• Adjuvant chemotherapy with 5-FU and other chemotherapy combinations is being studied for those with no known residual disease who have a high risk of recurrence .
Stage IV
TNM T4, N2, M0 (Stage IVA)
Any T, any N, M1 (Stage IVB) The cancer has spread to adjacent tissue and to lymph nodes in the region around the stomach or has spread to distant sites, most commonly the liver or other organs.
Standard Treatment Because survival is so poor with all available single and combined treatment methods, no one approach can be considered state-of-the-art. Palliative surgery, combination chemotherapy and occasionally radiotherapy are all options.
When it is possible to remove the primary tumor , palliative surgery will at least reduce the risk of bleeding or obstruction and may lead to a longer survival.
When the tumor is so large that it blocks the entrance from the esophagus to the stomach, a gastroscope can be passed down the esophagus and a temporary hole created by using a laser beam or cauterization. A plastic tube can then be inserted through the hole to maintain a swallowing passage ( see "Laser Therapy" ).
Chemotherapy—with 5-FU, FAMtx, EAP or ELF—can offer significant palliation to some patients and long-term remissions are sometimes possible.
