Treatments for stage 4 and recurrent stomach cancer

Last medical review:

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


Chemotherapy is usually offered for stage 4 or recurrent stomach cancer to help shrink the tumour and control the growth of the cancer. It may be given as a single drug or a combination of drugs.

Fluorouracil (also called 5-fluorouracil or 5-FU), capecitabine (Xeloda) or combinations with either of these drugs are often used.

Targeted therapy may be given in combination with chemotherapy drugs.

Targeted therapy

You may be offered targeted therapy for stage 4 stomach cancer.

  • Trastuzumab (Herceptin and biosimilars) may be used with chemotherapy for stomach cancer that makes too much of the HER2 protein (called HER2-positive stomach cancer).
  • Ramucirumab (Cyramza) may be used with paclitaxel or alone if chemotherapy drugs have stopped working.
  • Nivolumab (Opdivo) may be used with chemotherapy to treat advanced or metastatic stomach cancer.
  • Pembrolizumab (Keytruda) may be used with chemotherapy and trastuzumab to treat advanced or metastatic stomach cancer.


Surgery is sometimes offered for stage 4 or recurrent stomach cancer to relieve the symptoms of advanced cancer such as bleeding, blockage or pain (called palliative surgery). Surgeries that may be done include the following:

A subtotal gastrectomy may be done to remove the part of the stomach with the tumour.

A stent (hollow metal or plastic tube) may be placed during surgery 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.

A feeding tube is used to give a special liquid mixture of nutrients directly into the stomach or small intestine. 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 during surgery.

Surgery for a bowel obstruction (when the intestine is partly or completely blocked) may be done to remove or bypass the part of the intestine that is blocked. Find out more about a bowel obstruction.

Radiation therapy

You may be offered external radiation therapy for stage 4 or recurrent 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 bleeding, pain, difficulty 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 without treating 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

Talk to your doctor about clinical trials open to people with stomach cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • Michael Sanatani , MD, FRCPC

Medical disclaimer

The information that the Canadian Cancer Society provides does not replace your relationship with your doctor. The information is for your general use, so be sure to talk to a qualified healthcare professional before making medical decisions or if you have questions about your health.

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