ANNOUNCER: Treatment for gastric cancer, or cancer of the stomach, depends on how far the cancer has spread in the body. Doctors rate the extent of the disease through a process called staging.
DAVID ILSON, MD: Staging, basically, is defined by the depth of penetration of the tumor into the stomach wall, so that stage I would be very superficial involvement of the stomach lining. Stage II would be tumors that are more deeply penetrating into the muscle lining or through the wall of the stomach. And stage III disease typically is lymph node—involved cancer. Stage IV disease, which is the highest stage, would be distant metastasis, involving the liver or other sites away from the stomach.
ANNOUNCER: Early stages of gastric cancer are treated primarily with surgery.
DAVID ILSON, MD: For early stage disease, stage I disease or early stage II, surgery alone probably is adequate treatment. It's not clear that adding other therapies to early stage disease improves survival compared to surgery alone.
ANNOUNCER: There are two main types of surgery: a subtotal gastrectomy, where a portion of the stomach is taken out; and a total gastrectomy, where the entire organ is removed.
MANISH SHAH, MD: Depending on how extensive the tumor is within the stomach and also where it is within the stomach, we would choose either for a total gastrectomy, if the tumor was involved throughout the stomach, or a subtotal gastrectomy if only part of the stomach was involved.
ANNOUNCER: Regional lymph nodes are also removed and tested.
MANISH SHAH, MD: There are six chains of lymph nodes on the inside curve of the stomach or on the outside curve of the stomach. And removing all those lymph nodes is important to accurately stage the tumor, meaning accurately determine how advanced the tumor is.
JOHN MACDONALD, MD: If there's no cancer in the lymph nodes, those patients don't need any further treatment, and they have a high probability of being cured, maybe 80 to 90 percent.
ANNOUNCER: Gastric cancer can be cured if detected early. But few patients experience symptoms in early stages and most aren't diagnosed until the cancer has advanced.
DAVID ILSON, MD: Because we do not have effective screening and because gastric cancer is rare, most patients present with symptomatic disease and with more advanced cancer. So stage III, stage IV disease is much more common.
ANNOUNCER: If the tumor has spread outside of the stomach to the lymph nodes, it is considered stage III cancer. It is treated with surgery, followed by radiation and chemotherapy.
DAVID ILSON, MD: In patients that have had potentially curative surgery, particularly in patients with stage III disease that have had complete surgeries and removal of the cancer, chemotherapy and radiation after surgery has preventive benefit in terms of reducing the risk of recurrence. In that situation, the standard chemotherapy that's used is a drug called 5-FU, or fluorouracil. That's given by itself and in combination with radiation for a period of four to five months after surgery.
ANNOUNCER: Once the cancer spreads to other organs, it is the most advanced disease or stage IV. Surgery is generally no longer a treatment option.
DAVID ILSON, MD: For patients with stage IV disease, that is identified metastatic disease, the role of surgery is not clear, because even if we remove the primary stomach cancer, we're leaving behind a distant cancer in the liver or other organs.
ANNOUNCER: Doctors will instead prescribe a combination of chemotherapy medications.
JOHN MACDONALD, MD: The FDA approved a regimen for gastric cancer, which is one of a number of regimens that are out there, but using a combination of a drugs called docetaxel, cisplatin and 5-FU. There's another regimen that uses a combination of a drug called irinotecan and cisplatin, which is also helpful now.
ANNOUNCER: Alternative chemotherapies are being studied for treating advanced cancer, including oral versions of 5-FU and substituting cisplatin with oxaliplatin.
DAVID ILSON, MD: Oxaliplatin is currently the subject of trials comparing it to the older drug, cisplatin. Oxaliplatin may have some benefits in terms of side effects compared to cisplatin.
ANNOUNCER: Studies have found that oxaliplatin can cause less nausea and fatigue than cisplatin. But all combinations of chemotherapy drugs may carry a variety of side effects.
DAVID ILSON, MD: The problem is that combination therapy has more side effects, and the side effects start to overlap. Side effects like nausea, lowering of the blood counts, diarrhea become more intense with combination treatment. So as we become more aggressive with chemotherapy, then we have to limit the use of such treatments to fit patients that are going to be able to tolerate side effects.
ANNOUNCER: Although there is no cure for advanced stomach cancer, treatments can sometimes slow its progress and provide relief.
DAVID ILSON, MD: In general, we always have to offer patients hope. And even in the situation of advanced or metastatic disease, sometimes patients have very gratifying and very symptom-relieving responses to chemotherapy and sometimes those responses to treatment, again, may last six months, a year or longer. And even though the survival that we achieve sometimes is not long, those are periods of time in which patients can have good quality of life and function and participate in family events, so we always have to approach patients with hope and optimism.
I have been haveing extra periods on and off for a year now. I have had 3 ultrasounds done and the doctors say things are fine !!! I think my ob/gyn is being lazy and doesnt want to take the time to help me .
These doctors dont understand the pain I go throw every time this happens