Understand stomach cancer treatment options: A clinical overview of current therapeutic strategies

Stomach cancer, or gastric cancer, represents a complex oncological challenge involving the uncontrolled growth of abnormal cells within the stomach lining 2, 4. Because this disease is often diagnosed at advanced stages, clinical strategies are increasingly focused on multidisciplinary, personalized care tailored to the specific genetic profile, tumor location, and health status of the individual 1, 6. Understanding these treatment modalities is essential for navigating the standard of care and emerging therapeutic possibilities in modern oncology 9.

Surgical Interventions and Gastrectomy

Surgery remains a cornerstone of curative intent for localized gastric cancer. The primary surgical objective is the removal of the tumor along with surrounding lymph nodes to ensure clear margins and reduce the risk of recurrence 6, 16. A gastrectomy involves the partial or total removal of the stomach, a procedure often required when tumors are deep within the organ wall 1, 15. For patients with very early-stage cancers, less invasive endoscopic procedures, such as endoscopic mucosal resection or submucosal dissection, may be utilized to excise tumors without requiring traditional abdominal surgery 7, 10, 17.

Systemic Chemotherapy and Radiation

Chemotherapy is frequently integrated into the treatment plan, functioning as either a neoadjuvant strategy-administered before surgery to shrink tumors-or an adjuvant approach applied after surgery to eliminate residual cells 6, 10. In instances where the cancer is unresectable or has metastasized, systemic chemotherapy serves as a primary method for controlling disease progression and extending survival 6, 10. Radiation therapy may also be incorporated to provide localized control or to alleviate specific symptoms, such as pain, bleeding, or obstruction caused by tumor growth 10, 13.

Targeted Therapy and Molecular Profiling

Modern oncology utilizes molecular profiling to identify specific biomarkers, such as HER2 status, which informs the selection of targeted therapies 6, 10. Unlike broad-spectrum treatments, targeted drugs are designed to disable specific molecular signals that drive tumor growth, offering a more precise mechanism of action for eligible patients 1, 13. These therapies are often reserved for advanced or metastatic cases where traditional systemic treatments are insufficient to halt progression on their own 6, 10.

The Evolving Role of Immunotherapy

Immunotherapy has become a critical component of the treatment landscape for select gastric cancer patients. By utilizing checkpoint inhibitors, these treatments boost the immune system's natural ability to recognize and destroy cancerous cells 1, 10. Eligibility for these therapies is often determined by a patient’s PD-L1 expression, MSI-high status, or mismatch-repair deficiencies 10. Regulatory bodies have approved specific immunotherapy protocols as first-line options for advanced or metastatic adenocarcinoma of the stomach and gastroesophageal junction 14.

Specialized Intraperitoneal Treatments

Given the propensity of gastric cancer to disseminate into the abdominal cavity, specialized regional therapies are being explored to improve outcomes. Cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) involves the delivery of heated chemotherapy directly into the abdominal space following the surgical removal of visible tumors 3. While historically considered experimental, this combination is being utilized for carefully selected patients at specialized medical centers to address the risk of peritoneal spread more effectively than systemic delivery alone 3.

Supportive Care and Multidisciplinary Management

Effective management of stomach cancer extends beyond tumor eradication to include comprehensive supportive care. A multidisciplinary team, typically comprising surgical oncologists, medical oncologists, radiation oncologists, pathologists, and dietitians, is essential for addressing the metabolic and nutritional challenges inherent in digestive system cancers 6, 9. Managing side effects such as chronic nausea, weight loss, or difficulty swallowing is prioritized throughout the recovery period to maintain quality of life and physical strength during treatment cycles 8, 10.

Sources

1. Penn Medicine: Stomach Cancer Treatment
2. Harvard Health: Stomach Cancer - A to Z
3. Abdominal Cancers: Gastric Cancer
4. Mount Sinai: What a Cancer Specialist Says You Should Know About Stomach Cancer
5. Penn Medicine: Gastric (Stomach) Cancer
6. Acibadem Hospitals: Treatment of Gastric Cancer: What to Expect
7. Springer Nature: Japanese Gastric Cancer Treatment Guidelines 2025
8. Acibadem Hospitals: Stomach Cancer Treatment
9. WVU Cancer Institute: Gastric Cancer
10. Acibadem Hospitals: Stomach Cancer: Indigestion, Endoscopy & Treatment Planning
11. National Cancer Institute: Stomach Cancer Treatment (PDQ)
12. American Cancer Society: Treating Stomach Cancer
13. Mayo Clinic: Stomach Cancer Diagnosis and Treatment
14. U.S. Food and Drug Administration: Pembrolizumab Approval for Gastric Cancer
15. Cleveland Clinic: Gastrectomy
16. Johns Hopkins Medicine: Stomach Cancer Approaches
17. Cancer Research UK: Stomach Cancer Treatment