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Treatment

Depending on the stage of the tumor, a choice will be made between a healing (curative) treatment and a treatment where cure is no longer possible, but the quality of life can be increased (palliative).

The first choice in the treatment of gastric cancer is surgery to remove the tumor. If it is still in an early stage and in a favorable position, only a part of the stomach needs to be removed. If the tumor is already at an advanced (late) stage, the entire stomach will be removed.

If cure is no longer possible, attempts to improve the quality of life will be made by keeping the digestive tract patent. This can be done by removing a part of the stomach and the construction of a rearrangement (by-pass). If it is not possible to carry out this operation, a tube (stent) can be placed in the stomach so that the food can well pass. Also, a feeding tube (gastrojejunostomy) can be placed to guarantee the supply of nutrients.

If you would like to know more about the different treatment options please click on the topics below.

Surgery

About 50% of all people diagnosed with gastric cancer, is eligible for an operation. This is dependent of the stage that the tumor is in. Furthermore, the physical condition of a patient needs to be well enough to undergo an operation.

Partial stomach resection
The partial stomach resection (partial or distal gastrectomy) is an operation wherein the part of the stomach that involves the tumor, is removed. The part of the stomach that is free of tumor will not be removed. This operation can be performed in two different ways. The classical method is an open procedure, whereby the abdominal cavity is opened with an incision in the belly from the belly button up to the lower ridge of the rib. Furthermore, it is possible to undergo a keyhole operation (laparoscopy). Nowadays a keyhole operation is preferred above the open procedure, because it gives less complications and smaller scars.

Total stomach resection
A total stomach resection (total gastrectomy) is an operation whereby the stomach is removed. This can be done in two ways. The classical method involves opening of the abdominal cavity with an incision of the belly from belly button to the lower ridge of the rib. This is also called an open stomach resection. It is also possible to remove the stomach through a keyhole operation (laparoscopy).

In some cases the spleen and pancreas are also removed. This only happens when there is direct ingrowth of the tumor in the spleen or pancreas. Also, per patient it is decided which lymph nodes will be removed during the operation.

Chemotherapy

Medicine

Medicine

Patients with a good physical condition are eligible for chemotherapy. Chemotherapy uses cell-inhibiting drugs (cytostatics).

There are different types of cytostatics. These agents can be administered to the patient in different ways, such as by intravenous infusion, per tablet or per injection. Usually, chemotherapy is given before or after surgery.

Radiotherapy

Radiation (radiotherapy) is a local treatment, in which cancer cells are destroyed in whole or in part by irradiation. Cancer cells tolerate radiation worse than healthy cells. Therefore damaged cancer cells will not be able to recover. Healthy cells do recover in general though.

Usually radiotherapy is given to patients with a gastric cancer that is in a stage where surgery is no longer possible. It then serves as a palliative treatment for stomach bleeding for example. Palliative radiotherapy will not be able to heal you. In an experimental study radiotherapy is used after the operation as an adjunct to surgery.

Prospects after treatment

The disease-free survival duration depends on the stage wherein the gastric cancer is discovered. The earlier the diagnosis is made, the better the life expectancy. Also, the location of the tumor influences the survival.

In general 76% of the patients with gastric cancer in stage I is still alive after 5 years. For stage II this is 36%, for stage III this is 13%, and for stage IV only 1%.

The diffuse type has a worse prognosis in general. It is often the case that the later the diagnosis is made, the shorter the survival will be.

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