Surgery remains as a key treatment of localised gastric cancer (i.e. stomach cancers that have not spread outside of the stomach or to the adjacent lymph nodes).
The surgery can be performed either via open or laparoscopic (key-hole) approaches. The type of surgery depends on the part of the stomach where the cancer is in and the extent of the cancer within the stomach. Rarely, very early-stage cancer confined to the mucosa lining may be removed by endoscopic surgery. More commonly, stomach cancer surgery involves either:
- Total gastrectomy (for upper stomach cancer)
- Partial gastrectomy (for lower stomach cancer)
Gastric cancer surgery should also include extended D2 lymph node dissection to improve long-term cancer outcome.
Data from East Asian centres show that surgical treatment alone for stage 2 and stage 3 gastric cancer had a 40% risk of relapse at 3 years3. Addition of chemotherapy after surgery significantly improved the odds of long-term cure by 32–44%3, 4.
Chemotherapy treatment for stomach cancer may be better tolerated prior to surgery in most patients. However, new and efficacious protocols have been developed in Europe, whereby combination chemotherapy (administering chemotherapy before and after surgery5) improved patient outcome.
Combination chemotherapy improves symptoms and survival rate in metastatic (advanced) gastric cancer. Trials have shown that even elderly patients benefit as much from dose-attenuated chemotherapy as younger patients.
General side effects of chemotherapy include fatigue, nausea, vomiting, sore mouth, and increased risk of infection. Specific chemotherapy medicine may cause hair loss, diarrhoea or numbness of small nerves.
For patients who test positive for HER2 in their tumour specimen, the addition of targeted therapy against HER2 significantly improves the outcome. For patients who have failed one prior line of chemotherapy, adding targeted therapy against vascular endothelial growth factor to chemotherapy enhances the benefit of treatment.
Immunotherapy may bring profound benefit in a subset of patients who have failed chemotherapy. Combination of immunotherapy with chemotherapy is being explored as the front-line strategy and treatment for metastatic gastric cancer in Singapore.
Visit The Cancer Centre in Singapore for stomach cancer screening and treatment options.