Stomach cancer is cured by surgically removing the tumor in your stomach. But surgery is only available if your cancer is found in early stages, or if it’s confined to a small area in more advanced stages. If your tumor is found later or if your tumor is in the upper part of your stomach or the GE junction, you may have chemotherapy and radiation to shrink the tumor and increase your chances of having an operation or to reduce your symptoms.
Surgery is an operation to remove a tumor, surrounding tissue, and possibly lymph nodes. A surgical oncologist who specializes in stomach cancer will usually perform this operation.
Endoscopic Mucosal Resection (EMR)
You might be eligible for nonsurgical removal of your tumor using EMR. This procedure uses an endoscope—a long flexible tube with a small video camera attached—to look at the inside of your stomach and identify the tumor. Then, your surgeon passes small surgical tools through the tube to remove the tumor and a small area around it.
EMR for gastric cancer was developed in Japan, where the disease is far more prevalent. Doctors at Columbia’s Center for Global Excellence in Gastric Cancer Care were among the world’s leading experts in this approach.
A gastrectomy is an operation that removes part or all of your stomach, plus surrounding lymph nodes and your omentum, a layer of fat tissue covering your stomach and intestines. Sometimes surgeons will also remove part of your esophagus and small intestine, depending on how far cancer has spread.
A partial gastrectomy removes the part of your stomach that’s affected. A total gastrectomy removes your entire stomach. After this surgery, you can eat only a small amount of food at a time, so you will have to eat more often. You might have a tube placed into your intestine during surgery, with the other end on the outside of your body. This is called a jejunostomy tube or J tube. It allows you to have liquid nutrition.
Both of these operations traditionally require “open” surgery, where the surgeon uses a large incision in your abdomen. However, we now offer minimally invasive robotic surgery for these procedures.
Minimally Invasive Robotic Surgery
Minimally invasive robotic surgery, also called laparoscopic surgery, usually results in less pain and pain medicine, fewer lung complications, quicker recovery, and smaller scars. We use robot-assisted gastrectomy and lymph node dissection as our standard of care.
During robotic surgery, your surgeon uses a high-definition computer screen and controls that manipulate the surgical instruments. The instruments and a tiny camera are inserted into your abdomen through two to four small incisions in your abdomen.
Your surgeon controls the robotic arms and instruments from across the room, using an excellent magnified view to carefully perform each step of the operation. The robot allows for greater precision and control, especially when your surgeon must operate near blood vessels.
Chemotherapy is the most commonly known cancer treatment. Chemotherapy uses medications (chemicals) to stop cancer growth and spread, and to prevent cancer from recurring, by causing rapidly dividing cancer cells to become damaged and die.
Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why it causes side effects like hair loss.
Chemotherapy is often given through an IV in our infusion center, but it can sometimes be given through a pill.
Chemotherapy can be used to treat stomach cancers that have spread beyond the tumor site. It’s sometimes given before an operation to shrink the tumor or after an operation to kill cancer cells that were left behind.
Chemotherapy drugs are usually given in cycles, with each period of treatment followed by a period of rest, allowing the body time to recover.
Scientists recently discovered that up to 20% of stomach cancers contain too much of the protein HER2. This is called HER2-positive cancer. If you have a HER2-positive tumor, you might benefit from trastuzumab (Herceptin), a drug that targets the HER2 receptors to counter tumor growth. You would get this medicine alongside chemotherapy.
Another new targeted therapy is called ramucirumab (Cyramza), which works by blocking the formation of blood vessels that feed tumor growth. You would get this drug by IV if you have tumor growth after regular chemotherapy.
Recent studies have shown that some patients with stomach cancer may benefit from immunotherapy. Immunotherapy is a newer treatment that uses the body’s own immune system to target the cancer. The immune system is constantly monitoring the body for foreign substances such as germs, viruses, and even abnormal cancerous cells. Once a foreign substance is identified, the immune system is activated to attack and destroy these foreign substances. Sometimes it is difficult for the immune system to identify cancer cells, either because the cancer cells do not appear different enough from normal cells or because the cancer cell has found a way to hide from the immune system. Checkpoint inhibitors are class of immunotherapy drugs that take the “brakes” off of the immune system to help it recognize and attack cancer cells.
Your doctor and care team will talk with you about immunotherapy and if it might be an option for you.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncology specialists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy.
Not all people with stomach cancer need radiation treatments. (Your personal care team will determine if you do.) If they recommend it for you, your radiation oncologist will create a course of treatment. You might have treatment daily, weekly, or every other day for a period of time, usually during an outpatient appointment.
If radiation treatment is recommended, a radiation oncologist will work with our radiation oncology team to create an optimal course of treatment specifically for you. At Columbia University Irving Medical Center, treatment modalities available and most commonly used for this cancer are external beam radiation therapy, 3D conformal radiotherapy, and intensity modulated radiation therapy (IMRT).
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of colorectal cancer patients. Columbia Cancer offers several stomach cancer clinical trials. You can talk to your care team about whether a clinical trial is an option for you.