Gastric Cancer Support Group

Stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs, particularly the esophagus, small intestine. It also may extend through the stomach wall and spread to nearby lymph nodes and to organs such as the liver, pancreas, and colon. Stomach cancer also may spread to distant organs, such as the lungs, the lymph nodes above the collar bone, and the ovaries.

Stomach cancer represents roughly 2% (21,500) cases of all new cancer cases yearly in the United States, but it is much more common in Japan, Great Britain, South America, and Iceland, presumably due to increased dietary consumption of nitrates. It is also associated with high salt in the diet, smoking, and low intake of fruits and vegetables. Infection with H. pylori is the main risk factor in about 80% or more of gastric cancers. It is more common in men.

A very small percentage of diffuse-type gastric cancers are thought be genetic. Hereditary Diffuse Gastric Cancer (HDGC) has only recently been identified and research is ongoing, but genetic testing and treatment options are available for families at risk.

Metastasis occurs in 80-90% of individuals with stomach cancer, with a five year survival rate of 75% in those diagnosed in early stages and less than 30% of those diagnosed in late stages. The death rate is 12,400 a year in the United States.

Like any cancer, treatment is adapted to fit each person's individual needs and depends on the size, location, and extent of the tumor, the stage of the disease, and general health. Cancer of the stomach is difficult to cure unless it is found in an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. Treatment for stomach cancer may include surgery, chemotherapy, and/or radiation therapy. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials.

Surgery is the most common treatment for stomach cancer. The surgeon removes part (subtotal or partial gastrectomy) or all (total gastrectomy) of the stomach, as well as some of the tissue around the stomach, with the basic goal of removing all cancer and a margin of normal tissue. Depending on the extent of invasion and the location of the tumor, surgery may also include removal of part of the esophagus, spleen, ovaries, or intestines. Tumors in the lower parts of the stomach may call for a Billroth I or Billroth II procedure. Endoscopic mucosal resection is a treatment for early gastric cancer that has been pioneered in Japan, but is available in the United States at some centers. In this procedure, the tumor is removed from the wall of the stomach using an endoscope, with the advantage in that it is a smaller operation than removing the stomach. Surgical interventions are currently curative in less than 40% of cases, and, in cases of metastasis, may only be palliative.

Chemotherapy is the use of systemic drugs to fight the stomach cancer. Unfortunately, gastric cancer has not been especially sensitive to these drugs until recently, and, even now, primarily serve to palliatively reduce the size of the tumor and increase survival time. Some drugs used in stomach cancer treatment include: 5-FU(fluorouracil), BCNU (carmustine), methyl-CCNU (Semustine), and doxorubicin (Adriamycin), as well as Mitomycin C,and more recently cisplatin and taxotere in various combinations. Scientists are exploring the benefits of giving chemotherapy before surgery to shrink the tumor, or as adjuvant therapy after surgery to destroy remaining cancer cells. Combination treatment with chemotherapy and radiation therapy is also under study. Doctors are testing a treatment in which anticancer drugs are put directly into the abdomen (intraperitoneal hyperthermic chemoperfusion). Chemotherapy also is being studied as a treatment for cancer that has spread, and as a way to relieve symptoms of the disease. The side effects of chemotherapy depend mainly on the drugs the patient receives.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing. Stomach cancer tumors have low radiosensitivity and have a very limited response to this therapy. When used, it is generally in combination with surgery and chemotherapy, or used only with chemotherapy in cases where the individual is unable to undergo surgery. Radiation therapy may be used to relieve pain or blockage by shrinking the tumor in cases of terminal disease.

Biologic therapy is still in the testing stages for stomach cancer. The side effects of biological therapy vary with the type of treatment. Some cause flu-like symptoms, such as chills, fever, weakness, nausea, vomiting, and diarrhea. Patients sometimes get a rash, and they may bruise or bleed easily. These problems may be severe, and patients may need to stay in the hospital during treatment.