Standard-of-care treatment for gastric cancer involves radical surgery, radiation therapy, and chemotherapy, alone or in combination, depending on the stage of disease at the time of diagnosis or recurrence. The following info explains the standard of care for all stages of gastric cancer.
Treatment for stage 0 gastric cancer
It may be surprising, but there is a stage “zero” for gastric cancer. Unfortunately, it doesn’t mean no cancer is present. Stage 0 means that the cancer is confined to the mucosa of the lining of the stomach. The treatment for stage 0 is gastrectomy, which is removal of all or part of the stomach, with lymphadenectomy, which is removal of one or more lymph nodes. Combining gastrectomy with lymphadenectomy for stage 0 gastric cancer provides a very good chance of surviving for at least five years, if not being completely cured.
Treatment for stage 1 gastric cancer
When gastric cancer is stage 1, there may be invasion to the layer under the mucosa and spread to up to 2 regional lymph nodes. Treatment for stage I may involve partial or total gastrectomy with regional lymphadenectomy. If the lymph nodes are positive for cancer spread, postoperative chemoradiation therapy is recommended.
Neoadjuvant (prior to surgery) chemoradiation therapy is being examined for its potential value in increasing survival rates. Patients with stage I gastric cancer are advised to seek and consider an appropriate clinical trial.
Treatment for stage 2 gastric cancer
Stage 2 gastric cancer may involve adjacent tissue and up to seven lymph nodes. Treatment includes partial or total gastrectomy with regional lymphadenectomy. Pre-surgical chemotherapy is recommended. After surgery, radiation therapy and chemotherapy are advised.
Investigative therapies include postoperative chemoradiation therapy with continuous intravenous infusion of fluouracil (5-FU), as well as presurgical chemoradiation therapy.
Patients with stage 2 gastric cancer are also advised to seek and consider taking part in a clinical trial.
Treatment for stage 3 gastric cancer
With stage 3, the tumor may have invaded adjacent structures and up to seven lymph nodes. Treatment includes partial or total gastrectomy with regional lymphadenectomy. Chemotherapy should be given before and after surgery, and radiation therapy should follow surgery. The value of postsurgical chemoradiation with three combined chemo drugs is being investigated for its value in treating stage 3 gastric cancer. Neoadjuvant (presurgical) chemoradiation therapy is also being investigated for its potential value.
It is important for stage 3 gastric cancer patients to seek an appropriate clinical trial.
Treatment for stage 4 and recurrent gastric cancer
Stage 4 gastric cancer means that the cancer has spread to other parts of the body. Stage 4 is the same as metastatic cancer and advanced cancer. For stage 4 gastric cancer, palliative chemotherapy is given to reduce tumor burden and increase comfort. The palliative chemotherapies that may be used include a combination of chemotherapy drugs.
If a person with stage 4 gastric cancer is found to have HER2-positive tumors, the combination of chemotherapy changes. So you know, the tests used to determine HER2 status are immunohistochemistry and fluorescence in situ hybridization.
Patients with advanced or recurrent disease may have an obstruction in the digestive tract. Several treatment modalities can be used to resolve an obstruction. Among them are endoluminal laser therapy, endoluminal stent placement, or gastrojejunostomy. Radiation therapy is useful in relieving an obstruction, as well as controlling bleeding and pain.
Palliative surgery is reserved for bleeding and obstructions that fail to respond to laser therapy, stent placement, or radiation therapy.
Another treatment possibility: an anti-VEGF drug targets vascular endothelial growth factor receptor 2, which in clinical studies increased survival by about 1.5 months in one study and about 2 months in another study.
Why are clinical trials important?
Most of the preceding standard-of-care chemotherapies are cytotoxic agents. That means they work by killing cancer cells, but they also kill healthy cells. Cytotoxic agents work for awhile, but cancer cells tend to become resistant to the drugs over time. Cytotoxic agents also cause side effects such as nausea and vomiting, diarrhea, peripheral neuropathy, and fatigue.
Genomic research is revolutionizing cancer treatment. The identification of genetic biomarkers related to gastric cancer will enable the development of new biologic agents that target specific biomarkers. Biologic agents that target specific biomarkers may be more effective and have fewer side effects.
Next-generation sequencing (NGS) is a technique that is helping to advance genomic discovery at a faster pace. NGS, according to a March 2017 study, has strengthened the role of TP53 and CDH1 as driver mutations in gastric cancer, but more research is needed to translate those findings into new treatment strategies. Clinical scientists now need to use the NGS study data to determine novel driver mutations that can make an impact on treatment and outcomes.
Immunotherapy is a promising strategy that has produced amazing results in blood cancers, non-small-cell lung cancers, and more. As discoveries are made and advanced, findings translate into new agents that are tested in clinical trials. Every standard-of-care drug was first tested in clinical trials. That makes clinical trials opportunities to try promising new agents.
To find current clinical trials, the first step is to ask an oncologist for help. Don’t stop there, however. Refer to the National Cancer Institute’s trial-matching site. If an appropriate trial isn’t listed one week, don’t be discouraged. Continue to check the resource because new studies can emerge at any time.
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Judi Ebbert earned her PhD at the University of South Florida’s College of Public Health. She has worked at three NCI-designated comprehensive cancer centers and is a writer/editor at Moffitt Cancer Center. Judi has great interest in chronic disease prevention and treatment, and is an advocate for equitable access to care and optimal quality of life for all people. She loves swimming, her dogs and cats, great food, art, humor, and cinematic thrillers. She’s on Twitter at Judi@judithebbert.