Patients with Stage I gastric cancer have cancer that invades beneath the surface layer of cells lining the stomach. The cancer is referred to as Stage IA if the cancer does not involve the bladder muscle and has not spread to lymph nodes or distant sites in the body. The cancer is referred to as Stage IB if the cancer involves either the bladder muscle or 1 to 2 lymph nodes.
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of the treatment of Stage I gastric cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.
Surgery or multi-modality treatment with surgery, chemotherapy and/or radiation is the primary treatment for Stage I gastric cancer. Chemotherapy and/or radiation therapy without surgery is usually reserved for patients who are not able or do not wish to undergo major surgery.
SURGERY AS PRIMARY TREATMENT
Surgery is the primary treatment for early-stage gastric cancer. Depending on the extent and location of the cancer, surgery may involve endoscopic mucosal resection (use of an endoscope to view and remove only the cancerous area), removal of part of the stomach (subtotal gastrectomy), or removal of the entire stomach (total gastrectomy). Patients often have several surrounding lymph nodes removed as well, although there continues to be debate about how extensive this lymph node removal should be.
Patients with Stage I gastric cancer should consider treatment at a medical center with a surgical team that has experience and treats a large number of patients with gastric cancer each year. To learn more about surgical treatment, go to Surgery for Gastric Cancer.
ADJUVANT THERAPY (TREATMENT AFTER SURGERY)
It is important to understand that some patients with gastric cancer already have small amounts of cancer that have spread beyond the stomach and cannot be detected with any of the currently available tests. Undetectable areas of cancer are referred to as micrometastases. It is the presence of micrometastases that causes cancer recurrence following treatment with surgery alone. For some patients, additional treatment aimed at these micrometastases can improve duration of survival and potential for a cure. The delivery of cancer treatment following local treatment with surgery is referred to as adjuvant therapy. Although some patients with Stage I gastric cancer may not need adjuvant therapy, those who do often receive a combination of chemotherapy and radiation therapy.
STRATEGIES TO IMPROVE TREATMENT
The progress that has been made in the treatment of gastric cancer has resulted from the use of multi-modality treatment and improved patient and physician participation in clinical studies. Future progress in the treatment of gastric cancer will result from continued participation in appropriate studies. Currently, there are several areas of active exploration aimed at improving the treatment of gastric cancer.
Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.
New Adjuvant Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies is an active area of clinical research carried out in clinical trials. Adjuvant therapy may consist of chemotherapy alone or in combination with radiation therapy or targeted therapy. Targeted therapies interfere with specific biological pathways involved in cancer growth or survival. A type of targeted therapy that improves outcomes for selected patients with advanced gastric cancer is Herceptin® (trastuzumab). Herceptin targets a protein known as HER2 that can stimulate cancer growth. Roughly 20% of patients with gastric cancer have cancer that overexpresses (makes too much of) this protein; these cancers are referred to as HER2-positive. For patients with HER2-positive, metastatic gastric cancer, treatment with Herceptin can improve overall survival. Based on these results, studies are also evaluating the role of Herceptin and other targeted therapies for earlier-stage gastric cancer.
Neoadjuvant Therapy: The practice of administering chemotherapy before surgery is referred to as neoadjuvant. In theory, neoadjuvant chemotherapy can decrease the size of the cancer, thereby making it easier to remove with surgery. With the development of new chemotherapy regimens, new clinical trials of neoadjuvant therapy performed in patients with gastric cancer are currently ongoing.
Multiple Drug Resistance Inhibitors: Gastric cancer can be drug resistant at the outset of treatment or develop drug resistance after treatment. Several drugs are being tested to determine if they will overcome or prevent the development of multiple drug resistance in gastric cancer and other cancers.
Gene Therapy: Currently, there are no gene therapies approved for the treatment of gastric cancer. Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a dysfunction gene or replacing or adding a functional gene into a cell to make it function normally. Gene therapy has been directed towards the control of rapid growth of cancer cells, control of cancer death or efforts to make the immune system kill cancer cells.
Bang Y-J, Van Cutsem E, Feyereislova A et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet
. 2010; 376:687-697.