Statistically, about 60% of patients will recur after radical surgery for progressive gastric cancer, with 70% occurring within 2 years of surgery and about 90% within 5 years of surgery. Metastasis and recurrence are definitely not the end of the world for patients. With the improvement of radiotherapy and surgery techniques, the application of new targeted drugs and the realization of multidisciplinary treatment model, cases of successful treatment of metastasis and recurrence of gastric cancer abound. So, what treatments might doctors use after recurrence or metastasis?
Surgical treatment
Some locally recurring gastric cancers can still be removed surgically.
If distant metastases occur, a combination of organ resection may also provide good treatment, and doctors will evaluate a variety of factors to determine whether surgery is possible. For example, if the patient can tolerate surgery, if the metastases are solitary and no larger than 5 cm in diameter, if there are no more than 3 metastases, if adequate liver function is expected after resection, or if the metastases are multiple but limited, the surgeon may consider complete resection of the metastatic liver cancer.
Patients with ovarian metastases may also be able to be surgically resected in the early stages.
In addition, doctors may consider palliative surgery in cases of surgical complications such as obstruction, perforation, or bleeding.
Chemotherapy
After metastasis or recurrence of gastric cancer, whether resectable or not, systemic chemotherapy is usually indispensable and for some patients, it will even be the primary treatment.
For resectable lesions, physicians often use chemotherapy after surgery to consolidate treatment. For lesions that are likely to become resectable, the surgeon will usually give preoperative chemotherapy to shrink or even eliminate the lesion so that the tumor becomes resectable, and will usually continue to give chemotherapy after surgery. For unresectable lesions, doctors often use palliative chemotherapy to control tumor growth in order to prolong life, control symptoms, and improve the patient’s quality of life.
If a patient relapses or metastasizes more than 6 months after completing chemotherapy, they can usually stay on the original chemotherapy regimen, and if they relapse or metastasize within 6 months, the doctor will usually change the regimen.
For patients who develop extensive peritoneal implant metastases, physicians may also consider abdominal thermoperfusion and early peritoneal chemotherapy for symptom control on top of systemic chemotherapy.
Radiotherapy
Some gastric cancers that present with local recurrence may be due to abdominal adhesions after the initial surgery, severe invasion of the recurrent tumor beyond the stomach wall, fusion of some regional lymph nodes where metastases have occurred, and some gastric cancer recurrence or metastases in inoperable areas (e.g., invasion of lymph nodes adjacent to the abdominal aorta, metastases encapsulating or invading large vascular organs, etc.) that preclude secondary surgery. Doctors usually consider local tumor growth control with the help of radiotherapy in order to prolong survival. In some patients, the tumor may shrink and regain the opportunity for secondary surgery.
For patients with distant recurrence or metastases, chemotherapy remains the primary approach, and radiation therapy is used primarily to control clinical symptoms, such as bleeding, pain, or GI obstruction.
Targeted therapy
Patients with gastric cancer who test positive for HER2, or human epidermal growth factor receptor 2, can be treated with trastuzumab (Trastuzumab, trade name Herceptin). Apatinib, developed independently in China, inhibits tumor angiogenesis and has been shown to prolong survival in some metastatic gastric cancers, and is recommended by the Chinese Society of Clinical Oncology (CSCO) guidelines as a third-line treatment for advanced metastatic gastric cancer after standard treatment has failed. The effects of other targeted agents have not been confirmed by extensive clinical studies.
As cancer research has advanced, surgical techniques and radiotherapy have improved, and newer drugs have become available, patients with metastatic or recurrent gastric cancer have gradually benefited. The metastasis or recurrence of gastric cancer is not the “end of the world,” and some patients with local recurrence and metastasis still have a chance for surgical cure at this time. Some patients who cannot be removed surgically may be cured through comprehensive treatment. Even if extensive metastasis occurs, long-term survival with tumor may be achieved through palliative treatment. It is believed that with better understanding of cancer metastasis and recurrence, patients with metastasis and recurrence of gastric cancer will likely be cured.