Gastric Cancer

Although the specific causes of gastric cancer aren’t fully understood, any type of cancer generally begins when genetic mutations occur in cells. These mutations cause the cells to grow out of control and develop into tumors that can spread to other areas of the body.

Certain factors can increase the risk of developing gastric cancer, including:

• A diet high in salty and smoked foods and low in fruits and vegetables
• Age 50 or older for non-Asian and non-Hispanic people
• Ages 30 to 50 for Asian or Hispanic people
• Bacterial infection with Helicobacter pylori
• Family history of gastric cancer
• Gastric reflux
• Long-term stomach inflammation (gastritis)
• Male gender
• Obesity
• Pernicious anemia, low red blood cell count due to poor absorption of vitamin B12 in the intestines
• Smoking
• Stomach polyps, especially those larger than 2 cm

For some patients, gastric cancer can be related to gene mutations. Examples include hereditary diffuse type gastric cancer (CDH1 mutations), GAPPS syndrome (gastric adenocarcinoma), and proximal polyposis syndrome (APC mutations).

Genetic testing and screening can be very important for early detection, when treatment is most effective. UT Southwestern offers genetic testing for patients with a personal and/or family history of gastric and other cancers. For patients with known mutations in cancer risk genes, the UTSW cancer genetics program also offers comprehensive genetics follow-up services through the Genetic Cancer Prevention Clinic.

Gastric cancer can cause symptoms such as:

• Abdominal bloating or pain, which can occur even after a small meal
• Dark stools
• Difficulty swallowing, which worsens over time
• Fatigue and general decline in health
• Loss of appetite
• Nausea and vomiting blood that can bring up blood
• Severe, constant indigestion and excessive belching
• Severe, persistent heartburn
• Unexplained weight loss
• Weakness or fatigue

People might not experience symptoms in the early stages of gastric cancer. When symptoms do occur, they resemble those of other, less serious conditions such as heartburn or indigestion. It’s important to see experienced specialists with expertise in evaluating symptoms to confirm an accurate diagnosis.

Our physicians begin with a thorough evaluation that includes a:

• Discussion of symptoms
• Review of personal and family medical history
• Physical exam

We often order additional tests to help us diagnose gastric cancer and determine whether it has spread. Patients might need one or more tests such as:

• Upper endoscopy: Also called esophagogastroduodenoscopy (EGD), a minimally invasive procedure using an endoscope (long, thin tube with a tiny video camera) to view inside the esophagus and stomach for signs of cancer. Small tissue samples of any suspicious areas inside the stomach can easily be biopsied during endoscopy to examine for signs of cancer.
• Blood tests: Tests of a patient’s blood sample to check for anemia and to measure tumor-specific markers
• Computed tomography (CT) scan: Specialized X-ray technology that takes cross-sectional images to produce detailed 3D images of the stomach and nearby areas to check for signs of cancer
• Magnetic resonance imaging (MRI) scan: Imaging test that uses a large magnet and radio waves to produce detailed images of the stomach to check for signs of cancer
• Positron emission tomography (PET) scan: Imaging that uses a small amount of a radioactive substance that collects in cancer cells, along with a special camera, to create images of the stomach and nearby areas to see whether cancer has spread
• Endoscopic ultrasound: Imaging done with an endoscopy, using sound waves to produce images inside the stomach to examine cancer cells and see how far they have grown through the stomach wall.

Once we confirm a diagnosis, we work closely with each patient to develop a customized treatment plan for their needs. Treatment options depend upon the stage of cancer and the patient’s overall health and preferences.

Surgery

At the Simmons Cancer Center, UT Southwestern’s surgeons are experienced in all the surgical options for treating gastric cancer, such as minimally invasive gastrectomy and removal of the necessary lymph nodes.

For gastric cancer that has not spread, our specialized gastrointestinal cancer surgeons perform surgery to remove the tumor and a small margin of surrounding tissue. Options include:

• Endoscopy to remove small, early-stage tumors from the stomach lining
• Esophagogastrectomy to remove the lower part of the esophagus and the upper part of the stomach. The surgery occurs in the chest and the abdomen. A new esophagus is created from the remaining stomach or from a different piece of intestines
• Subtotal gastrectomy to remove the part of the stomach affected by cancer
• Total gastrectomy to remove the entire stomach and connect the esophagus to the small intestine to move food through the digestive system
• Extended lymphadenectomy, in which our surgeons have specialized training, to completely remove the lymph nodes surrounding the stomach to assure accurate staging and adequate surgery
• Palliative surgery that relieves symptoms and controls the cancer but does not remove it entirely

Depending on the size of the tumor and whether it has spread to other areas, we offer various surgical techniques:

• Laparoscopic surgery: Our surgeons make several small incisions in the abdomen and use small instruments inserted through the incision to perform a gastrectomy.
• Robotic-assisted laparoscopic surgery: Our surgeons have expertise in using an advanced surgical robotic system for laparoscopic gastric cancer surgery. The equipment includes a visual console and robotic arms that hold small instruments to perform the surgery. This minimally invasive approach uses smaller incisions, which results in quicker recoveries and improved ability to restart therapy.

Radiation therapy

This noninvasive treatment uses high-energy radiation beams to destroy cancer cells. Our radiation oncologists use machines that move around patients as they lie on a table to deliver radiation to the tumor.

We sometimes recommend radiation therapy before surgery to shrink the tumor and make it easier to remove. Radiation therapy can also destroy any cancer cells that might remain after surgery.

Chemotherapy

Our medical oncologists use cancer-fighting medications to destroy gastric cancer cells that have spread to other parts of the body. We sometimes use chemotherapy before or after surgery, or in combination with radiation therapy.

Targeted therapy

Some cancer-fighting medications can attack specific abnormalities in or on cancer cells or can boost the immune system to attack cancer cells. Our medical oncologists first test a patient’s cancer cells to find out whether a specific targeted therapy might work.