Treatment for Stage IV Gastric Cancer

If you have Stage IV cancer, you will probably be treated with a combination of surgery, chemotherapy, and radiation to reduce your symptoms. Your surgery might involve one of the following:

• 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.
• Endoluminal stent placement - The doctor places a thick, expandable metal tube (stent) where the stomach meets the esophagus. This keeps the esophagus open and lets food move from the esophagus to the stomach.
• Endoscopic laser surgery - The doctor passes a laser beam into a flexible tube (endoscope) that is passed down your throat and into your stomach. The laser beam vaporizes most of the tumor so that it stops blocking food from coming into your stomach.
• Electrocautery - A probe (cauter) is inserted during surgery. A high-frequency electrical current passes through the cauter and makes its tip very hot. This heat is used to destroy lesions and control bleeding in the stomach.
  

If your cancer cannot be treated with surgery, it will probably be treated with a combination of radiation therapy and chemotherapy. If you do have surgery, you might have radiation therapy and chemotherapy after the surgery (adjuvant therapy). Sometimes, chemotherapy and radiation therapy are given before surgery to shrink the tumor (neoadjuvant therapy). 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.
• Camptosar^® (irinotecan) - Irinotecan belongs to a group of chemotherapy drugs known as topoisomerase inhibitors. It stops cancer cells from growing. Irinotecan is given by an injection in a vein over 90 minutes once a week for 3 weeks, followed by a week off, and then once every 3 weeks. The dose depends on your size, your age, whether you have had radiation to your abdomen or pelvis, how well your liver is working, your blood counts, whether it is being given in combination with other chemotherapy drugs, and whether you have any side effects such as diarrhea.
• 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.
• Eloxatin^® (oxaliplatin) - Oxaliplatin belongs to the group of chemotherapy drugs known as alkylating agents. Oxaliplatin stops cancer cells from growing, which kills them. Oxaliplatin is given by an injection in a vein over 2 hours. The dose depends on your weight, your blood counts, whether it is being given in combination with other chemotherapy drugs, and the side effects of the medicine.
• Mutamycin^® (mitomycin) - Mitomycin belongs to a group of chemotherapy drugs known as antibiotics, but it acts like an alkylating agent. It blocks the cell from making DNA, which results in cell death. Mitomycin is given by an injection in a vein over 20 minutes every 6 to 8 weeks. The dose and how often you get the medicine depend on your weight, your blood counts, whether it is being given in combination with other chemotherapy drugs, how well your kidneys work, 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.
• Rheumatrex^® or Trexall™ (methotrexate) - Methotrexate belongs to a group of chemotherapy drugs known as antimetabolites. It prevents cells from making DNA and RNA, which stops the growth of cancer cells. Methotrexate is given as a pill by mouth, an injection in a vein for up to 20 minutes, or an injection into a muscle. The dose depends on your size, the type of cancer you have, whether it is being given in combination with other chemotherapy drugs, and how well your kidneys work.
• Taxotere^® (docetaxel) - Docetaxel belongs to the group of chemotherapy drugs known as taxanes. It is also called a mitotic inhibitor because of its effect on the cell during mitosis (cell division). Docetaxel stops cancer cells from growing, which kills them. Docetaxel is given by a shot in a vein over 1 hour every 3 weeks, or in lower doses every week. The dose depends on your size, how well your liver is working, whether it is being given in combination with other chemotherapy drugs, and how often the medicine is given.
• VePesid^® or Etopophos^® (etoposide) - Etoposide belongs to the class of chemotherapy drugs known as plant alkaloids. It stops cells from dividing, which kills them. Etoposide can be given by an injection in a vein over 30 to 60 minutes, or at higher doses over 1 to 4 hours. Etoposide can also be given by mouth as a capsule. The dose depends on your size, whether it is being given in combination with other chemotherapy drugs, 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.
• Xeloda^® (capecitabine) - Capecitabine belongs to a group of chemotherapy drugs known as antimetabolites. Capecitabine prevents cells from making DNA and RNA, which stops the cells from growing. Capecitabine is converted in your body to the chemotherapy drug 5-fluorouracil (5-FU). You will probably take capecitabine pills twice a day for 14 days, then no pills for 7 days. You will repeat this cycle every 3 weeks if you do not have any problems. The dose depends upon your size and whether it is being given in combination with other chemotherapy drugs, but sometimes the dose needs to be lowered if you have side effects.

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