Stomach Cancer Treatments and Survival

April 28, 2025

This page was reviewed under our medical and editorial policy by Yanghee Woo, M.D., associate professor, Division of Surgical Oncology, Department of Surgery, City of Hope^® Orange County Lennar Foundation Cancer Center.

Significant progress and advancements have been made in stomach cancer treatment, leading to improved patient survival and quality of life. The optimal treatment option may differ from patient to patient, but people diagnosed with stomach (gastric) cancer have several common options. The goals of these treatments include eliminating the cancer, managing or halting the cancer’s progression, preventing it from returning, providing relief from issues such as eating problems or pain, and improving the patient’s quality of life.

Treatment for stomach cancer is personalized to the type and stage of the patient’s disease; his or her overall health and goals for treatment; and the potential side effects of medications, therapies and procedures.

Who Treats Stomach Cancer?

Because stomach cancer treatments may be complex, several different clinicians may be part of a patient’s care team:

• A gastroenterologist, a doctor with expertise in treating digestive system conditions
• An interventional gastroenterologist, who may perform endoscopic ultrasounds and endoscopic submucosal dissections to treat early-stage stomach cancer
• A surgical oncologist, a surgeon who performs operations to treat cancer
• An anesthesiologist, who administers medications (anesthesia) during surgery, which help alleviate pain throughout the procedure
• A medical oncologist, a doctor who administers systemic cancer treatments such as chemotherapy, immunotherapy and targeted therapy
• A radiation oncologist, a doctor who prescribes and administers radiation therapy for cancer
• Dietitians and nutritionists, who provide information on proper diet and nutritional support before, during and after stomach cancer treatments
• Supportive medicine providers, who help with symptom management, including eating challenges and loss of appetite

Stomach Cancer Surgery

Several types of surgeries are used to ease stomach cancer symptoms and treat the disease, and they are performed in a number of ways, as listed below.

Endoscopic surgery: This procedure does not require an incision. Instead, the gastroenterologist or surgeon inserts a long, flexible instrument with an attached camera (endoscope) down the throat to perform stomach surgery.

Laparoscopic surgery: This procedure involves making several smaller cuts in the abdomen, through which surgical instruments and a long, thin tube with an attached camera (laparoscope) are inserted.

Robot-assisted laparoscopic surgery: This is a type of surgery performed remotely by a surgeon with the assistance of a robotic platform and instruments. The surgeon controls the robotic arms that hold the surgical instruments and laparoscope.

Open (traditional) surgery: This operation involves making a large cut in the abdomen.

Laparoscopic surgeries are sometimes called minimally invasive surgeries because their smaller cuts tend to leave less scarring and tissue damage, which may help speed healing.

For stomach cancer, surgical resection (removal of all the cancer) is considered the treatment of choice, when possible. Since not all stomach cancers are resectable, the doctor will order imaging tests to determine if cancer resection surgery is an option. The main surgeries performed to treat resectable stomach cancer include the following.

Endoscopic mucosal resection (EMR): An endoscope is placed into the throat and surgical tools are inserted through it. The surgeon uses these tools to cut or suction the cancer out. This procedure may be performed for cancer that has not spread too far into the stomach wall (early-stage cancer) or for precancerous tumors.

Endoscopic submucosal dissection (ESD): Like an EMR, an ESD is performed for early-stage cancer or precancerous tumors using an endoscope. The surgical tools used during an ESD include an instrument that injects fluid between the stomach wall and the tumor, and another used to cut and lift the tumor out.

Total gastrectomy: The entire stomach, nearby lymph nodes and a thin layer of tissue (omentum) that surrounds the stomach are all removed. Sometimes, the spleen and parts of the esophagus, pancreas and small intestine are also removed, then the remaining esophagus is connected to the remaining small intestine to allow for normal eating. This procedure may be performed using open, laparoscopic or robotic surgery.

Gastric wedge: GISTs may be removed this way without a formal gastrectomy

Subtotal gastrectomy: If cancer is localized or confined to the distal portion of the stomach, only part of the stomach is removed, along with nearby lymph nodes, part of the omentum and sometimes the spleen and parts of the esophagus and small intestine. The remaining stomach is then attached to the remaining small intestine to allow for normal eating. Similar to a total gastrectomy, a subtotal gastrectomy may be performed using open, laparoscopic or robotic surgery.

Lymphadenectomy (lymph node dissection): This is the removal of lymph nodes that drain the stomach and the cancer, which are then examined under a microscope to determine how far the cancer has spread. A D2 lymphadenectomy is the removal of second-tier lymph node drainage basin. This procedure is a special technique performed by experienced surgical oncologists. A D0 lymphadenectomy is the removal of no lymph nodes during the gastrectomy, usually during surgery for GISTs, which rarely spread to the lymph nodes. A D1+ is recommended for earlier-stage stomach cancer and is the removal of the lymph nodes stations just around the stomach. In order to stage stomach cancer, at least 16 lymph nodes need to be evaluated. It’s recommended that 30 or more nodes are evaluated for accurate staging of the cancer and optimized survival.

Side Effects after Surgery

Some patients experience side effects from stomach cancer surgery, especially after eating. The side effects are usually the strongest immediately after surgery and differ between the extent of surgery. Doctors may prescribe medication to help patients manage these side effects:

• Nausea
• Diarrhea
• Abdominal pain
• Heartburn
• Bile reflux

Palliative Surgical Procedures

If cancer is unresectable (unable to be completely removed) or the patient is not healthy enough to undergo a surgical procedure to remove it, other procedures may be performed. These include the following procedures.

Gastrojejunostomy (gastric bypass): If a stomach tumor lodges in the lower part of the stomach and blocks the flow of food into the small intestine, part of the small intestine will be disconnected and reattached to the upper portion of the stomach to allow for food digestion.

Feeding tube placement: For people with stomach cancer who are not getting enough nutrition because of symptoms such as a tumor blockage or treatment side effects like nausea, a minor opening is made in the abdomen and a gastronomy tube (G-tube) is placed directly into the stomach or a jejunostomy tube (J-tube) is placed directly into the small intestine. Nutritious liquids are then inserted into the tube.

Endoscopic tumor ablation: People who have bleeding or a tumor that blocks food digestion but are not healthy enough for surgery may benefit from this procedure. An endoscope with an attached laser is placed down the throat and the tumor is vaporized (ablated).

Stent placement: When a tumor blocks either stomach opening (where it connects to the esophagus or to the small intestine), a hollow metal tube (stent) may be deployed to allow food to pass. To place the stent, an endoscope is inserted down the throat and the stent is passed through it. Once placed, the stent expands the location for food to pass through.

In addition to these procedures, a subtotal gastrectomy is sometimes performed to treat tumor symptoms (such as pain, bleeding or blockage of food digestion) even though the surgery will not completely remove the cancer.

Chemotherapy for Stomach Cancer

Drugs that destroy cancer cells are known as chemotherapy. Systemic chemotherapy reaches cells throughout the body, and it is used either alone or more often, alongside other stomach cancer treatments to help improve outcomes.

The oncologist may recommend chemotherapy to shrink the cancer tumor, decrease recurrence and improve survival after surgery. At times, it may make surgery less difficult. It is also used after surgery to destroy any cancer cells that may remain. In both cases, it may be combined with radiation therapy (chemoradiation).

In some cases, chemotherapy is used as a main form of stomach cancer treatment or the backbone of multimodal systemic therapy for patients with the following cancers.

Unresectable stomach cancer: Stomach cancer may be unresectable (not able to be surgically removed) even when it has not spread beyond the stomach or area lymph nodes. In this case, it is treated with chemotherapy, which may be combined with other treatments like radiation therapy, immunotherapy or targeted therapy.

Metastatic stomach cancer: This type of cancer has spread beyond the stomach to distant organs and structures. For this reason, it is difficult to remove with surgery, and chemotherapy may be recommended to help destroy cancer cells throughout the body. Similar to unresectable stomach cancer, it is often used alongside other treatments.

Sometimes, chemotherapy shrinks the cancer enough that surgery becomes possible. Other times, the therapy helps manage cancer growth and spread and eases underlying symptoms of the disease.

Chemotherapy drugs are given by pill, capsule or intravenous (IV) infusion into a vein, usually in a combination of two to three drugs. Most chemotherapy drugs for stomach cancer are administered through a port. Since chemotherapy also destroys some normal cells, it may cause side effects such as:

• Nausea
• Vomiting
• Constipation
• Diarrhea
• Mouth sores
• Hair loss
• Shortness of breath
• Tiredness
• Bruising or bleeding skin
• Increased infections

To help the body recover after chemotherapy treatment, it's usually given in cycles that include rest periods.

Intraperitoneal Directed Therapy (Investigational in the United States)

In addition to systemic chemotherapy that treats the whole body, regional chemotherapy that is placed directly into an organ or cavity may be used to treat stomach cancer. This procedure is still investigational in the United States.

Normotherapic Intraperitoneal Chemotherapy (NIPS)

Catheter-based infusion of chemotherapy directed into the peritoneum may be helpful for patients who have peritoneal spread of gastric cancer.

HIPEC for Gastric Cancer

Hyperthermic intraperitoneal chemotherapy (HIPEC) is the administration of heated chemotherapy at 42 degrees Celsius directly into the abdominal cavity during surgery. It may be delivered by a laparoscopic or open approach. Timing and duration of HIPEC may differ based on the indications. For example, HIPEC may be given after gastrectomy and cytoreductive surgery to help ensure that any potential remaining cancer cells are destroyed. Hyperthermic means heated. True to its name, this type of chemotherapy drug is warmed, then put directly into the peritoneal cavity (that houses the stomach) using either open or laparoscopic surgery. Catheters and a pump move the medication through the stomach, and a heat exchanger keeps it warm.

Radiation Therapy for Stomach Cancer

In radiation therapy, high-energy particles like X-rays or protons are used to destroy cancer cells or stop them from growing.

It's often given along with chemotherapy before, after or instead of surgery.

Radiation therapy may be used to:

• Help control gastric cancer spread
• Improve symptoms so that patients are more comfortable

External beam radiation therapy (EBRT) is the type of radiation used to treat stomach cancer. This is administered using an outside machine that directs high-energy particles at the cancer. EBRT includes the following.

3D conformal radiation therapy (3D CRT): In this form of therapy, beams of radiation are formed into the tumor’s shape at the cancer, which helps ensure healthy tissues are not exposed to the radiation.

Intensity-modulated radiation therapy (IMRT): Similar to 3D CRT, IMRT beam strength (intensity) may also be adjusted in this type of therapy.

Stereotactic radiotherapy: This type of high-dose, highly focused radiation therapy is typically used for small tumors that have spread beyond the stomach.

Proton radiotherapy: Beams of proton particles are used to hit the tumor but do not go beyond it like traditional X-ray therapy beams do, in order to help limit damage to healthy tissues.

Potential side effects of radiation therapy include:

• Nausea
• Vomiting
• Diarrhea
• Fatigue
• Low blood cell counts
• Skin issues like redness, peeling or blisters where the radiation was directed

Immunotherapy for Stomach Cancer

Immunotherapy describes drugs or substances that assist the body’s immune system in finding and fighting cancer. For stomach cancer, immunotherapy drugs called checkpoint inhibitors may be used.

Checkpoints are proteins that stop the immune system from attacking normal, healthy cells. However, some cancer cells are able to trick the immune system into seeing them as normal, causing the checkpoint proteins to turn off immune system attacks on them as well.

Checkpoint inhibitors are drugs that block these checkpoint proteins so that the immune system will attack and fight the cancer cells. PD-1 and CTLA-4 are two common checkpoint inhibitors used to treat stomach cancer.

Immunotherapy side effects may vary based on the type used, and patients should discuss the benefits and potential complications of each treatment with their doctor.

Other Stomach Cancer Treatment Options

Additional treatment options for stomach cancer may include targeted therapy and clinical trials.

Targeted therapy: These are drugs or substances that target changes (mutations) in cancer cells in order to help stop cancer cell growth and spread. For example, some people diagnosed with stomach cancer have cancer cells with elevated levels of a growth-enhancing protein called HER2. Targeted therapy drugs are given (typically by IV infusion) to prevent HER2 from functioning.

Clinical trials: Potential cancer treatments that have been discovered and tested in the laboratory are offered to patients during a clinical trial. If they are found to be appropriate and safe, the scientists and clinicians involved in creating the clinical trial may submit the treatments to the U.S. Food and Drug Administration (FDA) for approval. The risks and benefits of joining a clinical trial for stomach cancer should be discussed with each patient’s care team.

Stomach Cancer Survival Rate

People diagnosed with stomach cancer between 2015 to 2021 had a five-year relative survival rate of 37.9%, according to the National Cancer Institute. This means that about 38% of stomach cancer patients are alive five years or more after diagnosis, compared to people without that cancer type. 

Below are the five-year relative stomach cancer survival rates for each stage of stomach cancer between 2015 to 2021, according to the National Cancer Institute.

• Localized (cancer is confined to the stomach): 76.5%
• Regional (cancer is confined to the stomach and surrounding lymph nodes): 37.2%
• Distant (cancer has spread to other parts of the body): 7.5%
• Unknown (cancer is not staged): 31.9%

The rate of new cases has declined over the past decade, and scientists continue to research new treatments to help improve the prognosis (the chance of recovery or disease return) for people with stomach cancer.

Stomach Cancer Care at City of Hope

Exciting advances at City of Hope are allowing patients with advanced disease to get drug combinations designed to shrink tumors, slow disease progression and improve quality of life. What’s more, the cancer center’s surgical teams are experts at using minimally invasive techniques — especially robotic surgery — for complex abdominal operations. This offers several advantages:

• Greater precision
• Less blood loss during surgery
• Fewer transfusion requirements
• Less pain after surgery
• Shorter postoperative recovery
• Earlier return of bowel function
• Earlier discharge after surgery

Having stomach cancer is a life-changing event. Care at City of Hope includes counseling and nutritional education, support and palliative care from staff, who are lifelong partners in each patient’s healing.