When you come to Siteman for stomach cancer treatment, WashU Medicine physicians will design a unique treatment plan just for you. They will work to remove your cancer and stop it from growing. They will also do everything they can to help you heal and thrive. With the help of expert support staff such as dieticians, they will make sure you feel your best during and after treatment.
Most patients with stomach cancer get a combination of treatments. This usually includes surgery and drug therapy. Your treatment plan will depend on the type and stage of your tumor. Your doctors will also tailor treatments to your age, your lifestyle, and other goals you may have.
Many patients at Siteman receive treatment through clinical trials. Siteman offers more clinical trials than any other center in our region. If any clinical trials are a good fit for you, your care team will include them in your treatment plan.
The treatments described here are for the most common kind of stomach cancer (adenocarcinoma). For more information about treatments for GIST or GI NET tumors.
What is surgery for stomach cancer?
There are different types of surgery for stomach cancer. Your doctors will choose a surgery for you based on how far your cancer has spread.
Surgical procedures for stomach cancer include:
- Removal of small tumors: This procedure is called an “endoscopic submucosal dissection.” It can work well for patients with small, early-stage cancers. Your doctor will remove your tumor through a tube placed through your mouth and into your stomach. This tool is called an endoscope. The surgeon does not make any incisions through your skin.
- Partial removal of the stomach: This procedure is also called a subtotal gastrectomy. During the procedure, the surgeon will take out most of the stomach (about 80%).
- Total removal of the stomach: This procedure is also called a total gastrectomy. After removing your stomach, your surgeon will connect your esophagus to your small intestine. After a period of recovery, you will be able to eat and digest food again.
- Gastrojejunostomy: This procedure is for stomach tumors that block the connection between the stomach and the small intestine. Tumors in this area prevent patients from digesting their food because the food is trapped in the stomach. Your surgeon will take out the tumor and the surrounding stomach tissue. Then, they will connect the rest of your stomach to a lower part of your small intestine called the “jejunum.” A gastrojejunostomy can help patients with later-stage stomach cancer feel better.
- Endoluminal stent placement: This procedure also helps patients with tumors blocking the passages into or out of the stomach. Your surgeon will place a thin tube called a stent to keep these passages open. After the procedure, you should be able to eat normally again.
What are the advantages of stomach cancer surgery at Siteman?
Patients who come to Siteman benefit from the care of expert, WashU Medicine surgeons. Many of our patients can have their surgeries done using minimally-invasive techniques. This means, instead of making one large incision, your surgeons will make several smaller ones. They will use special tools and cameras to do the surgery inside your body.
WashU Medicine surgeons at Siteman are also skilled at using robotic tools during surgeries. The tools allow for extra precision and better outcomes.
There are many advantages to minimally-invasive surgeries for stomach cancer.
Short-term benefits include:
- During surgery: shorter surgery times, less anesthesia needed, less blood loss
- After surgery: fewer complications
- Recovery:
- Shorter time spent in the hospital
- A quicker return to eating
- Faster return to treatments like chemotherapy
- Less rehabilitation needed overall
Not every patient is a candidate for minimally-invasive surgery. Your doctor will carefully evaluate your tumor to decide whether a minimally-invasive procedure is right for you.
Siteman’s SPAR Program for Better Surgical Outcomes
Stomach cancer patients who have surgery at Siteman participate in the SPAR program. SPAR stands for “Surgical Prehabilitation and Readiness.” The program helps patients prepare for surgery and get back to normal life sooner afterwards.
During this program, you will meet regularly with expert nurses. They will teach you how to care for yourself before surgery and during recovery. They may give you a plan to help you build strength through diet and exercise. They will also monitor your health for complications and setbacks.
Enhanced surgical recovery ensures that you:
- Are in the best possible condition before surgery.
- Have personalized care both during and after surgery.
- Experience the best possible outcome and rehabilitation after surgery.
What is drug therapy for stomach cancer?
Drug therapies are medications that attack cancer cells. Patients with stomach cancer might take drug therapies before surgery to shrink their tumors. Or, they might take drug therapies after surgeries to kill any cancer cells that might be left behind.
Drug therapies can help prevent stomach cancer from spreading to other parts of the body (metastasizing). They can also treat stomach cancer that has started to spread, or slow the cancer from spreading further.
Drug therapies for stomach cancer include:
- Chemotherapy: Chemotherapy is a type of medication that kills cancer cells wherever they are found in the body. You might get chemotherapy through an IV or take it as pills.
- Immunotherapy: Immunotherapy is a new form of cancer treatment that trains your own immune system to recognize and attack cancer cells. Siteman offers a number of clinical trials examining chemotherapy drugs for stomach cancer patients.
- Targeted therapy: Targeted therapies are medications that stop cancer cells from growing and multiplying. Sometimes, stomach cancer patients have tumors that make a protein called HER2. We say that these tumors are “HER2-positive.” HER2 makes tumors grow very fast. Patients with HER2-positive tumors can take targeted therapies that stop the HER2 from making the cancer cells grow.
When do patients with stomach cancer receive radiation therapy?
At this time, radiation therapy is not a primary treatment for patients with stomach cancer. In some cases, it can help patients with advanced stomach cancers feel better.
Clinical Trials for Stomach Cancer
Clinical trials are an important part of stomach cancer treatment at Siteman. These trials offer new options and opportunities for patients. Sometimes, a trial can be the key that unlocks a patient’s remission or recovery. The WashU Medicine physicians on your care team lead clinical trials. They will know if a trial is a good fit for you.
Learn more about clinical trials for stomach cancer at Siteman.
Gastrointestinal Neuroendocrine Tumors (GI NETs and GISTs)
Some tumors that occur in the stomach are not technically stomach cancer (adenomcarcinoma). These types of tumors are much rarer than adenocarcinomas. GI NETs (gastrointestinal neuroendocrine tumors) develop in cells that make hormones. These cells are called “neuroendocrine cells.” They are located throughout the body, including in the stomach and gastrointestinal tract. The most common type of GI NET is called a “carcinoid tumor.”
GISTs (gastrointestinal stromal tumors) develop in cells that help the muscles of the stomach and intestines contract. The contractions are how food moves through the digestive system.
Treatments for GI NETs and GISTs
Siteman Cancer Center offers a full range of treatment options for GI NETs and GISTs. These tumors are usually treated with a combination of surgery, drug therapy, and radiation therapy. We offer PRRT, an effective, leading-edge radiation therapy for GI NETs.
When do patients with GI NETs or GISTs have surgery?
Patients with GI NETs and GISTs often are treated with surgery. The procedure to remove them is called a “resection.”
At Siteman, WashU Medicine surgeons usually remove these tumors with a tool called an endoscope. This procedure is called an “endoscopic resection.” The endoscope is a tube that goes through the mouth and down into the stomach. Your surgeons will take the tumor out through the tube. You won’t need any incisions.
Drug Therapy for GI NETs and GISTs
Drug therapies are medicines that kill cancerous or abnormal cells. There are several types of drug therapies. All of them work differently. You might have one or more of the following drug therapies:
- Targeted therapies: Targeted therapies are medications that change or block specific features of tumor cells in order to stop them from growing. They don’t harm normal cells. They are especially important for GI NET tumors.
Targeted therapies can stop these tumors from making hormones and causing symptoms. They can even prevent GI NETs from growing.
Patients with GISTs sometimes take targeted drugs called “tyrosine kinase inhibitors.” These drugs stop signals that tell the tumor to grow.
- Chemotherapy: Chemotherapies are medicines that attack and kill cancer cells wherever they are found in the body. Patients with carcinoid tumors that have spread to the liver sometimes have chemotherapy injected. It treats the tumor directly at the tumor site.
Radiation Therapy for GI NETs and GISTs
Radiation therapy uses radiation to kill cancer cells. Sometimes, the radiation is in the form of a beam of energy.
Patients with GI NETs may also receive radiation through a medication. This treatment is called PRRT (Peptide Receptor Radionuclide Therapy). PRTT is a kind of theranostics treatment.
During PRRT, you’ll get a medication containing a small amount of radiation. The radiation will travel to your cancer cells. It will make them more visible on an imaging scan. Once the imaging scan has shown exactly where the cancer cells are, you will receive another medication containing radiation. The radiation will kill the cancer cells.