The stomach lies between the esophagus and the small intestine. It mixes food with stomach acid and helps digest protein. Stomach cancer, also known as gastric cancer, begins in the cells lining the innermost (mucosal) layer of the stomach and spreads outward.
There are different types of stomach cancer:
- Gastric cardia cancer occurs in the top portion of the stomach, where it connects with the esophagus
- Non-cardia gastric cancer refers to cancer found in all other areas of the stomach
Stomach cancer is relatively rare in the United States, but it is the second most common cause of cancer-related deaths in the world. Patients with stomach cancer may find it difficult to find a physician with expertise in the treatment of the disease. The specialists in the Center for Advanced Digestive Care (CADC) of NewYork-Presbyterian/Weill Cornell Medical Center are highly experienced in diagnosing and treating stomach cancer.
Our interdisciplinary team includes gastrointestinal specialists in endoscopy, radiology, surgery, and oncology who work together to provide each patient with coordinated, advanced, and customized care. The team includes experts with specialized training in advanced interventional endoscopy, which can be used to diagnose and stage stomach cancer.
Our team is also conducting clinical research assessing novel therapies to raise the survival rate for stomach cancer and improve patients' prognosis. Patients may have opportunities to participate in clinical trials of promising new approaches.
What Causes Stomach Cancer?
Stomach cancer mostly affects older people; two-thirds of people who have it are over age 65.
The following factors raise the risk of developing stomach cancer:
- Infection with bacteria called Helicobacter pylori (H. pylori)
- A history of stomach inflammation
- Male gender
- A diet high in salted, smoked, or pickled foods
- Cigarette smoking
- A family history of stomach cancer
While the incidence of non-cardia gastric cancer is decreasing due to better diet and food refrigeration, as well as the use of antibiotics to treat H. pylori bacterial infections, cardia gastric cancer has been increasing for reasons that remain unclear.
Symptoms of Stomach Cancer
Stomach cancer rarely causes symptoms until it has grown to an advanced stage. When symptoms do arise, they may include:
- Reduced appetite
- Unintentional weight loss
- Stomach pain
- A vague discomfort in the abdomen, usually above the navel (belly button)
- A sense of fullness in the upper abdomen after eating a small meal
- Heartburn or indigestion
- Vomiting, with or without blood
- Swelling or fluid build-up in the abdomen
Because these symptoms may be caused by other disorders that are not cancerous, it is important to see a healthcare professional for an examination, especially if the symptoms don't go away or they get worse.
Tests for Stomach Cancer
Physicians in the CADC diagnose stomach cancer using the following tests:
- Upper endoscopy: Examination of the stomach using a gastroscope (a tube inserted into the stomach with a camera at its tip) to help detect abnormalities.
- Endoscopic ultrasound (EUS): If cancer is confirmed, this test is performed using an endoscope with an ultrasound probe at the tip. EUS is used to help see the tumor, gauge its depth, and determine if the cancer has spread to the lymph nodes or invaded surrounding organs or vessels.
- Imaging tests: High-resolution computed tomography (CT or CAT) scanning and positron emission tomography (PET) scanning may also be performed.
Treatment of Stomach Cancer
Patients with stomach cancer may receive a combination of surgery, chemotherapy, and/or radiation therapy to shrink the tumor, relieve symptoms, control disease growth, and extend life.
Specializing in minimally invasive techniques, surgeons at the CADC may perform a subtotal or partial gastrectomy (removal of part of the stomach containing the cancer) or a total gastrectomy (removal of the entire stomach, connecting the esophagus to the small intestine). Our surgeons perform both procedures laparoscopically whenever possible, resulting in smaller incisions, less blood loss, and a quicker recovery for patients.
Our surgeons also take a minimally invasive approach to remove stomach polyps and gastrointestinal stromal tumors (GIST) — rare and slow-growing types of gastric tumors that usually begin in the lining of the stomach — using a combination of endoscopy and laparoscopy.
At NewYork-Presbyterian/Weill Cornell, patients who require chemotherapy for stomach cancer may receive their treatment in the bright, dedicated Gastrointestinal Cancer Infusion Center. Our medical oncologists may prescribe chemotherapy:
- Before or during surgery to shrink a tumor and make it easier for surgeons to remove it ("neoadjuvant therapy")
- After surgery, to kill any remaining cancer cells ("adjuvant therapy")
Patients with stomach cancers that make too much of a protein called HER2 may be treated with trastuzumab (Herceptin), which targets this protein.
With advanced (metastatic) gastrointestinal cancers, our doctors generally remove as much of the tumor as possible, and then give specially heated chemotherapy to kill any remaining cancer cells. During this procedure, the heated chemotherapy is administered into the abdomen either during the surgery to remove the tumor or in a separate surgery afterward. Heating certain anticancer drugs increases their potency and improves their uptake by cancer cells, thereby increasing their cancer-killing effects. This is a relatively new approach to treating stomach cancer.
Patients with GIST most often receive imatinib (Gleevec), a targeted oral chemotherapy that is extremely effective for treating this type of cancer.
Heated Intraperitoneal Chemotherapy (HIPEC)
When stomach cancer spreads to the surrounding abdominal cavity, a new procedure commonly known as HIPEC offers a new treatment option for this difficult-to-treat circumstance. Heated intraperitoneal chemotherapy (HIPEC) is a two-stage procedure that combines expertise from surgical oncology and medical oncology. First, a surgeon removes any visible tumors, a process known as cytoreduction. After cytoreduction is complete, the care team adds heated chemotherapy to the surgical site in a process known as chemoperfusion, intended to kill any remaining, unseen cancer cells. The chemotherapy is heated to a very specific temperature – warm enough to weaken cancer cells but not too warm to destroy healthy tissue. Applying the chemotherapy directly to the abdominal cavity allows it to slightly penetrate cavity walls where cancerous cells may be hiding, while also avoiding some side-effects associated with intravenous chemo. HIPEC is an option for a select group of patients, and has a special set of risks and side effects. Nevertheless, HIPEC gives a new option to some patients where other treatment options may not be as effective.
Our physicians may also combine chemotherapy with radiation therapy to destroy any remaining cancer cells following surgery or to relieve symptoms. Some patients are treated with brachytherapy: the application of radiation sources directly to the cancer during surgery.
Clinical Trials for Stomach Cancer
Patients treated for stomach cancer at the CADC may be able to participate in clinical trials of novel treatment approaches, whether they are receiving chemotherapy for the first time or they have received it before. Studies of chemotherapy given to patients whose disease returned after one or two prior regimens of anticancer drugs are under way; research has indicated that giving such additional chemotherapy may benefit patients. These studies give patients more options and help doctors better understand how to treat this disease.