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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Gastric cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the stomach?
STAGE EXPLANATION
Stages of cancer of the stomach
Stage 0
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the stomach is treated
Treatment by stage
STAGE 0 GASTRIC CANCER
STAGE I GASTRIC CANCER
STAGE II GASTRIC CANCER
STAGE III GASTRIC CANCER
STAGE IV GASTRIC CANCER
RECURRENT GASTRIC CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the stomach?

Cancer of the stomach, also called gastric cancer, is a disease in which cancer (malignant) cells are found in the tissues of the stomach. The stomach is a J-shaped organ in the upper abdomen where the food is broken down (digested). Food reaches the stomach through a tube called the esophagus that connects the mouth to the stomach. After leaving the stomach, partially digested food passes into the small intestine and then into the large intestine called the colon.

Sometimes cancer can be in the stomach for a long time and can grow very large before it causes symptoms. In the early stages of cancer of the stomach, a patient may have indigestion and stomach discomfort, a bloated feeling after eating, mild nausea, loss of appetite, or heartburn. In more advanced stages of cancer of the stomach, the patient may have blood in the stool, vomiting, weight loss, or pain in the stomach. The chance of getting stomach cancer is higher if the patient has had an infection of the stomach caused by Helicobacter pylori, or if the patient is older, is a man, smokes cigarettes, or frequently eats a diet that includes lots of dry, salted foods. Other factors that increase the chances of getting stomach cancer are a stomach disorder called atrophic gastritis or Menetrier's disease, a disorder of the blood called pernicious anemia, or a hereditary condition of growths (called polyps) in the large intestine.

If there are symptoms, a doctor will usually order an upper gastrointestinal x-ray (also called an upper GI series). For this examination, the patient drinks a liquid containing barium, which makes the stomach easier to see in the x-ray. This test is usually performed in a doctor's office or in a hospital radiology department.

The doctor may also look inside the stomach with a thin, lighted tube called a gastroscope. This is called a gastroscopy, and it finds most cancers of the stomach. For this test, the gastroscope is inserted through the mouth and guided into the stomach. The doctor may spray a local anesthetic (a drug that causes loss of feeling for a short period of time) into the throat or give the patient other medicine before the test so that no pain is felt.

If the doctor sees tissue that is not normal, he or she may cut out a small piece so it can be looked at under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the gastroscopy.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the stomach or if it has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of cancer of the stomach

Once cancer of the stomach is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. The doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the stomach:


Stage 0

Stage 0 cancer of the stomach is very early cancer. Cancer is found only in the innermost layer of the stomach wall.


Stage I

Cancer is in the second or third layers of the stomach wall and has not spread to lymph nodes near the cancer or is in the second layer of the stomach wall and has spread to lymph nodes very close to the tumor. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)


Stage II

Any of the following may be true:

1. Cancer is in the second layer of the stomach wall and has spread to lymph nodes further away from the tumor.

2. Cancer is only in the muscle layer (the third layer) of the stomach and has spread to lymph nodes very close to the tumor.

3. Cancer is in all four layers of the stomach wall but has not spread to lymph nodes or other organs.


Stage III

Any of the following may be true:

1. Cancer is in the third layer of the stomach wall and has spread to lymph nodes further away from the tumor.

2. Cancer is in all four layers of the stomach wall and has spread to lymph nodes either very close to the tumor or further away from the tumor.

3. Cancer is in all four layers of the stomach wall and has spread to nearby tissues. The cancer may or may not have spread to lymph nodes very close to the tumor.


Stage IV

Cancer has spread to nearby tissues and to lymph nodes further away from the tumor or has spread to other parts of the body.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the stomach or in another part of the body such as the liver or lymph nodes.


TREATMENT OPTION OVERVIEW


How cancer of the stomach is treated

There are treatments for most patients with cancer of the stomach. Two kinds of treatment are used:

Radiation therapy and biological therapy are being tested in clinical trials.

Surgery is a common treatment of all stages of cancer of the stomach. The doctor may remove the cancer using one of the following operations:

Subtotal gastrectomy removes the part of the stomach that contains cancer
and parts of other tissues and organs near the tumor. Nearby lymph nodes
are also removed (lymph node dissection). The spleen (an organ in the upper
abdomen that filters the blood and removes old blood cells) may be removed
if necessary.

Total gastrectomy removes the entire stomach and parts of the esophagus, the
small intestine, and other tissue near the tumor. The spleen is removed in
some cases. Nearby lymph nodes are also removed (lymph node dissection).
The esophagus is connected to the small intestine so a patient can continue
to eat and swallow.

If only part of the stomach is removed, a patient should still be able to eat fairly normally. Frequent, small meals may need to be eaten, as well as foods low in sugar and high in fat and protein, if the entire stomach is removed. Most patients can adjust to this new way of eating.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the stomach.

Treatment given after surgery when no cancer cells can be seen is called adjuvant therapy. Adjuvant therapy for cancer of the stomach is being tested in clinical trials.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.


Treatment by stage

Treatment of cancer of the stomach depends on the stage of the disease, the part of the stomach where the cancer is, and the patient's general health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Many patients with cancer of the stomach are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the stomach. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 GASTRIC CANCER

Treatment may be one of the following:

1. Surgery to remove part of the stomach (subtotal gastrectomy).

2. Surgery to remove the entire stomach and some of the tissue around it (total gastrectomy).

Lymph nodes around the stomach may also be removed during surgery (lymph node dissection).


STAGE I GASTRIC CANCER

Treatment may be one of the following:

1. Surgery to remove part of the stomach (subtotal gastrectomy) with removal of associated lymph nodes (lymphadenectomy).

2. Surgery to remove the entire stomach and some of the tissue around it (total gastrectomy) with removal of associated lymph nodes (lymphadenectomy).


STAGE II GASTRIC CANCER

Treatment may be one of the following:

1. Surgery to remove part of the stomach (subtotal gastrectomy).

2. Surgery to remove the entire stomach and some of the tissue around it (total gastrectomy).

3. A clinical trial of surgery followed by adjuvant radiation therapy and/or chemotherapy.

Lymph nodes around the stomach may also be removed (lymph node dissection).


STAGE III GASTRIC CANCER

Treatment may be one of the following:

1. Surgery to remove the entire stomach and some of the tissue around it (total gastrectomy). Lymph nodes may also be removed.

2. A clinical trial of surgery followed by adjuvant radiation therapy and/or chemotherapy.

3. A clinical trial of chemotherapy with or without radiation therapy.


STAGE IV GASTRIC CANCER

Treatment may be one of the following:

1. Surgery to relieve symptoms, reduce bleeding, or remove a tumor that is blocking the stomach.

2. Chemotherapy to relieve symptoms.


RECURRENT GASTRIC CANCER

Treatment may be chemotherapy to relieve symptoms. Clinical trials are testing new chemotherapy drugs and biological therapy.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the stomach, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about cancer of the stomach may be helpful:

What You Need To Know About Stomach Cancer

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 02/1998


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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