Non-Surgical Approaches to Managing Stomach Cancer

Stomach cancer, also known as stomach cancer, poses a significant problem in oncology due to its aggressive nature and frequent late-stage diagnosis. While surgery remains the primary therapy option for localized illnesses, not all patients are appropriate candidates for surgery. Furthermore, some people may choose non-surgical options for managing stomach cancer due to personal preferences, medical comorbidities, or worries about the risks and problems associated with surgery.  

Stomach cancer, also known as gastric cancer, is a disorder in which abnormal cells in the stomach multiply and divide uncontrollably, resulting in a tumor. The specific cause of stomach cancer is unknown, however, several risk factors may contribute. Common causes include Helicobacter pylori (H. pylori) infection, chronic gastritis, and intestinal metaplasia, dietary factors such as high salt intake, a lack of fruits and vegetables, processed meats, tobacco and alcohol use, family history and genetic factors, age and gender, previous stomach surgery or medical conditions, and occupational exposures.

1. pylori infection can cause persistent inflammation and ulcers in the stomach lining, which is a major risk factor for stomach cancer. Chronic gastritis can cause alterations to the gastric mucosa, such as the replacement of normal stomach cells by intestinal-like cells.

Similarly, dietary causes include a high intake of salty, smoked, or pickled foods, a limited intake of fruits and vegetables, and processed meats high in nitrates and nitrites. Furthermore, tobacco use and excessive alcohol intake have been linked to an increased risk of stomach cancer.

Moreover, family history and genetic variables, age and gender, prior stomach surgery or medical issues, and occupational exposure to specific chemicals, such as asbestos, coal dust, and metalworking fluids, all increase the chance of stomach cancer.

Stomach cancer is the fifth most frequent cancer worldwide, accounting for 5.7% of all new cases and 7.7% of cancer-related deaths. In 2020, there were 1.1 million new cases and 769,000 fatalities. Geographic variance varies, with the highest rates being in Eastern Asia, Eastern Europe, and areas of South America. The incidence of stomach cancer has been reducing in developed countries due to advances in food preservation, sanitation, and the lower prevalence of Helicobacter pylori infections. 

However, certain groups continue to have higher rates, including older persons, men, and those of Asian or Pacific Islander heritage. Helicobacter pylori infection, chronic gastritis, peptic ulcer disease, atrophic gastritis, tobacco use, strong alcohol use, a salty diet, and a family history of stomach cancer or specific genetic diseases all increase the risk.

Early detection and screening are difficult, but endoscopic screening is suggested in high-risk groups. Treatment options for stomach cancer vary according to the disease stage, with early-stage cancers having a better prognosis. The overall 5-year survival rate for stomach cancer is around 32%.

This comprehensive article explores non-surgical treatment options for stomach cancer, such as systemic therapies, radiation therapy, endoscopic interventions, supportive care, and palliative measures.

Exploring Non-Surgical Treatment Options For Stomach Cancer

1. Systemic Therapies:

• Chemotherapy: Advanced or metastatic stomach cancer is typically treated with systemic chemotherapy regimens that include cytotoxic medicines such as fluoropyrimidines, platinum compounds, taxanes, and anthracyclines. Chemotherapy can be used as first-line therapy, neoadjuvant therapy (before surgery), adjuvant therapy (after surgery), or palliative therapy to alleviate symptoms and enhance quality of life.
• Targeted Therapy: Targeted medicines targeting specific molecular targets implicated in stomach cancer, such as HER2, VEGF, and EGFR, provide alternate therapy choices for individuals with advanced disease. Trastuzumab, ramucirumab, and cetuximab are targeted medicines that can be administered alone or in conjunction with chemotherapy to decrease tumor development and spread.
• Immunotherapy: Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, have shown promise in the treatment of advanced gastric cancer by boosting the immune system’s response to tumor cells. Immunotherapy can be used alone or in combination with chemotherapy as a first-line or salvage treatment option for individuals with advanced illnesses.

1. Radiation Therapy:

   • External Beam Radiation Therapy (EBRT): External beam radiation therapy sends high-energy X-ray beams to the tumor site from outside the body, targeting cancer cells while causing minimal damage to healthy tissues. Radiation therapy can be used as the primary treatment for localized stomach cancer, as adjuvant therapy after surgery, or as palliative therapy to alleviate symptoms like pain or bleeding.
   • Brachytherapy: Brachytherapy is the implantation of radioactive sources directly into or near the tumor site, delivering a high dosage of radiation to cancer cells while preserving adjacent organs and tissues. Brachytherapy can be utilized as an adjunct to EBRT or as the principal treatment option for certain patients with early-stage or localized illnesses.

2. Endoscopic Interventions:

   • Endoscopic Mucosal Resection (EMR): Endoscopic mucosal excision is a minimally invasive method for removing early-stage gastric cancers that are limited to the mucosal layer of the stomach lining. EMR uses an endoscope equipped with specific cutting equipment to excise the tumor, enabling the total excision of targeted lesions without surgery.
   • Endoscopic Submucosal Dissection (ESD): Endoscopic submucosal dissection is a more advanced endoscopic technique that allows for the complete removal of larger or more difficult gastric cancers affecting the submucosal layer. ESD enables accurate separation of the tumor from the underlying tissue layers, allowing for total tumor removal while sparing the surrounding healthy tissue.
   • Endoscopic Stenting: Endoscopic stenting can be used to treat symptoms of gastric outlet obstruction caused by advanced stomach cancer. Self-expanding metal stents (SEMS) or plastic stents are put endoscopically across a constricted segment of the stomach or duodenum to restore luminal patency and facilitate food and fluid passage.

3. Supportive Care and Palliative Measures:

   • Symptom Management: Palliative treatment aims to relieve symptoms and improve the quality of life for patients with advanced or metastatic stomach cancer. Pain control, nausea and vomiting relief, nutritional support, and psychological interventions to address emotional discomfort and improve coping skills are all possible symptom management options.
   • Hospice Care: Hospice care offers full end-of-life support to patients with advanced cancer who have chosen comfort-oriented care. Hospice services include pain management, symptom control, emotional support, and spiritual care, with the goal of maximizing comfort and dignity during the latter stages of disease.

Conclusion: Treating stomach cancer without surgery necessitates a comprehensive approach suited to each patient’s unique needs and preferences. While surgery remains the primary treatment for localized illness, non-surgical methods such as systemic medications, radiation therapy, endoscopic procedures, supportive care, and palliative measures are critical in managing advanced or metastatic stomach cancer. By strategically mixing these modalities and incorporating supportive care throughout the illness trajectory, healthcare practitioners can optimize outcomes and improve quality of life for patients dealing with stomach cancer.