Stomach, or gastric, cancer is a cancer that starts from the lining of the stomach wall. The stomach is located in the upper abdomen, and begins the process of digesting the food we eat into nutrients the body can use. The most common form of stomach cancer, gastric adenocarcinoma, is found in approximately 20,000 people in the United States per year, typically in people older than 65. Males are more likely to get this cancer than women. Gastric adenocarcinoma is much more common in other parts of the world, particularly in Asia and South America, possibly due to lifestyle and environmental factors. Other, less common, types of stomach cancer include lymphoma, gastrointestinal stromal tumors (GIST, cancer of the muscle or connective tissue of the stomach wall), and carcinoid tumors (cancer of the hormone-producing cells of the stomach).
The diagnosis of gastric cancer is commonly made by endoscopy, in which a small tube with a camera at the end is inserted through the mouth into the stomach. Once the diagnosis has been made, certain tests will be performed to find out how advanced your tumor is. These tests may include:
The stage of a cancer is a standardized description of how far (advanced) a cancer is. The higher the stage, the more advanced the cancer. Stage 0 describes gastric cancer that is only found on the innermost lining (mucosa) of the stomach. Stage 0 is also called carcinoma in situ. With increasing stage, there is increasing depth of spread into the stomach wall, and an increasing number of lymph nodes that contain cancer. Stage 4 describes cancer that has spread to other organs, such as the liver and lungs.
Treatment of gastric cancer involves a combination of surgery, chemotherapy and radiation therapy. Which combination of therapies is right for you depends on the stage of your cancer. In general, there are two main strategies:
Our team of physicians, consisting of surgeons, medical oncologists and radiation oncologists, work together to choose the treatment strategy that is best for each individual patient.
Surgery (gastrectomy) is the most common form of treatment for gastric cancer. The tumor may be removed by taking out part or all of the stomach. Nearby lymph nodes are also removed and examined for evidence of cancer spread. In appropriately selected patients, these operations can be performed laparoscopically, with the safety and cancer outcomes as traditional open operations.
Figure 1. Distal gastrectomy with Bilroth II reconstruction. Before (left) and after (right) diagrams of the anatomy. This is the operation performed for cancers of the lower stomach.
Figure 2. Subtotal gastrectomy with Roux-en-Y reconstruction. Before (left) and after (right) diagrams of the anatomy. This is the operation performed for cancers of the upper or middle stomach. If the entire stomach needs to be removed, then small intestine is connected to the lower esophagus.
Chemotherapy (or systemic therapy) is a drug or combination of drugs that are given to kill cancer cells wherever they are in the body. Chemotherapy may be given in a number of different settings:
Radiation therapy is an integral part of the multimodality treatment of gastric cancer. Together with chemotherapy, it is used to improve cure rates after surgery. Radiation therapy is very useful for alleviating local symptoms caused by the tumor such as bleeding.
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