Gastric Cancer Treatment: Treatment - Patient Information [NCI]

What Is Stomach Cancer?

Stomach (gastric) cancer is cancer that starts in the cells lining the stomach. The stomach is an organ on the left side of the upper abdomen that digests food. The stomach is part of the digestive tract, a series of hollow, muscular organs joined in a long, twisting tube from the mouth to the anus. The digestive tract processes nutrients in foods that are eaten and helps pass waste material out of the body:

• Food moves from the throat to the stomach through a tube called the esophagus.
• After food enters the stomach, it is broken down by stomach muscles that mix the food and liquid with digestive juices.
• After leaving the stomach, partly digested food passes into the small intestine and then into the large intestine.
• The end of the large intestine, called the rectum, stores the waste from the digested food until it is pushed out of the anus during a bowel movement.

Anatomy of the digestive tract. The digestive tract is made up of organs that food and liquids travel through when they are swallowed, digested, absorbed, and leave the body as feces. These organs include the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum, and anus.

Types of stomach cancer

Adenocarcinoma of the stomach begins in the mucus-producing cells in the innermost lining of the stomach. Nearly all stomach cancers are adenocarcinomas.

Adenocarcinoma of the stomach is divided into two main classes, depending on where it forms in the stomach:

• Gastric cardia cancer begins in the top inch of the stomach, just below where it meets the esophagus.
• Non-cardia gastric cancer is cancer that begins in all other sections of the stomach.

Adenocarcinoma of the stomach also may be described as intestinal or diffuse, depending on how the cells look under a microscope:

• Intestinal adenocarcinomas are well differentiated, meaning the cancer cells look similar to normal cells under a microscope.
• Diffuse adenocarcinomas are undifferentiated or poorly differentiated, meaning the cancer cells look different from normal cells under a microscope. Diffuse adenocarcinomas tend to grow and spread more quickly than the intestinal type and be harder to treat.

Gastroesophageal junction adenocarcinoma (GEJ) is a cancer that forms in the area where the esophagus meets the gastric cardia. GEJ may be treated similarly to stomach cancer or esophageal cancer.

Gastrointestinal neuroendocrine tumors are cancers that begin in neuroendocrine cells (a type of cell that is like a nerve cell and a hormone-making cell) that line the gastrointestinal tract. Neuroendocrine cells make hormones that help control digestive juices and the muscles used in moving food through the stomach and intestines. Learn about gastrointestinal neuroendocrine tumors.

Gastrointestinal stromal tumors (GIST) begin in nerve cells that are found in the wall of the stomach and other digestive organs. GIST is a type of soft tissue sarcoma. Learn about gastrointestinal stromal tumors.

Primary gastric lymphoma is a type of non-Hodgkin lymphoma that forms in the stomach. Most primary gastric lymphomas are either mucosa-associated lymphoid tissue (MALT) gastric lymphoma or diffuse large B-cell lymphoma of the stomach.

Rarely, other types of cancer, such as squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma, can also begin in the stomach.

Stomach Cancer Symptoms

Early on, stomach cancer usually doesn't have symptoms, making it hard to detect. Symptoms usually begin after the cancer has spread.

When symptoms of early-stage stomach cancer do occur, they may include

• indigestion and stomach discomfort
• a bloated feeling after eating
• mild nausea
• loss of appetite
• heartburn

Symptoms of advanced stomach cancer (cancer has spread beyond the stomach to other parts of the body) may include the symptoms of early-stage stomach cancer and

• blood in the stool
• vomiting
• weight loss for no known reason
• stomach pain
• jaundice (yellowing of eyes and skin)
• ascites (build-up of fluid in the abdomen)
• trouble swallowing

These symptoms may be caused by many conditions other than stomach cancer. It's important to check with your doctor if you have any of these symptoms. Your doctor will ask when your symptoms started and how often you've been having them. If it is stomach cancer, ignoring symptoms can delay treatment and make it less effective.

To learn more, see Stomach Cancer Diagnosis.

Stomach Cancer Diagnosis

If you have symptoms that suggest stomach cancer, your doctor will need to find out if they're due to cancer or another condition. They may

• ask about your personal and family medical history to learn about your possible risk factors for stomach cancer
• do a physical exam, which will include feeling your abdomen for anything abnormal
• run blood tests to check for anemia (a low red blood cell count), which could be a sign of bleeding in the stomach
• check your stool for hidden (occult) blood, which could be a sign of bleeding in the stomach

Depending on these results, your doctor may recommend tests to find out if you have stomach cancer.

Tests to diagnose stomach cancer

The following tests and procedures are used to diagnose stomach cancer. The results will also help you and your doctor plan treatment.

Upper endoscopy with biopsy

Upper endoscopy is a procedure to look inside the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus. It may also have a tool to remove a sample of cells or tissue (biopsy) so a pathologist can view it under a microscope to check for signs of cancer.

The sample of tissue may be checked for Helicobacter pylori (H. pylori) infection and used for biomarker testing.

Talk with your doctor to learn what to expect during and after your biopsy.

To learn about the type of information that can be found in a pathologist's report about the cells or tissue removed during a biopsy, see Pathology Reports.

Upper endoscopy. A thin, lighted tube called an endoscope is inserted through the mouth and down the throat to check for abnormal areas in the esophagus, stomach, and first part of the small intestine.

Barium swallow

Barium swallow is a series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

Barium swallow for stomach cancer. The patient drinks a liquid that contains barium (a silver-white metallic compound). The barium coats and outlines the inside of the esophagus and stomach. This allows abnormal areas, such as stomach cancer, to be seen on x-rays.

CT (CAT) scan

A CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. To learn more, see Computed Tomography (CT) Scans and Cancer.

Biomarker testing

Biomarker testing is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer. Some biomarkers affect how certain cancer treatments work. Biomarker testing may help you and your doctor choose a cancer treatment for you.

To check for these biomarkers, samples of tissue containing stomach cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the stomach cancer cells have these biomarkers.

For stomach cancer, biomarker testing includes the following:

• HER2: The cancer cells may have larger than normal amounts of a protein called HER2.
• PD-L1: The cells may have larger than normal amounts of an immune checkpoint protein called PD-L1.
• Microsatellite instability: The cells may have microsatellite instability. This may be caused by mistakes that don't get corrected when DNA is copied in a cell.
• Mismatch repair deficiency: The cells may have a defect in a mismatch repair gene.
• Tumor mutational burden: If the cells have a high tumor mutational burden, it means they have many gene mutations.
• NTRK : The cells may have changes in one of the NTRK genes.

Learn more about Biomarker Testing for Cancer Treatment.

Learn more about Stomach Cancer Treatment.

Tests to stage stomach cancer

If you're diagnosed with stomach cancer, you will be referred to a gastrointestinal oncologist. This is a doctor who specializes in diagnosing and treating cancers of the stomach and intestines. Your doctor will recommend tests to find out if the cancer has spread and if so, how far. Sometimes the cancer is only in the stomach. Or, it may have spread from the stomach to other parts of the body. The process of learning the extent of cancer in the body is called staging. It is important to know the stage of the stomach cancer to plan treatment.

The following imaging tests and procedures may be used to find out your stage:

• Endoscopic ultrasound is a procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
• PET-CT scan combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself.
  • For the PET scan, a small amount of radioactive glucose is injected into a vein. The scanner rotates around the body and makes a picture of where glucose is being used in the body. Cancer cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
  • For the CT scan, a series of detailed x-ray pictures of areas inside the body is taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
• Magnetic resonance imaging (MRI) with gadolinium is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Laparoscopy is a surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples to be checked under a microscope for signs of cancer. A solution may be washed over the surface of the organs in the abdomen and then removed to collect cells. These cells are also looked at under a microscope to check for signs of cancer.

Getting a second opinion

You may want to get a second opinion to confirm your stomach cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get important medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans before giving a recommendation. The doctor who gives the second opinion may agree with your first doctor, suggest changes or another approach, or provide more information about your cancer.

To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. For questions you might want to ask at your appointments, see Questions to Ask Your Doctor about Cancer.

Stomach Cancer Survival Rates and Prognosis

If you've been diagnosed with stomach cancer, you may have questions about how serious the cancer is and your chances of survival. The likely outcome or course of a disease is called prognosis.

The prognosis for stomach cancer depends on

• the stage of the cancer, including whether the cancer is only in the stomach or has spread to lymph nodes or other places in the body
• your overall health

When stomach cancer is found early, there is a better chance of recovery. Stomach cancer is often advanced when it is diagnosed. At advanced stages, stomach cancer can be treated but is rarely cured. Learn more about Stomach Cancer Treatment.

Survival rates for stomach cancer

Doctors estimate stomach cancer prognosis by using statistics collected over many years from people with stomach cancer. One statistic that is commonly used in making a prognosis is the 5-year relative survival rate. The 5-year relative survival rate tells you what percent of people with the same type and stage of stomach cancer are alive 5 years after their cancer was diagnosed, compared with people in the overall population. For example, the 5-year relative survival rate for stomach cancer is 36%. This means that, overall, people diagnosed with stomach cancer are 36% as likely as similar people who do not have stomach cancer to be alive 5 years after diagnosis.

The 5-year relative survival rates for different stages of stomach cancer are:

• 75% for localized stomach cancer (cancer is in the stomach only)
• 35% for regional stomach cancer (cancer has spread beyond the stomach to nearby lymph nodes or organs)
• 7% for metastatic stomach cancer (cancer has spread beyond the stomach to a distant part of the body)

Understanding survival rate statistics

Because survival statistics are based on large groups of people, they cannot be used to predict exactly what will happen to you. The doctor who knows the most about your situation is in the best position to discuss these statistics and talk with you about your prognosis. It is important to note the following when reviewing survival statistics:

• No two people are alike, and responses to treatment can vary greatly.
• Survival statistics use information collected from large groups of people who may have received different types of treatment.
• It takes several years to see the effect of newer and better treatments, so current survival statistics may not reflect newer treatments.

To learn more about survival statistics and to see videos of patients and their doctors exploring their feelings about prognosis see Understanding Cancer Prognosis.

Stomach Cancer Stages

Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It is important to know the stage of the stomach cancer to plan the best treatment.

There are several staging systems for cancer that describe the extent of the cancer. Stomach cancer staging usually uses the TNM staging system. You may see your cancer described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to your cancer. When talking to you about your cancer, your doctor may describe it as one of these stages.

For information about how doctors stage stomach cancer, see the tests to stage stomach cancer section on Stomach Cancer Diagnosis. Learn more about Cancer Staging.

The information on this page is about staging for adenocarcinoma of the stomach, the most common type of stomach cancer.

Layers of the stomach wall

The stomach wall is made up of five layers of tissue and muscle. Knowing about these layers can help you understand the stage of your cancer.

Layers of the stomach wall. The wall of the stomach is made up of the mucosa (innermost layer), submucosa, muscle layer, subserosa, and serosa (outermost layer). The stomach is an organ in the upper abdomen.

• The mucosa is the innermost layer of the stomach wall. It is made of both epithelial cells and glandular cells. The glandular cells make mucus to protect the stomach lining and digestive juices to help break down food. Most stomach cancers start in glandular cells of the mucosa. Cancers that start in glandular cells are adenocarcinomas.
• The submucosa is the layer of connective tissue between the mucosa and the muscle layer. It contains blood vessels, lymph vessels, and nerve cells.
• The muscle layer is the next layer. The muscle layer helps the stomach mix food with digestive juices and move it into the small intestine, where nutrients are absorbed.
• The subserosa is a thin layer of connective tissue between the muscle layer and the serosa.
• The serosa is the outermost layer of the stomach wall.

Stomach cancers become more advanced as they spread from the mucosa to the outer layers.

To learn more about the stomach, see What Is Stomach Cancer?

Stage 0 (carcinoma in situ) of the stomach

Stage 0 refers to carcinoma in situ. This means that abnormal cells are found in the mucosa. These abnormal cells may become cancer and spread into nearby normal tissue.

Learn about treatment of stage 0 (carcinoma in situ) of the stomach.

Stage I (also called stage 1) stomach cancer

Stage I is divided into stages IA and IB.

• In stage IA,
  • cancer has formed in the mucosa and may have spread to the submucosa.
• In stage IB,
  • cancer has formed in the mucosa and may have spread to the submucosa and has spread to 1 or 2 nearby lymph nodes; or
  • cancer has formed in the mucosa and has spread to the muscle layer.

Learn about treatment of stage I stomach cancer.

Stage II (also called stage 2) stomach cancer

Stage II is divided into stages IIA and IIB.

• In stage IIA,
  • cancer may have spread to the submucosa and has spread to 3 to 6 nearby lymph nodes; or
  • cancer has spread to the muscle layer and to 1 or 2 nearby lymph nodes; or
  • cancer has spread to the subserosa.
• In stage IIB,
  • cancer may have spread to the submucosa and has spread to 7 to 15 nearby lymph nodes; or
  • cancer has spread to the muscle layer and to 3 to 6 nearby lymph nodes; or
  • cancer has spread to the subserosa and to 1 or 2 nearby lymph nodes; or
  • cancer has spread to the serosa.

Learn about treatment of stage II stomach cancer.

Stage III (also called stage 3) stomach cancer

Stage III is divided into stages IIIA, IIIB, and IIIC.

• In stage IIIA,
  • cancer has spread to the muscle layer and to 7 to 15 nearby lymph nodes; or
  • cancer has spread to the subserosa and to 3 to 6 nearby lymph nodes; or
  • cancer has spread to the serosa and to 1 to 6 nearby lymph nodes; or
  • cancer has spread to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen.
• In stage IIIB,
  • cancer may have spread to the submucosa or to the muscle layer and has spread to 16 or more nearby lymph nodes; or
  • cancer has spread to the subserosa or to the serosa and has spread to 7 to 15 nearby lymph nodes; or
  • cancer has spread to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen. Cancer has also spread to 1 to 6 nearby lymph nodes.
• In stage IIIC,
  • cancer has spread to the subserosa or to the serosa, and to 16 or more nearby lymph nodes; or
  • cancer has spread to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen. Cancer also has spread to 7 or more nearby lymph nodes.

Learn about treatment of stage III stomach cancer.

Stage IV (also called stage 4) stomach cancer

In stage IV, cancer has spread to other parts of the body, such as the lungs, liver, distant lymph nodes, and the tissue that lines the abdomen wall.

Stage IV stomach cancer is also called metastatic stomach cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if stomach cancer spreads to the lung, the cancer cells in the lung are actually stomach cancer cells. The disease is called metastatic stomach cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Learn about treatment of stage IV stomach cancer.

Recurrent stomach cancer

Recurrent stomach cancer is cancer that has recurred (come back) after it has been treated. Stomach cancer may come back in the stomach, lymph nodes, or other parts of the body, such as the liver, lung, or bone. Tests will be done to help determine where the cancer has returned in your body. The type of treatment that you have for recurrent stomach cancer will depend on where it has come back.

Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in Coping with Stomach Cancer and the booklet When Cancer Returns.

Learn about treatment of recurrent stomach cancer.

Stomach Cancer Treatment

Different types of treatments are available for stomach cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.

Talking with your cancer care team before treatment begins about what to expect will be helpful. You'll want to learn what you need to do before treatment begins, how you'll feel while going through it, and what kind of help you will need. To learn more, see Questions to Ask Your Doctor about Your Treatment.

For treatment by stage, see Stomach Cancer Treatment by Stage.

Endoscopic mucosal resection

Endoscopic mucosal resection is a procedure that uses an endoscope to remove carcinoma in situ and early-stage cancer from the lining of the digestive tract. An endoscope is a thin, tube-like instrument with a light and a lens and tools to remove tissue.

Surgery

Surgery is a common treatment for stomach cancer. The type of surgery depends on where the cancer is located.

Other treatments may be given in addition to surgery:

• Treatment given before surgery is called preoperative therapy or neoadjuvant therapy. Chemotherapy may be given before surgery to shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. Chemoradiation given before surgery, to shrink the tumor, is being studied.
• Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. After the doctor removes all the cancer that can be seen, some patients may be given chemotherapy, radiation therapy, or both to kill any cancer cells that are left.

Gastrectomy

Gastrectomy, the removal of part or all of the stomach, is the main surgery for stomach cancer:

• Subtotal gastrectomy is the removal of the part of the stomach that contains cancer, nearby lymph nodes, and parts of other tissues and organs near the tumor. The spleen may also be removed.
• Total gastrectomy is the removal of the entire stomach, nearby lymph nodes, and parts of the esophagus, small intestine, and other tissues near the tumor. The spleen may also be removed. Then the surgeon attaches the esophagus to the small intestine so the patient can continue to eat and swallow.

Endoluminal stent placement

Endoluminal stent placement may be done when the tumor blocks the passage into or out of the stomach. In this procedure, the surgeon places a stent (a thin, expandable tube) from the esophagus to the stomach or from the stomach to the small intestine to allow the patient to eat normally.

Endoluminal laser therapy

Endoluminal laser therapy is a procedure in which an endoscope (a thin, lighted tube) with a laser attached is used as a knife to open a gastrointestinal blockage.

Gastrojejunostomy

Gastrojejunostomy is the removal of the part of the stomach with cancer that is blocking the opening into the small intestine. Then the surgeon connects the stomach to the jejunum (a part of the small intestine) to allow food and medicine to pass from the stomach into the small intestine.

Radiation therapy

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Stomach cancer is sometimes treated with external radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Learn more about External Beam Radiation Therapy for Cancer and Radiation Therapy Side Effects.

Chemotherapy

Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

Chemotherapy for stomach cancer is usually systemic, meaning it is injected into a vein or given by mouth. When given this way, the drugs enter the bloodstream to reach cancer cells throughout the body.

Chemotherapy drugs used to treat stomach cancer include

• capecitabine
• cisplatin
• docetaxel
• doxorubicin
• epirubicin
• fluorouracil (5-FU)
• irinotecan
• leucovorin
• oxaliplatin
• paclitaxel
• trifluridine/tipiracil

To learn more about how chemotherapy works, how it is given, common side effects, and more, see Chemotherapy to Treat Cancer and Chemotherapy and You: Support for People With Cancer.

Targeted therapy

Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Your doctor may suggest biomarker tests to help predict your response to certain targeted therapy drugs. Learn more about Biomarker Testing for Cancer.

Targeted therapies used to treat stomach cancer include

• ramucirumab
• regorafenib
• trastuzumab
• trastuzumab deruxtecan

Learn more about Targeted Therapy to Treat Cancer.

Immunotherapy

Immunotherapy helps a person's immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about Biomarker Testing for Cancer.

Immunotherapy drugs used to treat stomach cancer include

• nivolumab
• pembrolizumab

These drugs work in more than one way to kill cancer cells. They are also considered targeted therapy because they target specific changes or substances in cancer cells.

Learn more about Immunotherapy to Treat Cancer and Immunotherapy Side Effects.

Hyperthermic intraperitoneal chemotherapy (HIPEC)

Regional chemotherapy is a method of placing chemotherapy directly into an organ or a body cavity, such as the abdomen, to mainly affect cancer cells in those areas.

A type of regional chemotherapy called hyperthermic intraperitoneal chemotherapy, or hot chemotherapy, is being studied to treat stomach cancer and may be offered at certain treatment centers. After the surgeon has removed as much of the cancer as possible during surgery, a chemotherapy drug, such as mitomycin or cisplatin, is warmed and pumped directly into the peritoneal cavity through a thin tube for about 2 hours. The surgeon then drains the chemotherapy from the abdomen and rinses the abdomen before closing the incision.

Clinical trials

A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. For some patients, taking part in a clinical trial may be an option.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

To learn more, see Clinical Trials Information for Patients and Caregivers.

Follow-up testing

Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. These tests are sometimes called follow-up tests or check-ups.

You may also have blood tests for tumor markers such as CEA and CA 19-9. Increased levels of these markers may mean your stomach cancer has come back. Learn more about Tumor Markers.

Stomach Cancer Treatment by Stage

Cancer stage is an important factor in deciding the best treatment for stomach cancer. Other factors, such as your preferences and overall health, are also important.

For some people, taking part in a clinical trial may be an option. Clinical trials of new cancer drugs or treatment combinations may be available. To learn more about clinical trials, including how to find and join a trial, see Clinical Trials Information for Patients and Caregivers.

Treatment of stage 0 stomach cancer (carcinoma in situ)

Gastrectomy (surgery to remove all or part of the stomach and nearby lymph nodes) is the main treatment for stage 0 stomach cancer (carcinoma in situ).

Endoscopic mucosal resection uses an endoscope to remove abnormal growths or tissue from the lining of the digestive tract without open surgery. It may be done in people with small tumors that have a low risk of spreading to nearby lymph nodes.

To learn more about these treatments, see Stomach Cancer Treatment.

Treatment of stage I stomach cancer

Gastrectomy (surgery to remove all or part of the stomach and nearby lymph nodes) is the main treatment for stage I stomach cancer. Some people may receive chemotherapy and/or radiation therapy before or after surgery. Giving chemotherapy at the same time as radiation therapy may help the radiation therapy work better.

There are many chemotherapy drugs used for stage I stomach cancer, including capecitabine, cisplatin, docetaxel, epirubicin, fluorouracil (5-FU), leucovorin, and oxaliplatin. These drugs may be given alone or in combination.

Endoscopic mucosal resection is a less invasive procedure that may be used in people with small tumors that have a low risk of spreading to nearby lymph nodes.

To learn more about these treatments, see Stomach Cancer Treatment.

Treatment of stages II and III stomach cancer

Gastrectomy (surgery to remove all or part of the stomach and nearby lymph nodes) is the main treatment for stage II stomach cancer and stage III stomach cancer. Some people may receive chemotherapy and/or radiation therapy before or after surgery. Giving chemotherapy at the same time as radiation therapy may help the radiation therapy work better.

There are many chemotherapy drugs used for stage II and stage III stomach cancer, including capecitabine, cisplatin, docetaxel, epirubicin, fluorouracil (5-FU), leucovorin, and oxaliplatin. These drugs may be given alone or in combination.

To learn more about these treatments, see Stomach Cancer Treatment.

Treatment of stage IV stomach cancer, stomach cancer that cannot be removed by surgery, and recurrent stomach cancer

Treatment of stage IV stomach cancer, any stage of stomach cancer that cannot be removed by surgery, and recurrent stomach cancer is palliative. Palliative therapy is treatment meant to improve the quality of life of people who have a serious or life-threatening disease, such as cancer. Many of the same treatments for cancer, such as chemotherapy or other kinds of drugs and radiation therapy, can also be used for palliative therapy to help a patient feel more comfortable. Learn more about Palliative Care in Cancer.

The first palliative treatment for HER2-negative tumors might include chemotherapy with or without the immunotherapy drug nivolumab. For HER2-positive tumors, it might include the immunotherapy drug pembrolizumab and the targeted therapy drug trastuzumab combined with chemotherapy.

Subsequent palliative therapy may include one of the following:

• chemotherapy
• ramucirumab with or without chemotherapy
• pembrolizumab for DNA mismatch repair deficiency cancer, microsatellite instability-high cancer, or tumor mutational burden -high cancer
• trastuzumab deruxtecan for HER2-positive cancer

There are many chemotherapy drugs used as palliative therapy for advanced stomach cancer, including capecitabine, cisplatin, docetaxel, doxorubicin, epirubicin, etoposide, fluorouracil (5-FU), irinotecan, leucovorin, oxaliplatin, paclitaxel, and trifluridine and tipiracil. These drugs may be given alone or in combination.

A specific way of giving chemotherapy called hyperthermic intraperitoneal chemotherapy, or HIPEC, may be an option at some treatment centers. This treatment uses warmed chemotherapy to wash the inside of the abdomen during surgery.

If you have side effects from the cancer or its treatment, you may be given other treatments to help reduce those side effects so you are more comfortable. For example, if you have a blockage in your stomach, you may receive endoluminal laser therapy or endoluminal stent placement to relieve the blockage or a gastrojejunostomy to bypass the blockage. Radiation therapy or surgery may be done to stop bleeding, relieve pain, or shrink a tumor that is blocking the stomach.

To learn more about these treatments, see Stomach Cancer Treatment.

Coping with Stomach Cancer

Stomach cancer and its treatments may cause physical and emotional side effects. When you first learn that you have stomach cancer, you may wonder how you're going to cope with the upcoming changes in your life. One step you can take is to be informed of the changes that may occur and what resources are available to help you. Speaking up about any problems you have can give you a greater sense of control. Your health care team can talk with you about ways to reduce these side effects so you feel better.

For resources on the common physical side effects of treatment for stomach cancer, see Stomach Cancer Treatment. Learn more about side effects of cancer treatment and ways to manage them. For help with emotional side effects, see Emotions and Cancer.

Changes in eating and nutrition

Stomach cancer and its treatments may affect your ability to eat enough food or absorb the nutrients from food. If part or all of your stomach has been removed, you might need to eat smaller amounts of food more often or make changes to what you eat. Your doctor or dietitian may recommend that you stay upright for some time after eating. They can also help you adjust your diet to make sure you get the nutrition you need.

To get tips on eating during cancer treatment, see Eating Hints: Before, during, and after Cancer Treatment.

Learn more about how cancer affects nutrition in Nutrition in Cancer Care.

Changes in body image

Stomach cancer and its treatment can change how you look and feel about yourself. Know that you aren't alone in how you feel. Coping with changes to your body and the way you see yourself can be hard. But, over time, many people learn to adjust and move forward.

Learn more about how body changes may affect your self-image and sex life after treatment and ways to cope and communicate your feelings in How Cancer Affects Your Self-Image and Sexuality.

Stress in dealing with follow-up care

Many people who have been treated for stomach cancer need to visit their doctor regularly to get follow-up exams or tests. Planning and scheduling these appointments can be stressful and time-consuming. Waiting for test results can cause anxiety and an ongoing fear of recurrence. The added costs of things such as copays, medicines, and parking and transportation fees only add to the stress. For tips on how to deal with the fear of cancer coming back, see the section Coping with Fear of Recurrence on our A New Normal page.

Cost of cancer treatment

Cancer is one of the most costly diseases to treat in the United States. Even if you have health insurance, you may face major financial challenges and need help dealing with the costs of stomach cancer treatment. The problems a person has related to the cost of treatment is known as financial toxicity. For tips and ways to cope, see Managing Cancer Costs and Medical Information. To learn about financial toxicity and find out if you are at risk, see Financial Toxicity (Financial Distress) and Cancer Treatment.

Last Revised: 2024-04-10

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If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.

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