Treatment for Stage II Gastric Cancer

If you have Stage II cancer, you will probably be treated with a combination of surgery, chemotherapy, and radiation therapy. Depending on where your cancer is located and how far it has spread, your surgery will probably involve a partial or total gastrectomy.

• Partial (subtotal) gastrectomy - The surgeon removes the part of the stomach that contains the cancer, as well as some of the normal stomach tissue around the cancer. Sometimes, he or she also takes out part of the esophagus or intestine, the spleen (an organ that filters blood and destroys old blood cells), and the lymph nodes near the stomach. The surgeon then reattaches the part of the stomach that is left to the small intestine or esophagus. Since your stomach will be smaller, it will only be able to store a small amount of food. So you will only be able to eat a small amount of food at a time. This means that you will need to eat more often.
• Total gastrectomy - The surgeon removes the entire stomach. The surgeon might also take out the spleen, nearby lymph nodes, and parts of other organs (such as the esophagus, intestines, and pancreas). After removing these organs, the surgeon attaches the end of the esophagus to the small intestine to make a replacement stomach out of  intestinal tissue. Your food can be stored in this new stomach before it moves down the intestinal tract. This replacement stomach can only store a small amount of food. So you will only be able to eat a small amount of food at a time. This means that you will need to eat more often.
  

Your doctor might also recommend adjuvant (after surgery) radiation therapy and chemotherapy to help prevent the cancer from coming back (recurring). The radiation therapy will probably be external beam radiation therapy.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. EBRT can harm both the cancer cells and nearby healthy tissue. Most people are treated with EBRT for a few minutes 5 days a week for several weeks as an outpatient.
  

Your doctor might choose one of more of the following chemotherapy drugs:

• Adrucil^® or Efudex^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes or 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated every week, every other week, or every 3 weeks. The dose depends on your size and whether it is being given in combination with other chemotherapy drugs.
• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, causing them to die. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, whether it is being given in combination with other chemotherapy drugs, how well your liver works, and the type of cancer you have.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, whether it is being given in combination with other chemotherapy drugs, and how well your kidneys work.
• Ellence^®, Farmorubicin^®, or Pharmorubicin^® (epirubicin) - Epirubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. It stops cancer cells from growing, which kills them. Epirubicin hydrochloride is given as a shot in a vein over about 15 minutes. The dose and how often you get epirubicin hydrochloride depend upon your size, your blood counts, whether it is being given in combination with other chemotherapy drugs, how well your liver is working, and the type of cancer being treated.
• Wellcovorin^® (leucovorin or folinic acid) - Leucovorin is a water-soluble folate vitamin. It is used to help make 5-FU more effective and it can protect normal cells from being killed by methotrexate. Leucovorin is given as a shot into a vein (intravenously) or taken as tablets by mouth. The dose and how often you get leucovorin depend on your weight and whether it is being given in combination with other chemotherapy drugs.
  

This content has been reviewed and approved by Myo Thant, MD.