Treatment

Treatments

Adenocarcinoma is the most common gastric tumor and often blocks the stomach or causes bleeding. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principle investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for stomach cancer include surgery, radiation therapy, chemotherapy, chemoradiation, and targeted therapy. Clinical trials are testing many other approaches, some of which are becoming standard of care.

Surgery and Other Procedures

Surgery is the only curative treatment. To determine the right approach it is common to do endoscopic biopsies and tests to determine the depth of invasion of the tumor into the wall of the stomach. Laparoscopy is used to peek into the abdomen to see if the cancer has spread to other organs. Surgery is usually done after a period of chemotherapy.

Subtotal gastrectomy: The usual operation is subtotal gastrectomy which removes about 80% of the stomach. Occasionally total gastrectomy is required. A second period of chemotherapy is often used after recovery from surgery. Even patients who have a total gastrectomy can have very good gastrointestinal function after recovery.

If the tumor is blocking the stomach but the cancer cannot be completely removed by standard surgery, the following procedures may be used:

Endoluminal stent placement: This procedure involves insertion of a stent (a thin, expandable tube) in order to keep a passage open. For tumors blocking the passage into or out of the stomach, surgery may be done to place a stent from the esophagus to the stomach or from the stomach to the small intestine to allow the patient to eat normally.

Endoluminal laser therapy: An endoscope, a thin, lighted tube, with a laser attached is inserted into the blocked area so the laser can be used as a knife to remove the blockage.

Gastrojejunostomy: Surgery to remove the part of the stomach with cancer that is blocking the opening into the small intestine. The stomach is connected 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 oncology has active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. No one should be over or undertreated. Siteman is a leader in using shorter radiation durations than the national average with the same outcomes.

Systemic Therapy

Chemotherapy involves the administration of drugs, either orally or intravenously to kill cancer cells. Therapy that falls under medical treatment has a wide range of approaches, may be used before surgery, in conjunction with radiation or by itself, including timing of treatment. It can be given before or after surgery, in conjunction with radiation (chemoradiation) or by itself. Several drugs are approved for treating gastric cancer.

Targeted therapy: Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy used in the treatment of gastric cancer.

Monoclonal antibody therapy, given intravenously, uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.

Supportive research: Siteman has their own clinical trials of agents that target the micro-tumor environment and increase the effectiveness of systemic therapies by removing suppressive immune cells that work against the treatment.