Stomach Cancer Stomach Cancer Treatment by Stage

Cancer stage is an important factor in deciding the best treatment for stomach cancer. Other factors, such as your preferences and overall health, are also important.  

For some people, taking part in a clinical trial may be an option. Clinical trials of new cancer drugs or treatment combinations may be available. To learn more about clinical trials, including how to find and join a trial, see Clinical Trials Information for Patients and Caregivers.  

Treatment of stage 0 stomach cancer (carcinoma in situ)

Gastrectomy (surgery to remove all or part of the stomach and nearby lymph nodes) is the main treatment for stage 0 stomach cancer (carcinoma in situ). 

Endoscopic mucosal resection uses an endoscope to remove abnormal growths or tissue from the lining of the digestive tract without open surgery. It may be done in people with small tumors that have a low risk of spreading to nearby lymph nodes.

To learn more about these treatments, see Stomach Cancer Treatment.  

Treatment of stage I stomach cancer

Gastrectomy (surgery to remove all or part of the stomach and nearby lymph nodes) is the main treatment for stage I stomach cancer. Some people may receive chemotherapy and/or radiation therapy before or after surgery. Giving chemotherapy at the same time as radiation therapy may help the radiation therapy work better.

There are many chemotherapy drugs used for stage I stomach cancer, including capecitabine, cisplatin, docetaxel, epirubicin, fluorouracil (5-FU), leucovorin, and oxaliplatin. These drugs may be given alone or in combination.

Endoscopic mucosal resection is a less invasive procedure that may be used in people with small tumors that have a low risk of spreading to nearby lymph nodes.

To learn more about these treatments, see Stomach Cancer Treatment.

Treatment of stages II and III stomach cancer

Gastrectomy (surgery to remove all or part of the stomach and nearby lymph nodes) is the main treatment for stage II stomach cancer and stage III stomach cancer. Some people may receive chemotherapy and/or radiation therapy before or after surgery. Giving chemotherapy at the same time as radiation therapy may help the radiation therapy work better.

There are many chemotherapy drugs used for stage II and stage III stomach cancer, including capecitabine, cisplatin, docetaxel, epirubicin, fluorouracil (5-FU), leucovorin, and oxaliplatin. These drugs may be given alone or in combination.

To learn more about these treatments, see Stomach Cancer Treatment.

Treatment of stage IV stomach cancer, stomach cancer that cannot be removed by surgery, and recurrent stomach cancer

Treatment of stage IV stomach cancer, any stage of stomach cancer that cannot be removed by surgery, and recurrent stomach cancer is palliative. Palliative therapy is treatment meant to improve the quality of life of people who have a serious or life-threatening disease, such as cancer. Many of the same treatments for cancer, such as chemotherapy or other kinds of drugs and radiation therapy, can also be used for palliative therapy to help a patient feel more comfortable. Learn more about Palliative Care in Cancer.  

The first palliative treatment for HER2-negative tumors might include chemotherapy with or without the immunotherapy drug nivolumab. For HER2-positive tumors, it might include the immunotherapy drug pembrolizumab and the targeted therapy drug trastuzumab combined with chemotherapy.  

Subsequent palliative therapy may include one of the following: 

• chemotherapy  
• ramucirumab with or without chemotherapy  
• pembrolizumab for DNA mismatch repair deficiency cancer, microsatellite instability-high cancer, or tumor mutational burden-high cancer
• trastuzumab deruxtecan for HER2-positive cancer   

There are many chemotherapy drugs used as palliative therapy for advanced stomach cancer, including capecitabine, cisplatin, docetaxel, doxorubicin, epirubicin, etoposide, fluorouracil (5-FU), irinotecan, leucovorin, oxaliplatin, paclitaxel, and trifluridine and tipiracil. These drugs may be given alone or in combination.   

A specific way of giving chemotherapy called hyperthermic intraperitoneal chemotherapy, or HIPEC, may be an option at some treatment centers. This treatment uses warmed chemotherapy to wash the inside of the abdomen during surgery.

If you have side effects from the cancer or its treatment, you may be given other treatments to help reduce those side effects so you are more comfortable. For example, if you have a blockage in your stomach, you may receive endoluminal laser therapy or endoluminal stent placement to relieve the blockage or a gastrojejunostomy to bypass the blockage. Radiation therapy or surgery may be done to stop bleeding, relieve pain, or shrink a tumor that is blocking the stomach.  

To learn more about these treatments, see Stomach Cancer Treatment.