Gastric cancer, also known as stomach cancer, is a disease where malignant cells form in the lining of the stomach. When described as “metastatic,” it means the cancer cells have spread from the stomach to other, distant parts of the body. This indicates a more advanced stage of the disease.
What is Metastatic Gastric Cancer
Metastatic gastric cancer refers to stomach cancer that has advanced beyond its initial site and nearby lymph nodes, spreading to distant organs. Cancer cells can travel through the body via the lymphatic system, a network of vessels, and the bloodstream. Direct extension, where the tumor grows into adjacent organs, also represents a pathway of spread.
The most common sites where gastric cancer metastasizes include the liver, peritoneum (the membrane lining the abdominal cavity), lungs, and bones. Other sites include the spleen, pancreas, ovaries, and the brain. The presence of metastasis signifies Stage IV gastric cancer, indicating the disease is widespread.
Treatment Options
Treatments for metastatic gastric cancer aim to control disease progression. Systemic therapies are employed to reach cancer cells throughout the body.
Chemotherapy
Chemotherapy uses drugs to shrink tumors and manage symptoms. Commonly used drug classes include fluoropyrimidines and platinum-based agents, which target rapidly dividing cancer cells. Chemotherapy involves a combination of drugs.
Targeted Therapy
Targeted therapy drugs specifically attack molecular pathways or mutations found in cancer cells, minimizing harm to healthy cells. For example, some gastric cancers are HER2-positive, meaning they have excess HER2 protein that promotes cell growth. Drugs like trastuzumab directly target this protein, inhibiting cancer cell growth. Another targeted therapy, ramucirumab, blocks VEGFR2, a protein involved in blood vessel development, starving the tumor of blood supply.
Immunotherapy
Immunotherapy harnesses the body’s own immune system to recognize and destroy cancer cells. Checkpoint inhibitors, such as nivolumab and pembrolizumab, block proteins that normally prevent the immune system from attacking cancer. These treatments can activate the immune response against cancer, particularly in tumors with specific biomarkers like PD-L1 expression or high microsatellite instability (MSI-H).
Radiation Therapy
Radiation therapy uses high-energy beams to destroy cancer cells. It is not a standalone treatment for metastatic gastric cancer. Its role is for symptom management, such as relieving pain from bone metastases or reducing bleeding.
Surgery
Surgery for metastatic gastric cancer is limited to palliative measures, aiming to relieve symptoms rather than cure the disease. For instance, surgery might be performed to alleviate blockages in the digestive tract or control bleeding caused by the tumor. This helps improve comfort and daily function.
Clinical Trials
Clinical trials offer access to novel and experimental therapies not yet widely available. Participation provides new treatments and contributes to advancements in cancer care.
Managing Symptoms and Quality of Life
Palliative and supportive care address symptoms in metastatic gastric cancer. Patients experience symptoms such as pain, nausea, vomiting, fatigue, loss of appetite, and weight loss.
Pain management involves medications. Nausea and vomiting can be controlled with antiemetic drugs, which help improve the ability to eat. Nutritional support, including dietary adjustments or supplements, counteracts weight loss and maintains strength.
A multidisciplinary team supports patients. This team includes oncologists, palliative care specialists, registered dietitians, and social workers, who collaborate to address physical and nutritional needs. Emotional and psychological support, including counseling or support groups, helps patients and their families cope with anxiety, depression, and the emotional burden of diagnosis. Early palliative care improves quality of life and may help patients better tolerate anti-cancer therapies.
Prognosis and Support
Prognosis for metastatic gastric cancer varies, influenced by several factors. Extent and location of spread, patient’s overall health, and treatment response all play a role. While treatments can extend life and improve comfort, metastatic gastric cancer is rarely cured.
The 5-year relative survival rate for metastatic gastric cancer is around 7%. However, this statistic is an average derived from large groups and does not predict individual outcomes. Open communication with the medical team is important for understanding the disease course and making informed decisions.
Support systems are important for coping with metastatic gastric cancer. Family and friends provide emotional comfort and practical assistance with daily tasks. Joining support groups can connect patients with others facing similar challenges, fostering a sense of community and reducing feelings of isolation. Professional counseling provides strategies for managing emotional distress and improving coping mechanisms.