Surgery or chemotherapy first is not a generalization. Most gastric cancers staged as early or mid-stage will be treated with surgery first. In contrast, for locally advanced gastric cancer, physicians may need to consider more factors.
- Some locally advanced gastric cancers are usually operated on first when complete resection is predicted and the cancer is at risk for hemorrhage, obstruction, or perforation, but these patients are still at some risk of recurrence even after surgery with combination therapy such as chemotherapy. Some specific pathological types of gastric cancer (for example, gastric liver-like adenocarcinoma) do not respond well to chemotherapy, and physicians will also generally recommend early surgery.
- There are also locally advanced gastric cancers in which the tumor may have invaded a surrounding area that is difficult to remove (e.g., the head of the pancreas), invaded the mesenteric root, encircled a major large blood vessel, or developed metastases in the para-aortic lymph nodes, but has not yet developed distant metastases, and there may still be a chance of surgical removal of the lesion. At this point, the surgeon will usually administer chemotherapy first and then operate after the tumor has shrunk and is eligible for surgery. After surgery, the patient will usually receive additional chemoradiotherapy, etc.