Stomach (Gastric) Cancer

Stomach cancer is relatively rare in the United States, but it is the second most common cause of cancer-related deaths in the world. The stomach cancer specialists at NewYork-Presbyterian are highly experienced in diagnosing and treating stomach cancer, using combinations of treatments to customize a plan of care for each of our patients. We also offer clinical trials of new therapies that hold promise for extending the lives of people with stomach cancer.

A Team of Stomach Cancer Specialists

If you have stomach cancer, we will assemble a multidisciplinary team of gastrointestinal specialists in interventional endoscopy, radiology, surgery, medical oncology, radiation oncology, and nutrition and dietetics to meet your needs. They will work together to provide you with coordinated, advanced, and customized care.

Surveillance Programs to Find Stomach Cancer Early

There are groups of individuals whose risk is elevated due to certain factors, such as H. pylori infection, chronic inflammation (atrophic gastritis), and ethnicity (Asian Americans are at the highest risk). NewYork-Presbyterian offers stomach cancer screening with endoscopy to people at increased risk. The earlier a cancer is found, the better the chance of a cure.

Accurate Diagnosis and Staging

An essential component of your care is an accurate diagnosis and measurement of the extent of your disease—a process called staging. We use the results of these tests to determine the most efficient course of care for you. We offer the most advanced diagnostic and staging tools for stomach cancer, including:

• Upper endoscopy. This test involves 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, our endoscopists perform this test using an endoscope with an ultrasound probe at the tip. They use EUS 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. Sometimes they can remove superficial tumors using approaches, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).
• Confocal laser endomicroscopy. Our interventional endoscopists use this technique to obtain enhanced images of the stomach wall to detect and treat early cancers that are not visible by other methods. NewYork-Presbyterian is one of the few centers in the country using this technology.
• Imaging tests. We may also perform high-resolution computed tomography (CT or CAT) scanning and positron emission tomography (PET) scanning to assess your cancer.

Minimally invasive Stomach Cancer Surgery

If your stomach cancer is operable, our surgeons 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).

• Endoscopy. Some patients with early gastric cancer may benefit from endoscopic techniques, such as EMR and ESD. We perform EMR and ESD to remove shallow lesions without the need for surgery.
• Minimally invasive surgery. We perform these procedures using minimal invasive techniques—either conventional laparoscopy or robotic-assisted, according to the surgeons preference—whenever possible, resulting in smaller incisions, less blood loss and less pain after surgery, a quicker recovery, and a shorter hospital stay.
• D-2 lymphadenectomy. We also perform D-2 lymphadenectomy, a technically challenging surgical procedure performed during gastric cancer surgery to remove cancerous lymph nodes, which is important for accurate staging and future treatment.

GIST surgery If you have a gastrointestinal stromal tumor (GIST)—a rare type of gastric tumor that usually begins in the lining of the stomach—we may use a combination of endoscopy and laparoscopy to remove the tumor. People with GIST most often receive imatinib, a targeted chemotherapy drug that is extremely effective for treating this type of cancer. You can take it each day at home because it is taken by mouth.

Advanced Chemotherapy

You may receive chemotherapy before or during surgery (to shrink your tumor) or after surgery (to kill any remaining cancer cells). You can receive intravenous therapies in our modern, comfortable infusion centers.

• Chemotherapy. Multiple standard chemotherapy agents are available to treat stomach cancer as well as investigational drugs, including immunotherapy, as part of a clinical trial. Sometimes chemotherapy is combined with radiation therapy and administered together.
• Trastuzumab. If you have a stomach cancer that makes too much of a protein called HER2, you may receive trastuzumab, which targets this protein.

Heated Abdominal Chemotherapy

NewYork-Presbyterian offers an advanced chemotherapy approach for people whose stomach cancer has spread to the surrounding abdomen. Called heated intraperitoneal chemotherapy (HIPEC), this two-stage procedure brings together the expertise of our cancer surgeons and medical oncologists. First, the surgeon removes as much cancerous tissue as possible. Then heated chemotherapy is given into the abdomen—either during the surgery to remove the tumor or in a separate surgery afterward. Heating certain anticancer drugs increase their potency and improve their uptake by cancer cells, increasing their cancer-killing effects. HIPEC is a relatively new approach to treating stomach cancer and is not for all patients. Your doctor will let you know if it is an option for you.

Precise Radiation Therapy

Our physicians may combine chemotherapy with radiation therapy to destroy any remaining cancer cells following surgery or to relieve symptoms. Some people receive brachytherapy: the application of radiation given directly to the cancer during surgery.

Treating All of You

To support your quality of life, we offer palliative care, which includes services such as pain management and symptom management. Our nutritionists, social workers, palliative care experts, and others will help you and your loved ones address the effects of cancer and its treatment—physical, emotional, and spiritual. We understand the burden cancer can place on your life and the lives of your loved ones, and we do whatever we can to lessen that burden.

Clinical Trials for Stomach Cancer

You may be able to participate in a clinical trial of a novel treatment approach, whether you are receiving chemotherapy for the first time or you have received it before. Clinical trials offer patients more options and help doctors better understand how to treat stomach cancer. 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.