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

Partial

A surgeon removes the lower part of the stomach with the cancer. The surgeon then attaches the remaining part of the stomach to the intestine. Nearby lymph nodes and other tissues may also be removed.

Total

A surgeon removes the entire stomach, nearby lymph nodes, parts of the esophagus and small intestine, and other tissues near the tumor. Rarely, the spleen may also be removed. The surgeon then connects the esophagus directly to the small intestine.

Gastrojejunostomy removes cancer that is blocking the opening of your small intestine, which is called the duodenum. Your doctor then connects your stomach directly to the middle part of your small intestine, which is called the jejunum. After this procedure, food and medicine will pass directly from the stomach into the small intestine. This procedure requires going under anesthesia and can take from two to four hours.

You may need to adhere to a specialized diet for months after this procedure, which may include nutritional monitoring, vitamin supplementation, and sugar restriction.

The most common treatment for gastric cancer is chemotherapy, which involves administering cancer-killing drugs.

Chemotherapy for stomach cancer is usually systemic, meaning it is injected into a vein or given by pills into the mouth. When given this way, the drugs enter the bloodstream to reach cancer cells throughout the body. Chemotherapy may be administered in an outpatient hospital setting, at the doctor’s office, or at home, while some individuals may require hospital stays during treatment.

Radiation therapy (also called radiotherapy) uses a large machine to administer high-energy rays into the patient’s body to kill the cancer cells.

Unlike chemotherapy, radiation targets localized cells, meaning it only kills cells in the specific part of the body that has cancer. In gastric cancer treatment, radiation therapy is often given alongside chemotherapy. The radiation, emitted from a large machine outside the body, is administered during visits to a hospital or clinic. Treatments typically take place for around five days a week over the span of several weeks.

Immunotherapy treatments help the immune system recognize cancer cells and destroy them.
One approach commonly used in gastric cancer involves inhibiting “checkpoints”, which are proteins that normally help cancer cells hide from the immune system. Currently, the two main immune checkpoint inhibitor therapies for gastric cancer are nivolumab and pembrolizumab.

There are several other immunotherapy treatments in clinical trials for gastric cancer, including personalized cell-based therapies made from patients’ own immune cells.

Targeted therapies are drugs that destroy cancer cells by selectively attacking specific genetic mutations or other abnormalities in tumors.

Recent advances in biomarker testing allows for the increased use of targeted therapies, as doctors are able to tailor treatment plans to a patient’s specific type of cancer molecules.

To learn more about targeted therapies in gastric cancer, visit our Biomarkers and Gastric Cancer page.

Laser therapy may be done when your cancer blocks the passage into or out of the stomach. A laser is a concentrated beam of intense light that kills tissue with heat. The doctor uses an endoscope to place the laser in your digestive tract. The laser destroys the cancer cells blocking the digestive tract.

Hyperthermic intraperitoneal chemotherapy (HIPEC), is under study for stomach cancer treatment and may be available at certain centers. After surgery to remove as much cancer as possible, a warmed chemotherapy drug is injected directly into the peritoneal cavity for about 2 hours through a thin tube. The surgeon then drains and rinses the abdomen before closing the incision.

Endoscopic mucosal resection uses an endoscope to remove stage 0 cancer from the lining of the digestive tract. These abnormal cells are not actually cancer but may become cancer and spread into nearby normal tissue.

Stent placement may be done if your cancer blocks the passage into or out of the stomach. Your doctor uses an endoscope to place a stent (a tube made of metal mesh or plastic) in your intestine. It can be placed either from the esophagus to the stomach, or the stomach to the small intestine. Food and liquid can then pass through the center of the tube.