Staging is a description used to indicate the size of a cancerous tumor and whether it has spread. If you have been told you have Stage 1 gastric cancer, this means that the cancer is under the stomach lining and has not spread into the stomach wall. When the cancer is limited to the stomach lining, and has not reached nearby lymph nodes, it's referred to as Stage 1A cancer. When the cancer has spread to 1-6 lymph nearby nodes or into the muscle wall of the stomach, it's called Stage 1B cancer.
Staging for gastric cancer is based on the results of several tests. Most patients undergo a routine chest X-ray examination and a barium swallow performed under fluoroscopy (direct X-ray examination). You would also have computerized tomography (CT) scans of your chest, upper abdomen and possibly the neck. Other tests include:
- Gastroscopy, an examination performed through an endoscope, a flexible tube inserted through the esophagus that allows the physician to visualize, photograph and biopsy, or sample, the cancer.
- Endosonography, an ultrasound test performed through an endoscope. Ultrasound tests use sound waves to detect different densities of tissue, including cancer. Endosonography can detect spread of cancer into various layers of the stomach, adjacent organs and lymph nodes.
- Laparoscopy is a procedure that involves the insertion of an endoscope through a small incision in the abdomen. Ultrasonography can be performed through the laparoscope, improving the accuracy of diagnosis. Another procedure, called peritoneal lavage, involves the infusion of fluid into the abdomen and can increase the accuracy of diagnosis of peritoneal spread.
- Positron Emission Tomography (PET): Positron emission tomography (PET) scanning may be used to detect cancer in lymph nodes.
Treatment for Stage 1 gastric cancer can vary from person to person, based on a number of factors, including the size, location, extent of the tumor and your overall health. Your team of WellStar cancer specialists, which includes specialists in medical oncology, surgery, radiation oncology, radiology and pathology, will evaluate these factors. These experts will work together to formulate a personalized treatment plan consistent with the highest standards of care. Your treatment options may include one or a combination of methods to control and eliminate the cancer:
- Surgery to eliminate all cancer by removing part of the stomach, a procedure called a subtotal gastrectomy as well as any associated lymph nodes, a surgery called lymphadenectomy.
- Surgery to remove the entire stomach and parts of the esophagus, the small intestine, pancreas and other tissue near the tumor, called a total gastrectomy, as well as any associated lymph nodes.
- Chemotherapy, using chemicals to treat the cancer, may be used before surgery to reduce the size of a tumor or, more commonly, following surgery.
- Radiation therapy uses high doses of X-rays to kill cancer cells and shrink tumors.
In cases where surgery is not an option, chemotherapy and radiation can improve symptoms but it's unlikely they will cure the cancer.
Treatment After Surgery
There is a possibility that, while treatments like surgery for stage 1 gastric cancer initially appear to be successful, small, undetectable amounts of cancer may have spread into the lymph nodes. These undetectable areas of cancer, called micrometastases can cause the cancer to reoccur after treatment with surgery alone. Cancer that returns after treatment is called recurrent cancer.
Treatment to cleanse the body of these micrometastases is calledadjuvant therapy. Adjuvant therapy is considered the standard treatment for patients with gastric cancer for whom all detectable cancer can first be removed by surgery. Adjuvant therapy for post surgical treatment of gastric cancer may include chemotherapy, radiation therapy and/or biological therapy. While both chemotherapy and biological therapy fight cancer, they work in different ways. Chemotherapy attacks cancer directly, while biological therapy helps your immune system fight cancer.
WellStar is advancing cancer treatment by studying effectiveness of new anti-cancer drugs and therapies through clinical trials. In cases of recurrent cancer, clinical trials may be an effective option for treatment. Ask your WellStar oncologist for more information about becoming a candidate for current clinical trials.