The primary treatment for stomach cancer is surgery. The goal of treatment is to remove as much of the cancer as possible, while preserving the stomach and its function. It is often used in combination with other treatments. Chemoradiation, a combination of radiation therapy and chemotherapy may be used before surgery to shrink the tumor or to try to kill off any remaining cancer cells after surgery. Surgical removal is not always an option since most stomach cancers are found in advanced stages.

Gastric surgeries are long and difficult procedures that often have postoperative complications. It is important to seek out an experienced surgeon and hospital for these procedures.

Surgery for Early Stage Stomach Cancer

Endoscopic mucosal resection (EMR) is a procedure to remove small, noninvasive cancer during an endoscopy. A tube with a lighted tip and camera is inserted through the mouth and throat. The tumor is removed along with a margin of healthy tissue to try to ensure that all the cancer is completely removed. The doctor will examine and take samples of the removed tissue. Tissue samples will be examined under a microscope for the presence of cancer.

This procedure is not as common in the US because most stomach cancers are found in advanced stages. It is usually done in countries where stomach cancer is more common and found earlier because of screening.

Surgery for Advanced Stomach Cancer

A gastrectomy is the removal of part or all of the stomach. The amount of tissue removed depends on the location and size of the tumor. Nearby lymph nodes may also be removed and tested for the presence of cancer. Cancer in the lymph nodes means the cancer may have spread to other areas of the body.

Types of gastrectomies:

  • Distal subtotal gastrectomy—This involves the removal of the part of the stomach closest to the small intestine. A portion of the first part of the small intestine may be removed at the same time. The remaining stomach is attached to the small intestine.
  • Proximal subtotal gastrectomy—The stomach closest to the esophagus is removed. A portion of the esophagus may be removed at the same time. The remaining stomach is attached to the esophagus.
  • Total gastrectomy—The entire stomach is removed, along with other nearby abdominal organs (if necessary). A piece of small intestine is then used to form a new holding pouch for food. This holding pouch is then attached to the esophagus.

Gastrectomies can be done as:

  • Open—During open surgery, an incision is made in the abdomen. Doing so exposes the organs so they can be accessed by the surgeon. The stomach and nearby lymph nodes are removed through the incision. Most gastrectomies are done as open procedures.
  • Laparoscopy—Tubes with a lighted scope and camera are inserted through abdomen to access the tumor site. The stomach and nearby lymph nodes are removed through the tubes. Healing time and recovery are somewhat faster with this option than with an open procedure.
Nutritional Support

A feeding tube can be inserted through the abdominal wall and directly into the small intestine. This is done when eating is difficult and nutritional needs are not able to be met. Nutritional support helps prevent starvation, as well as aspiration of material into the lungs.

People who have a gastrectomy have smaller stomachs. In order to get proper nutrition, some dietary changes need to be made. The most common approaches include:

  • Eating smaller meals
  • Eating more frequent meals
  • Avoiding a high intake of fat at any given time
  • Making sure that the calories you take in are as nutritious as possible
  • Utilizing dietary supplements if you are having difficulty maintaining good nutrition
Palliative Care

Surgery may not be effective for managing cancer itself but may be needed to relieve complications and improve quality of life. Most of these procedures are done during an endoscopy and may include:

  • Subtotal gastrectomy—Part of the stomach is removed.
  • Feeding tube insertion—To provide nutrition even if the stomach is not available.
  • Gastric bypass—The digestive path will be reconnected to pass the stomach, may be needed if cancer is causing blockage.
  • Laser ablation—Cancerous tissue is removed with the high heat of a laser beam, may help decrease large tumors or remove tissue that is causing blockage.
  • Stent—A stent can be used to open an area that may be blocked by a tumor.

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