therapy

  For systemic radiation therapy for stomach cancer, liquid radioactive drugs (radiopharmaceuticals like radioactive isotopes) are swallowed or administered intravenously. These drugs circulate throughout the bloodstream to selectively bind to and deliver radiation directly to cancerous tissues. Radioactive iodine is one example.

  • Benefits: Because it targets cancerous cells throughout the entire body, it is a minimally invasive way to treat metastatic stomach cancer. The precision binding minimizes damage to healthy tissues while alleviating symptoms like bone pain and organ dysfunction. It is often combined with chemotherapy.
  • Side Effects: The body's response can cause fatigue, digestive issues (nausea, vomiting, diarrhea, constipation), skin irritation at the injection site, and occasional pain at the tumor site. Radiation can interfere with healthy blood cell production, leading to an increased risk of infection, anemia, and bleeding. Long-term effects can include organ damage.

Medical Therapies for Stomach Cancer

Systemic medical therapies are crucial for treating both early-stage and advanced stomach cancers. Unlike localized treatments such as surgery or radiation, these therapies travel throughout the bloodstream to reach cancer cells anywhere in the body. Your care team may recommend chemotherapy, which uses powerful medications to destroy rapidly dividing cancer cells and shrink tumors. In other cases, molecular therapy (also known as targeted therapy) may be utilized. This innovative approach focuses directly on the specific genetic mutations driving your tumor's growth, blocking cancer progression while minimizing damage to healthy cells. Often, these systemic therapies are used together or in combination with surgery and radiation to provide the most effective treatment possible.

• Chemotherapy

  Delivered via IV infusion or swallowed in pill form, chemotherapy for stomach cancer uses a custom blend of powerful drugs to destroy cancer cells or inhibit their growth.

  • Benefits: Chemo can shrink tumors prior to surgery, destroy microscopic cells post-surgery to reduce the risk of recurrence, and act as a highly effective primary treatment for advanced or metastatic disease to control growth and alleviate symptoms.
  • Side Effects: Chemo drugs target rapidly dividing cells throughout the body, which irritates the gastrointestinal system, hair follicles, and blood cell production. Patients often experience extreme fatigue, nausea, vomiting, diarrhea or constipation, altered taste leading to loss of appetite, painful mouth sores, temporary hair loss, and neuropathy (numbness, tingling, or pain in the hands and feet). The physical toll can also cause emotional and mental strain, contributing to anxiety and depression. Low blood cell counts increase the risk of infection, anemia, and excessive bleeding.
• Molecular (Targeted) Therapy

  Molecular therapy for stomach cancer is a type of precision medicine. Instead of attacking all dividing cells, these drugs target specific genetic or molecular changes in the tumor—such as the HER2 protein involved in cell growth, or angiogenesis, which is the formation of new blood vessels that supply the tumor.

  • Benefits: By focusing on the unique tumor profile, targeted therapy can slow cancer progression, block pathways that allow cancer to spread, and improve treatment effectiveness. It can be combined with chemotherapy.
  • Side Effects: Because it avoids nonspecific damage to healthy cells, it generally has fewer side effects than chemotherapy. However, patients may still experience fatigue, gastrointestinal issues, skin reactions (rashes or dry skin), elevated blood pressure (hypertension), bleeding or clot formation, allergic infusion-related reactions, liver toxicity requiring close monitoring, and a suppressed immune system that increases infection vulnerability.

Clinical Trials

Clinical trials are research studies designed to evaluate newly developed treatments. They give patients access to groundbreaking novel chemotherapy regimens, radiation delivery techniques, surgical procedures, and targeted therapies long before they are available in other settings, serving as a source of hope for patients with advanced or treatment-resistant tumors.

The Moffitt Cancer Center Difference in Stomach Cancer Treatment

Moffitt is one of the largest and highest-volume cancer centers in the nation, and the surgeons in our Gastrointestinal Oncology Program have extensive experience in performing complex procedures, including partial and total gastrectomies. We also offer the latest chemotherapy drugs and radiation delivery techniques for stomach cancer. Additionally, through our robust portfolio of clinical trials, our patients can benefit from emerging treatment options that are not yet widely available.

Moffitt stands apart from other cancer centers due to the world-class expertise of our multidisciplinary team and our commitment to delivering evidence-based, highly individualized cancer care. If you would like to explore your treatment options for stomach cancer with a specialist at Moffitt, you can request an appointment by calling 1-888-663-3488 or using our online form. We do not require referrals. 

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