The treatment of gastric cancer is tailored to each individual and may consist of surgery, precision cancer medicines, chemotherapy, and radiation therapy. The specific treatment can depend on the stage and genomic profile of the cancer. Optimal treatment will often require more than one therapeutic approach and is likely to involve several different types of physicians. These physicians may include a gastroenterologist, a surgeon, a medical oncologist, a radiation oncologist, or other specialists. Care must be carefully coordinated between the various treating physicians.
Surgery for Gastric Cancer
Surgery for gastric cancer is performed in order to remove the cancer and learn additional information about the cancer. Surgery can be performed with curative intent for some patients with earlier stage cancers. Patients with more-advanced cancer may undergo surgery for reduction of symptoms and prevention of obstruction of the bile duct.
Radiation Therapy for Pancreatic Cancer
Radiation therapy or radiotherapy uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment and is not useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer. Optimal treatment of patients with gastric cancer often requires more than one therapeutic approach.
Systemic Therapy: Precision Cancer Medicines and Chemotherapy
Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Some patients with early stage cancers already have small amounts of cancer that have spread away from the pancreas that cannot be treated with surgery or radiation. These patients require systemic treatment to decrease the chance of cancer recurrence. More advanced cancers that cannot be treated with surgery and radiation can only be treated with systemic therapy. Systemic therapies commonly used in the treatment of cancer include:
Precision Cancer Medicines
Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be used to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack gastric cancer cells with specific abnormalities, leaving normal cells largely unharmed.
All patients with gastric cancer should undergo genomic biomarker testing for HER2, PD-1 and other targets in order to determine if they can benefit from treatment with a precision cancer medicine. Roughly 20% of patients with gastric cancer have cancer that over expresses (makes too much of) this protein; these cancers are referred to as HER2-positive. For patients with HER2-positive gastric cancer, treatment with Herceptin can improve overall survival.1,2,3
Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. The drugs are usually given in cycles so that a recovery period follows every treatment period.4,5,6
Several chemotherapy medications administered alone or in combination can modestly prolong survival of patients with various stages of gastric cancer including the following;
- 5 – Flourouracil
- Xeloda (capecitabine)
- Lonsurf (Trifluridine/tipiracil)
- Lynparza (rubraca)
- Cyramza (ramucirumab)
New treatment strategies are sorely needed for this difficult to treat cancer and current emphasis is on the development of new precision cancer medicines.
In order to learn more about the most recent information available concerning the treatment of pancreatic cancer, click on the appropriate stage.
Stage 0: Cancer in situ is cancer that is limited to the surface layer of cells lining the stomach, which is called the epithelium.
Stage IA: Cancer invades beneath the surface layer of cells, but not into the muscle wall and there is no lymph node or distant spread of cancer.
Stage IB: Cancer invades beneath the surface layer of cells, with spread to 1-2 lymph nodes, or invades into the muscle of the wall of the stomach without regional lymph node or distant spread of cancer.
Stage II: Cancer invades beneath the surface, with spread to 3 or more lymph nodes; into the muscle of the wall of the stomach, with spread to 1-6 lymph nodes; into the next-to-the-last layer of the stomach, with spread to no more than 2 lymph nodes; or into the outermost layer of the stomach but not to the lymph nodes.
Stage III: Cancer has spread to adjacent structures and/or regional lymph nodes.
Stage IIIA: Cancer invades the muscle of the wall of the stomach and 7 or more lymph nodes, the next-to-the-last layer of the stomach and 3-6 lymph nodes, or the outermost layer of the stomach (the serosa) and 1-2 lymph nodes.
Stage IIIB: Cancer invades the next-to-the-last layer of the stomach and 7 or more lymph nodes, the outermost layer of the stomach and 3-6 lymph nodes, or adjacent structures and few (1-2) or no lymph nodes.
Stage IIIC: Cancer involves the outermost layer of the stomach and 7 or more lymph nodes, or adjacent structures and 3 or more lymph nodes.
Stage IV – Metastatic: Cancer has spread to distant sites.
1 Bang Y-J, Van Cutsem E, Feyereislova A et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010; 376:687-697.
2 Abstract LBA28_PR ‘KEYNOTE-059 Update: Efficacy and Safety of Pembrolizumab Alone or in Combination With Chemotherapy in Patients With Advanced Gastric or Gastroesophageal (G/GEJ) cancer.
4 Yung-Jue Bang, MD, PhD et al. online in the Journal of Clinical Oncology.
5 Shitara, K., Doi, T., Dvorkin, M., et al. Trifluridine/tipiracil versus placebo in patients with heavily pretreated metastatic gastric cancer (TAGS): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Oncology. 2018;19(11): 1437-1438.
6 Fuchs CS, Tomasek J, Yong CJ, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. The Lancet. Published early online October 3, 2013. doi:10.1016/S0140-6736(13)61719-5