Treatments for stage 4 stomach cancer

The following are treatment options for stage 4 stomach cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemotherapy

Chemotherapy is a main treatment for stage 4 stomach cancer to slow the growth of the cancer. Chemotherapy for stomach cancer may be given as a single drug or as a combination of 2 or more drugs. Sometimes radiation therapy is given over the same time period as chemotherapy (this is called chemoradiation). The most common chemotherapy options for stage 4 stomach cancer are:

  • 5-fluorouracil (Adrucil, 5-FU) – leucovorin (folinic acid) is often given along with 5-fluorouracil to make 5-fluorouracil work better
  • capecitabine (Xeloda)
  • cisplatin (Platinol AQ)
  • carboplatin (Paraplatin)
  • epirubicin (Pharmorubicin)
  • docetaxel (Taxotere)
  • irinotecan (Camptosar)
  • oxaliplatin (Eloxatin)
  • paclitaxel (Taxol)
  • doxorubicin (Adriamycin)
  • mitomycin (Mutamycin)
  • methotrexate
  • etoposide (Vepesid)
Some examples of chemotherapy regimens (a combination of 2 or more drugs) used for stage 4 stomach cancer are:
  • ECX – epirubicin, cisplatin and capecitabine
  • ECF – epirubicin, cisplatin and 5-fluorouracil
  • DCF (TCF) – docetaxel, cisplatin and 5-fluorouracil
Lonsurf (trifluridine/tipiracil) may be used to treat stage 4 stomach cancer. It is used after you have had at least 2 different types of chemotherapy, including oxaliplatin and fluorouracil, along with docetaxel or paclitaxel, or irinotecan.

Targeted therapy may be given in combination with chemotherapy drugs.

Targeted therapy

Trastuzumab (Herceptin) and ramucirumab (Cyramza) are targeted therapy drugs used to treat stage 4 stomach cancer. Trastuzumab (Herceptin) may be offered for stage 4 stomach cancer that is HER2-positive.

Targeted therapy is usually given until the cancer no longer responds to treatment, grows larger or spreads.

Palliative surgery

Surgery is sometimes offered for stage 4 stomach cancer to relieve the symptoms of advanced cancer such as bleeding, blockage or pain.

Partial gastrectomy

Some people who are well enough to have surgery may have part of the stomach removed that contains the tumour.

Placement of a stent

A stent is a hollow metal or plastic tube. Stents may be used if a tumour is blocking the opening of the stomach near the esophagus. It will allow a person with advanced stomach cancer to swallow more easily.

Placement of a feeding tube

If surgery or other methods cannot relieve a blockage caused by a stomach tumour, a person with advanced stomach cancer may have a feeding tube placed through a surgical opening in the abdomen. A feeding tube is used to give the person liquid nutrition to help maintain their weight.

Surgery for a bowel obstruction

A bowel obstruction is when the small intestine or colon is partly or completely blocked. The blockage prevents food, fluids and gas from passing through the intestines normally. If you have a bowel obstruction, you may need surgery to remove or bypass the part of the intestine that is blocked.

Radiation therapy

External beam radiation therapy may be offered for stage 4 stomach cancer. It is used alone or in combination with chemotherapy (called chemoradiation). It may be used to relieve the symptoms caused by advanced stomach cancer such as uncontrolled bleeding, pain, trouble swallowing (dysphagia) or a blockage.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better rather than treat the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Clinical trials

You may be asked if you want to join a clinical trial for stomach cancer. Find out more about clinical trials.

Expert review and references

  • American Cancer Society. Stomach Cancer. Atlanta, GA: American Cancer Society; 2014: http://www.cancer.org/acs/groups/cid/documents/webcontent/003141-pdf.pdf.
  • American Society of Clinical Oncology (ASCO). Stomach cancer. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2014.
  • Avital, I. et al . Cancer of the stomach. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011: 80: pp. 924-954.
  • BC Cancer Agency (BCCA). Stomach Cancer Management Guidelines. BC Cancer Agency; 2013: http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Gastrointestinal/02.Stomach/default.htm.
  • Cancer Research UK. Stomach cancer. Reviewed ed. Cancer Research UK; 2014.
  • Health Canada. Cyramza Summary Basis of Decision (SBD). 2015: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2015_cyramza_176810-eng.php.
  • MacKenzie M, Spithoff K, Jonker D, et al . Systemic therapy for advanced gastric cancer. Cancer Care Ontario. Evidence-Based Series (EBS) and Practice Guidelines (PG). Toronto, ON: Cancer Care Ontario; 2014.
  • National Cancer Institute. Gastric Cancer Treatment (PDQ®) Patient Version. Bethesda, MD: National Cancer Institute; 2014.
  • National Cancer Institute. Gastric Cancer Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
  • National Comprehensive Cancer Network. Gastric Cancer (Version 1.2014). National Comprehensive Cancer Network; 2014.