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Gastric (stomach) cancer is a complex condition, and every patient requires a personalized treatment plan. The tumors behave differently depending on where the tumor is located, how the tumor appears under the microscope, and the genetic makeup of the tumor and patient. Gastric cancer even acts differently in patients of different racial and ethnic backgrounds. Because the incidence of gastric cancer has decreased during the last decade in the United States, few centers have the experience and expertise to provide the highest level of multidisciplinary care.
At UT Southwestern Medical Center, our dedicated gastric cancer team creates individualized treatment plans for patients with gastric cancer. We meet as a team and review the details from every case, so we have a complete picture and can offer a wholistic care plan tailored to each patient, their symptoms, and their tumor. Given the high volume of patients we treat with gastric and gastroesophageal cancer, we are able to offer the latest therapies to treat this complex disease.
As the only National Cancer Institute (NCI)-designated comprehensive cancer center in North Texas, we deliver the best cancer care available today and push to discover new treatments. NCI designation means we offer patients the ability to participate in the broadest possible range of clinical trials, with access to potential therapies not available at other facilities.
A Specialized Approach to Care: Our Team Makes a Difference
At the Harold C. Simmons Comprehensive Cancer Center, our experts in gastric cancer take a multidisciplinary approach to diagnosis and treatment. Treatment for these cancers depends on many different considerations, including patient factors, symptoms, tumor type, location, and stage. In many cases, treatment will include the integration of different therapies such as chemotherapy, surgery, and radiation. Each of our team members is dedicated to leading-edge gastric cancer care and to the seamless integration along the entire care pathway.
Patients benefit from our specialization, our individualized treatment plans, and our access to the most innovative, promising new therapies, such as minimally invasive and robotic surgical techniques.
Expert Navigation Through the Entire Process
Our team includes surgical oncologists, thoracic surgeons, medical oncologists, radiation oncologist, gastroenterologists, registered dieticians, genetic counselors, and social workers.
Our nurse navigator, Minda Hill (Minda.Hill@UTSouthwestern.edu), provides patients with a constant touchpoint throughout the treatment process. She is responsible for seamless intake, gathering of information, efficient scheduling of tests and appointments, and she assists with transfers between services.
Types of Gastric Cancer
Gastric cancers can begin growing anywhere in the stomach. These include gastroesophageal (GE) junction cancer, which occurs where the esophagus (food tube) connects to the stomach, and pyloric cancer, where the stomach connects to the small intestine.
Gastric and gastroesophageal adenocarcinoma is the most common type of gastric cancer. More than 90% of gastric cancers are adenocarcinomas and develop in cells that form the innermost lining of the stomach (the mucosa). Cancers of the esophagus that invade into the gastroesophageal junction and stomach can also be squamous cell carcinoma, which arises from the squamous cells that make up the mucosal lining of the esophagus.
Other types of cancer that grow in the stomach include:
- Gastrointestinal stromal tumor (GIST): These rare tumors grow in very early forms of cells in the stomach wall, known as interstitial cells of Cajal. Some GISTs are benign (noncancerous), and others are malignant (cancerous). Although GISTs can develop anywhere in the digestive tract, most begin in the stomach.
- Carcinoid tumor: These tumors start in the stomach cells that produce hormones. Most carcinoid tumors do not spread to other organs.
- Other cancers: Other types of cancer, lymphoma, small cell carcinoma, and leiomyosarcoma can also start in the stomach, but these cancers are very rare.
Causes and Risk Factors of 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
- Long-term stomach inflammation (gastritis)
- Male gender
- Pernicious anemia, low red blood cell count due to poor absorption of vitamin B12 in the intestines
- Stomach polyps, especially those larger than 2 cm
Symptoms of Gastric Cancer
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
Diagnosing Gastric Cancer
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.
Treatment for Gastric Cancer
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.
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 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.
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.
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.
To treat the whole patient, we offer other resources patients might need during their cancer journey. Our support services include nutrition counseling, cancer psychological counseling, support groups, pain management, genetic counseling, and much more.
UT Southwestern offers clinical trials that can provide patients with an opportunity to complement traditional therapy for gastric cancer with the newest, most promising treatment strategies. Patients should speak with their doctors about these opportunities.
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Fort Worth, Texas 76104 817-288-9700