Metastatic Gastric Cancer
Metastatic gastric cancer occurs when cancer that started in the stomach spreads to other parts of the body, most commonly the liver, peritoneum, lungs, or bones. While this advanced stage cannot usually be cured, treatments can help control the disease, reduce symptoms, and improve quality of life.
Table of contents
- What Is Metastatic Gastric Cancer?
- Where Gastric Cancer Spreads
- Symptoms
- Diagnosis
- Prognosis and Survival
- Treatment Options
- Managing Symptoms and Quality of Life
What Is Metastatic Gastric Cancer?
Metastatic gastric cancer, also called stage 4 stomach cancer, is cancer that began in the stomach and has spread to at least one other part of the body, such as the liver, lungs, or other organs or tissues.[2] The term metastatic means the spread of cancerous cells to another part of the body.[4]
Healthcare professionals may refer to stomach cancer that has spread to the liver as “stomach cancer with liver metastasis.” Under a microscope, the cancer cells in the new location still resemble those in the stomach. This is why doctors classify the type of cancer depending on where it began, not where it has spread.[4]
Other terms used to describe this condition include secondary cancer, metastases, or advanced cancer.[2] Sometimes cancer is advanced when it is first diagnosed. In other cases, the cancer has come back and spread after treatment for the original cancer.[2]
Unfortunately, advanced cancer cannot usually be cured. However, treatment might control it, help symptoms, and improve quality of life for some time.[2]
Where Gastric Cancer Spreads
The most common sites where stomach cancer spreads are the liver (in 48% of metastatic cancer patients), peritoneum (32%), lung (15%), and bone (12%).[3] The peritoneum is the tissue lining the abdominal cavity.[2]
The pattern of spread can vary depending on where the cancer started in the stomach and the type of cancer cells. Metastases to the lung, nervous system, and bone are more frequent in cancer of the cardia (the upper part of the stomach where it meets the esophagus), and more common in men. Cancer in other parts of the stomach more frequently spreads within the peritoneum.[3]
The type of cancer cells also matters. Signet ring adenocarcinomas more frequently spread within the peritoneum, bone, and ovaries, and less frequently to the lungs and liver compared with other types of adenocarcinoma.[3]
The liver and the peritoneum are commonly single sites of metastasis, while lung metastases often occur together with liver metastases.[3]
Symptoms
The symptoms of metastatic stomach cancer can vary depending on where the cancer has spread.[2] Common symptoms include:[4]
- Indigestion or heartburn
- Abdominal bloating
- Nausea
- Loss of appetite
- Blood in the stool
- Vomiting
- Losing weight without trying
- Abdominal pain
- Jaundice (yellow eyes or skin)
- Ascites (abdominal fluid buildup)
- Problems swallowing
When stomach cancer has spread to the liver, it may cause liver problems such as jaundice. Cancer that has spread to the bones may cause bone pain and fractures. Cancer that has spread to the bladder or bowels may cause difficulties with urination or bowel movements, including blood in the urine or stool, and pain.[4]
Advanced cancer can also cause extreme tiredness, which may be overwhelming. This may be due to the cancer itself or related conditions like anemia. The cancer might block the entrance to the stomach or small bowel, preventing food from passing through. This causes pain, sickness, and makes patients feel very unwell.[17]
Diagnosis
A doctor will use a series of tests to diagnose metastatic stomach cancer. These typically include a physical examination to feel for masses or anything unusual, and an examination of the person’s medical history, including family history.[4]
Diagnostic tests may include:[4]
- Blood tests, including complete blood count
- Upper endoscopy (a procedure to look inside the esophagus and stomach)
- Barium swallow
- CT scan or PET scan
- Biopsy (taking a small sample of tissue for examination)
These tests help determine the extent of cancer spread and guide treatment decisions.
Prognosis and Survival
The median survival in metastatic gastric cancer is 3 months overall, with the worst outcomes among those with bone and liver metastases (2 months).[3]
Survival varies depending on several factors, including age at diagnosis, year of diagnosis, tumor grade, and treatment approach.[6] From 2008 to 2015, data showed that the median overall survival of patients who received surgery plus chemotherapy was the longest at 14.2 months. The median survival of patients who received chemotherapy alone or surgery alone was 7.0 and 3.9 months, respectively.[6]
In patients who have metastatic disease, cure is rarely achieved. Therefore, the treatment goal is to prolong life and improve quality of life.[5] Every person’s situation is different. A cancer specialist has all the information about each individual case and is the best person to discuss outlook and survival.[2]
Treatment Options
Chemotherapy
Chemotherapy is usually the main treatment offered for stage 4 or recurrent stomach cancer. It helps shrink the tumor and control the growth of the cancer.[15] Chemotherapy may be given as a single drug or a combination of drugs. Fluorouracil (also called 5-fluorouracil or 5-FU), capecitabine, or combinations with either of these drugs are often used.[15]
Palliative chemotherapy is suggested for patients with unresectable or recurrent disease to delay the development of disease-related symptoms and prolong survival. Many chemotherapeutic regimens have been developed and evaluated, and the median overall survival can be extended to 6 to 14 months in clinical trials.[6]
Targeted Therapy
Targeted therapy may be given in combination with chemotherapy drugs. These treatments work by targeting specific features of cancer cells.[15]
For stomach cancer that makes too much of the HER2 protein (called HER2-positive stomach cancer), trastuzumab may be used with chemotherapy. Trastuzumab deruxtecan may be used for HER2-positive stomach cancer after treatment with trastuzumab.[15]
Ramucirumab may be used with paclitaxel or alone if chemotherapy drugs have stopped working.[15]
Immunotherapy
Nivolumab may be used with chemotherapy to treat advanced or metastatic stomach cancer. Pembrolizumab may be used with chemotherapy and trastuzumab to treat advanced or metastatic stomach cancer.[15]
Surgery
Surgery is sometimes offered for stage 4 or recurrent stomach cancer to relieve symptoms of advanced cancer such as bleeding, blockage, or pain (called palliative surgery).[15]
A subtotal gastrectomy may be done to remove the part of the stomach with the tumor. A stent (hollow metal or plastic tube) may be placed during surgery if a tumor is blocking the opening of the stomach near the esophagus. It will allow a person with advanced stomach cancer to swallow more easily.[15]
A feeding tube may be 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. 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.[15]
According to current guidelines, patients with stage IV disease are not typically indicated for surgery aimed at cure. However, some selected patients with metastatic disease may have a survival benefit from chemotherapy plus surgery.[6]
Radiation Therapy
Radiation therapy may be offered for stage 4 or recurrent stomach cancer. It is used alone or in combination with chemotherapy. It may be used to relieve symptoms caused by advanced stomach cancer such as bleeding, pain, difficulty swallowing, or a blockage.[15]
Managing Symptoms and Quality of Life
Nutrition and Eating Problems
Many patients with metastatic gastric cancer experience loss of appetite and may lose weight. This can happen for different reasons, but it is important to drink plenty and try to eat when you can.[17]
Some helpful strategies include:[17]
- Eating several small meals and snacks throughout the day instead of large meals
- Asking your doctor or dietitian to recommend high-calorie drinks to boost your calorie intake
- Eating whatever you feel like eating rather than what you think you should eat
- Drinking plenty even if you can’t eat
- Not filling your stomach with a large amount of liquid before eating
- Trying to eat high-calorie foods to keep your weight up
Managing Tiredness
Tiredness is a common symptom of advanced cancer. It’s important to rest regularly throughout the day. You don’t have to sleep during these times—just sitting or lying down will help.[17]
Research shows that daily light to moderate exercise can give you more energy, even when you feel tired. Going for a gentle walk is very good. Gentle exercises in bed or standing up can help if you can’t move around easily. A hospital physiotherapist might be able to help you plan an exercise program that suits your needs.[17]
Controlling Pain
You might have pain in the area of the cancer, but not everyone does. Painkillers can usually control pain well. There are many different painkillers and ways of taking them. Your doctor and nurse can help you to be pain-free most of the time.[17]
Nausea and Vomiting
Treatment for sickness depends on what is causing it. Some painkillers or cancer treatments can cause sickness. You might also feel sick if you are constipated. Talking this over with a doctor or nurse is a good idea so you can get the treatment you need.[17]
Some people find that ginger is a good natural remedy for sickness. Try eating stem ginger or crystallized ginger if you like it, or drinking boiled water with a small piece of fresh ginger in it. Some people find sipping fizzy ginger drinks can help.[17]
Multidisciplinary Support
A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services is needed to optimize possible outcomes for patients.[21]
Finding out that the cancer cannot be cured is distressing and can be a shock. It’s common to feel uncertain and anxious, and normal to not be able to think about anything else. Lots of information and support is available to you, your family, and friends.[2]
You may want to consider palliative care to make you feel better without treating the cancer itself. This may be because 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. Talk to your healthcare team—they can help you make decisions about your care.[15]
