The only curative treatment for gastric cancer is surgery with removal of the stomach and radical excision of all the associated lymph nodes. Patients with early gastric cancer may be suitable for endoscopic resection of the cancer. For early gastric cancer, surgery alone may be sufficient.
The use of adjuvant chemotherapy and radiation therapy is common after surgery for patients with advanced gastric cancer – this reduces the likelihood of tumour recurrence. The chemotherapy options for gastric cancer now include oral-only regimens which are more acceptable to some patients.
In patients who present with large tumours that are locally-advanced which are not suitable for immediate surgery, the option of neo-adjuvant chemoradiation therapy is available in order to prepare them for curative surgery.
For patients with very advanced or metastatic gastric cancer, options for palliative treatment include stenting or surgical bypass of obstructing tumours, radiotherapy for control of bleeding and chemotherapy for reduction of symptoms and tumour growth.
The prognosis of gastric cancer depends on the stage at the time of diagnosis and surgery. The overall stage of the cancer is determined by the degree of spread through the wall of the stomach (T-stage) and the number of lymph nodes involved by the cancer (N-stage) as well as whether or not there are distant metastases (M-stage).
Patients with metastatic disease in Stage 4 usually require palliative care. Patients without metastases who have had complete removal of the stomach cancer and all the associated lymph nodes have a five-year survival of approximately 26% to 95%, provided they follow the recommended adjuvant therapy. As patients with Stage 1 and Stage 2 cancer usually achieve five-year survival exceeding 70%, the importance of early detection of gastric cancer should not be underestimated.
