Our Clinical Trials Find out about new research studies for gastric cancer 
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The choice of treatment for stomach cancer largely depends on the stage of the disease -- that is, how much the tumor has grown, how deeply it has invaded other layers of the stomach, and whether it has spread to nearby organs, lymph nodes, or other parts of the body. Based on these factors, Memorial Sloan-Kettering doctors will devise a treatment plan that may include surgery, chemotherapy, or radiation therapy.
Recent studies suggest that for patients at high risk of recurrence for stomach cancer, chemotherapy or radiation therapy, or a combination of the two, either prior to or following surgery may improve survival compared to surgery alone. One approach is using chemotherapy before and after surgery 1, and another is a combination treatment of radiation and chemotherapy after surgery. These are two standards of care for patients with this disease.2
Surgery
Surgery is the most common form of treatment for stomach cancer. Depending on the extent to which the cancer has spread, the doctor may perform one of the following operations:
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Partial, or Subtotal, Gastrectomy
This involves the removal of part of the stomach, as well as parts of other tissues or organs near the tumor (such as the small intestine or esophagus, depending on the location of the tumor).
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Total Gastrectomy
This involves the removal of the entire stomach and parts of the esophagus, small intestine, and other tissue near the tumor. Following total gastrectomy, the esophagus is directly connected to the small intestine, to allow the patient to continue to eat and swallow normally.
During the surgery, the surgeon will also remove nearby lymph nodes to examine them for cancer cells (called lymphadenectomy). Sometimes the spleen (an organ in the upper abdomen that filters blood and eliminates old blood cells) and part of the pancreas are also removed.
Minimally Invasive Surgery
At Memorial Sloan-Kettering, an active program of minimally invasive surgery (also known as laparoscopy) is available to evaluate and stage many stomach cancers and precancerous conditions.3 In selected patients, minimally invasive surgery can be used to remove stomach tumors. The minimally invasive surgical approach for stomach cancer may spare some patients from having to undergo unnecessary and noncurative operations, and in those patients undergoing laparoscopic surgery, it may speed up their recovery process.
During these procedures, a thin, lighted tube with a video camera at its tip (called a laparoscope) is inserted through a tiny incision in the abdominal wall, and the image is projected onto a large viewing screen. Guided by this highly magnified image, the surgeon can operate through tiny surgical "ports" using specially designed surgical instruments.
Chemotherapy
Chemotherapy is also used to treat stomach cancer, either by itself or in combination with surgery and/or radiation therapy. It may be given to patients whose cancers have invaded the layers of the stomach wall, lymph nodes, and nearby organs. Chemotherapy may also be given before surgery (neoadjuvant therapy) to shrink the tumor, or it may be given after surgery (adjuvant therapy) to kill any remaining cancer cells.
When given alone or in combination with radiation therapy, chemotherapy may also help to alleviate symptoms related to stomach cancer or to delay cancer recurrence and extend survival, especially in patients whose cancers cannot be completely removed through surgery. The drugs most commonly used to treat stomach cancer are 5-fluorouracil, irinotecan, cisplatin, and docetaxel. Our investigators continue to identify novel therapeutic drugs to improve the care of patients with stomach cancer. For example, the newer targeted therapy agents, including bevacizumab and cetuximab, as well as new combinations of conventional drugs are currently under investigation at Memorial Sloan-Kettering.
Some of these drugs are given intravenously or orally. This therapy is known as a systemic therapy, meaning that chemotherapy drugs travel through the blood to cells all over the body. Although used very rarely, another method used to treat stomach cancer is intraperitoneal (IP) chemotherapy. In IP therapy, chemotherapy drugs are placed directly into the internal lining of the abdominal area (called the peritoneal cavity) and are released through a surgically implanted catheter. This allows a high concentration of chemotherapy agents to reach the cancerous tissue, thereby increasing the effectiveness of treatment.
Radiation Therapy
Radiation therapy is most commonly used in combination with chemotherapy to treat stomach cancer. We are involved in a number of trials with the Radiation Therapy Oncology Group (RTOG), investigating new combinations of chemotherapy and radiation therapy. In addition, our researchers are also actively studying the effects of neoadjuvant chemotherapy followed by surgery and postoperative radiation/chemotherapy.
Memorial Sloan-Kettering doctors are involved in ongoing efforts to decrease the toxicity, or damage, to healthy tissues that may occur during radiation therapy for stomach cancer. Intensity-modulated radiation therapy (IMRT) and respiratory gating are two approaches that have potential merit in decreasing toxicity to normal tissue.
IMRT is a type of 3-D radiation therapy that targets tumors with greater precision than conventional radiation therapy. Using highly sophisticated computer software and 3-D images from CT scans, the radiation oncologist can develop an individualized treatment plan that delivers high doses of radiation to cancerous tissue while sparing surrounding organs and reducing the risk of injury to healthy tissues.
Respiratory gating is another type of radiation therapy used at Memorial Sloan-Kettering to treat stomach cancer with minimal damage to healthy tissue. Because tumors and organs in the abdomen shift during breathing, precise delivery of radiation therapy to cancerous tissue can be difficult. Respiratory gating entails the delivery of radiation treatment only at certain points during a patient's breathing cycle, when the "mobile" tumors and/or regions of the abdomen are in a specific position. This approach decreases the radiation dose to the surrounding healthy tissues.
