Each year, 22,000 Americans are diagnosed with gastric cancer (stomach cancer). This disease, which begins in the cells lining the innermost, or mucosal layer of the stomach and spreads outward, is relatively rare in the US but the second most common cause of cancer-related deaths in the world. Gastric cancer is prevalent in many Asian nations, parts of South America, and the former Soviet Union. These differences are in part due to higher consumption of preserved and salted foods in those countries, and poorly refrigerated food.
There are two types of gastric cancer: gastric cardia cancer, which occurs in the top portion of the stomach near the junction of the esophagus, and non-cardia gastric cancer, which may be found in all other areas of the stomach. These two types of cancer have different risk factors and patterns of incidence.
While the overall incidence of gastric cancer is decreasing in the US, this reduction in gastric cancer cases applies primarily to non-cardia gastric cancer. This reduction in non-cardia gastric cancer is believed to be due to better diet, better food refrigeration, and use of antibiotics to treat helicobacter pylori bacteria (H. pylori bacteria) infection, a major risk factor for non-cardia gastric cancer. Conversely, cardia gastric cancer, rare at one time, is now increasing in Western nations for reasons for that are still unclear, and it accounts for about 50% of all stomach cancer in men in the US.
Early symptoms of gastric cancer include indigestion and stomach pain or discomfort; a sense of fullness in the upper abdomen especially after eating, loss of appetite, and mild nausea. More advanced stomach cancer may produce unexplained weight loss, stomach pain, vomiting, tarry (black) stool, trouble swallowing, jaundice (yellowing of the skin and eyes), and swelling of the abdomen.
Age, gender, ethnicity, family history, diet, smoking, and stomach disease may affect your risk of gastric cancer. Individuals who have the highest risk are:
If a physician suspects gastric cancer, he or she will generally perform an upper endoscopy using a gastroscope to help detect abnormalities. The gastroscope is a very thin tube containing a tiny light and a camera, which is inserted through the mouth into the stomach after a local anesthetic is given. Our physicians will take a biopsy via the endoscope, which pathologists will examine to determine the diagnosis.
If cancer is confirmed, doctors will then use state-of-the art technology, including endoscopic ultrasound which can precisely determine the stage of cancer by gauging a cancer's depth and whether it has spread. Like gastroscopy, in the endoscopic ultrasound procedure, the physician inserts a small, thin scope into the stomach which bounces sound waves off the stomach walls and neighboring lymph nodes to pinpoint the cancer's stage, similar to sonar. Other tests often given include high resolution computed tomography (CT or CAT) scans and positron emission tomography (PET) scans.
Recent research shows that a combination of surgery, chemotherapy and radiation therapy give patients the best chance of recovery, or controlling disease and extending life. Our gastrointestinal experts excel in the most up-to-date treatments for gastric cancer.
Our surgeons may remove part of the stomach containing the cancer — called a subtotal or partial gastrectomy — or remove the entire stomach and part of the esophagus — called a total gastrectomy, in which the esophagus is connected to the small intestine. These procedures are often performed laparoscopically.
To remove gastrointestinal stromal tumors (GIST) — a rare and slow-growing type of gastric tumors that begin in the lining of the stomach (or lung), and stomach polyps — our surgeons use a combined endoscopy and laparoscopy. This method, as with laparoscopy for gastric resection, provides patients with benefits that include shorter postoperative recovery time and a quicker return to normal function as compared to an open surgical procedure.
Chemotherapy may be used before surgery to shrink a tumor and make it easier for doctors to surgically remove it (neoadjuvant therapy). It may also be used during surgery, immediately after a tumor is removed, or after surgery in a separate procedure, to kill any remaining cancer cells too small to be removed by surgeons (adjuvant therapy).
With advanced (metastatic) gastrointestinal cancers, physicians generally surgically remove as much of the tumor as possible, then use a chemotherapy infusion to kill any remaining cancer cells. In this procedure, chemotherapy is first heated and then administered into the abdomen either during the surgery to remove the tumor or in a separate surgery afterward. Heating certain anti-cancer drugs both increases their potency and improves their uptake by cancer cells, thereby increasing their cancer-killing effects.
With GISTs, physicians often administer imatinib (Gleevec), a molecularly targeted oral chemotherapy that has been shown to be extremely effective in treating this type of cancer.
Physicians may also combine chemotherapy with radiation to destroy any remaining cancer cells following surgery. This often takes the form of intraoperative brachytherapy – a procedure where surgeons implant radioactive seeds either temporarily or permanently at the time of surgery to deliver precisely targeted doses of radiation to the tumor site while sparing the surrounding healthy tissue.
NewYork-Presbyterian's Department of Digestive Diseases is a member of the National Cancer Institute-sponsored clinical trial consortium, one of eight in the US, which is performing a range of Phase II studies of new therapies for gastric and other cancers.
Our research is contributing to the understanding of how changes in stomach cells are driven by infection and inflammation, leading to changes that result in gastric cancer. Researchers are investigating a range of other factors in the development of gastric cancer, including the role of the hormone gastrin, histamine production, and certain innate immune factors in the development of stomach cancer.
We are also conducting research into the link between inflammation, gastric cancer and helicobacter pylori bacteria (H. pylori bacteria), a bacterium which causes stomach inflammation and is a known risk factor for gastric cancer.