Stomach Cancer

Surgery

Surgery is the primary treatment for early-stage stomach cancer.

• Subtotal (Partial) Gastrectomy: Removal of the cancerous part of the stomach along with nearby lymph nodes.
• Total Gastrectomy: Removal of the entire stomach, often necessary for cancers near the oesophagus. The oesophagus is then connected directly to the small intestine.
• Minimally Invasive Surgery: Laparoscopic techniques may be used in selected cases for faster recovery.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells. It may be given:

• Before surgery (neoadjuvant) to shrink tumours
• After surgery (adjuvant) to destroy remaining cancer cells
• In advanced cases to relieve symptoms and improve survival

Common drugs include fluorouracil (5-FU), cisplatin, epirubicin, and capecitabine. Side effects may include fatigue, nausea, hair loss, and low blood counts.

Radiation Therapy

Radiation uses high-energy rays to target and kill cancer cells.

• Often used in combination with chemotherapy, especially in locally advanced cancers
• May be used post-surgery to prevent recurrence
• Side effects include skin irritation, stomach upset, and fatigue. The types of radiation therapy performed for stomach cancer are as follows.

1. External Beam Radiation Therapy (EBRT)

This is the most common type of radiation for stomach cancer:

• High-energy X-rays are directed at the tumour from outside the body.
• It is usually administered over several sessions across a few weeks.
• Image-guided techniques are used to minimise exposure to healthy tissues.

Common side effects include fatigue, nausea, vomiting, and irritation of the stomach lining, but these can often be managed with supportive care.

2. CyberKnife (Robotic Radiosurgery)

CyberKnife is a non-invasive, highly precise form of stereotactic body radiation therapy (SBRT):

• It delivers focused beams of radiation to the tumour from multiple angles using a robotic arm.
• This precision minimises damage to surrounding healthy organs such as the liver, pancreas, and intestines.
• CyberKnife is especially useful for treating small, well-defined tumours and for patients who are not candidates for surgery.
• It is typically completed in 1–5 sessions and is painless with minimal downtime.

Speak to your clinical team to know your suitability for CyberKnife.

3. Proton Beam Therapy

Proton therapy uses positively charged particles (protons) instead of traditional X-rays:

• Protons can be controlled to release most of their energy directly at the tumour site, reducing radiation exposure to nearby healthy tissues.
• This is particularly advantageous in stomach cancer, where precision is crucial due to the close proximity of vital organs like the liver, kidneys, and spinal cord.
• It is suitable for selected cases where conventional radiation may pose higher risk.

Consult your oncologist to evaluate if Proton Beam Therapy is appropriate for your case.

Targeted Therapy

Targeted therapy focuses on specific molecules that help cancer grow.

• Trastuzumab (Herceptin): Used for stomach cancers that are HER2-positive
• Other drugs like ramucirumab may be used to block blood vessel growth to the tumour
• These therapies are generally used in advanced or metastatic cases

Immunotherapy

Immunotherapy stimulates the body’s immune system to fight cancer cells.

• Checkpoint inhibitors like pembrolizumab may be used for certain advanced stomach cancers with high microsatellite instability (MSI-H) or PD-L1 expression
• Usually given when other treatments have failed or are not an option
• Side effects can include immune-related inflammation of healthy tissues

Palliative Care

In advanced stages, when cure is not possible, palliative treatment focuses on relieving symptoms and improving quality of life

• This may involve managing pain, bleeding, or obstruction
• Usually given when other treatments have failed or are not an option
• Endoscopic stents, feeding tubes, or medications are often used