# Treatment methods for stomach cancer
The treatment of stomach cancer depends heavily on the stage of the disease, the location of the tumor, overall health, and personal preferences. The main treatments are described here by group.
Surgery
ProveniIncluded in official guidelines, or approved by EMA or FDA
Surgical removal of the tumor is the cornerstone of treatment for many patients, especially in early stages. The surgeon may remove part of the stomach (subtotal gastrectomy) or, if necessary, the entire stomach (total gastrectomy), together with nearby lymph nodes and possibly surrounding tissue.
How it works: by completely removing the tumor and surrounding tissue, the surgeon attempts to eliminate all cancer cells and prevent further spread. After total removal of the stomach, the esophagus is connected directly to the small intestine.
Known side effects and consequences include nutritional difficulties (because the stomach is missing or much smaller), weight loss, possible diarrhea, and in some cases dumping syndrome (rapid transport of food to the small intestine, with weakness and vomiting). Many patients require nutritional supplements.
Chemotherapy
ProveniIncluded in official guidelines, or approved by EMA or FDA
Chemotherapy is often given before surgery (neoadjuvant chemotherapy) to shrink the tumor, or after surgery (adjuvant chemotherapy) to kill remaining cancer cells. Sometimes it is also used in metastatic disease.
How it works: chemotherapy drugs are cytostatic substances that target rapidly dividing cells, including cancer cells. They disrupt cell division and lead to cell death.
Known side effects include nausea and vomiting, fatigue, hair loss, reduced blood cell count (with increased infection risk and anemia), and sometimes nerve damage (peripheral neuropathy). The severity varies by drug and by person.
Targeted therapy
ProveniIncluded in official guidelines, or approved by EMA or FDA
For certain types of stomach cancer – especially tumors that are HER2-positive (a specific protein on cells) – targeted drugs are used. These specifically target cancer cells with certain genetic or biological characteristics.
How it works: targeted drugs block specific proteins or signals that drive cancer growth. This can lead to cessation of cell division or cell death, with less damage to healthy cells than chemotherapy.
Known side effects may include heart problems, diarrhea, skin rash, and fatigue, depending on the specific drug.
Immunotherapy (immune checkpoint inhibitors)
ProveniIncluded in official guidelines, or approved by EMA or FDA
Immunotherapy is being used increasingly, especially in advanced stomach cancer or when the tumor has certain characteristics (such as high microsatellite instability or PD-L1 expression). These drugs help the immune system detect and attack cancer cells.
How it works: immunotherapy drugs block inhibitory signals (checkpoints) on immune cells, so they can recognize and destroy cancer.
Known side effects are immune-related adverse events (irAE's): inflammation of various organs (lungs, kidneys, intestines, heart, hormone glands) with symptoms such as coughing, shortness of breath, diarrhea, heart rhythm disturbances, or fatigue. These can be serious and require closer monitoring.
Radiation therapy
ProveniIncluded in official guidelines, or approved by EMA or FDA
Radiation is sometimes used as additional treatment after surgery, especially if the tumor has grown deep into the stomach wall or if certain lymph nodes are affected. It can also be part of a combined approach with chemotherapy.
How it works: ionizing radiation damages the DNA of cancer cells, preventing them from dividing and causing them to die.
Known side effects include fatigue, skin irritation in the irradiated area, nausea, vomiting, diarrhea, and in rare cases permanent damage to surrounding organs (esophagus, kidneys, spleen).
Combination treatments
ProveniIncluded in official guidelines, or approved by EMA or FDA
In practice, stomach cancer is usually not treated with a single treatment, but with combinations. A common approach is chemotherapy before surgery, followed by additional chemotherapy after the operation. Immunotherapy can be added, especially in cases of advanced disease.
Although combinations can be more effective against the tumor, the cumulative effect of side effects can be considerable, making regular monitoring by the treatment team essential.
Palliative treatment
ProveniIncluded in official guidelines, or approved by EMA or FDA
For patients with advanced disease that is not operable, the focus is on symptom management and quality of life. This may include less intensive chemotherapy, immunotherapy, or medications to treat pain, nausea and other complaints.
How it works: palliative treatment focuses on comfort and quality of life rather than cure. Chemotherapy can still slow growth, but the goal is different.
Known side effects are the same as described above, but the emphasis is on balancing any benefits against impact on wellbeing.
Supportive care
ProveniIncluded in official guidelines, or approved by EMA or FDA
Regardless of the tumor and treatment stage, good care includes nutrition and dietetics guidance (food can taste very different, and the stomach can take in less food), psychological support, pain management and treatment of nausea, and monitoring for complications.
After removal of the stomach, lifelong vitamin supplementation (especially B12 and iron) is needed, because the stomach is important for the absorption of these substances.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._