Mayo Clinic Comprehensive Cancer Center: Surgical treatments for stomach cancer

Travis E. Grotz, M.D., Surgical Oncologist: At Mayo Clinic, we treat all types of stomach cancer. One of the most common types of stomach cancer is the diffuse type, or sometimes called signet ring cell type. And what's unique about that type of stomach cancer is it's kind of lost its ability to stick together, the cancer cells. And so it doesn't form a nice lump or a ball that we can see on an imaging test or on endoscopy. And so that's hard to diagnose. It's hard to stage and understand where the tumor really is and what, where it spread to.

Cornelius A. Thiels, D.O., M.B.A., Surgical Oncologist: Gastric cancer, particularly in the U.S., can often present a more advanced stage. And sometimes even metastatic, meaning it's already spread outside of the stomach when patients are diagnosed with it. Traditionally that's been very difficult to treat and typically not considered curable. We now have tried to develop new protocols and treatment strategies to treat these more advanced tumors.

Michael L. Kendrick, M.D., Surgical Oncologist: We put a lot of effort into each of the multispecialty areas that interact with gastric cancer to keep on the cutting edge.

Dr. Grotz: Every patient, when they come here with stomach cancer, is evaluated by an entire team of experts.

Dr. Thiels: At Mayo, we tend to try to use the most advanced imaging we can in both diagnosing and surveilling people with cancers. When it comes to diagnosis, we think that it's beneficial to use modalities like PET scans and CT scans, when indicated, to try to get a really good understanding of the type of cancer a patient has, where it's spread to, or other organs it's involving. And so we can develop a treatment plan tailored to that individual patient.

Dr. Grotz: A lot of patients will come here initially, get that full work-up and evaluation, kind of get the master plan from the whole team. And then they often will go home, receive their chemotherapy close to home, where they have all their support system, and then come back for surgery or radiations and other kind of treatment.

Dr. Kendrick: Treatment of gastric cancer has changed a lot in the last few decades.

Dr. Grotz: Some of the innovative treatment options for patients with stomach cancer include endoscopic removal of early tumors. We also have minimally invasive surgery, both robotic and laparoscopic surgery, to decrease pain and a shorter hospital length of stays, quicker return to eating, quicker recovery, less complications and blood loss.

Dr. Kendrick: For those with very advanced disease, from a surgical point of view, we're even more aggressive and able to treat certain locally advanced tumors that we couldn't before.

Dr. Thiels: And that's because we have all the specialists to do more advanced surgeries, to resect multiple organs if we need to. And then we also have a protocol to treat patients with disease that spread outside of the stomach to the peritoneum.

Dr. Grotz: We've developed a kind of a pathway here of treatment with systemic chemo and also chemotherapy that's given directly into the abdomen that we can get some patients to potentially curative surgery. And so where some of these patients may not have had really any hope before, now we're offering patients hope at long-term survival.