ANNOUNCER: It is estimated that over 11,000 Americans will die this year as a result of gastric cancer, which is cancer of the stomach. At least one in one hundred Americans will develop gastric cancer in their lifetime.
MANISH A. SHAH, MD: Gastric cancer generally comes in two forms. One is an adenocarcinoma, which is about 90 percent of them, and then the other 10 percent are less common forms, like gastrointestinal stromal tumors. That's a cancer of the supporting cells like connective tissue. They're also known as GIST tumors.
ANNOUNCER: Stomach cancer in this country is more common after age 50, and there are a variety of risk factors associated with it.
MANISH A. SHAH, MD: The risk factors for stomach cancer include an infection with Helicobacter pylori, which is also known as H. pylori. It also includes tobacco, obesity, being a male. If they have a history of ulcers, a family history of stomach cancer, people should look out for those things and get evaluated.
ANNOUNCER: People suffering from early gastric cancer usually experience no symptoms. Even when the disease progresses, symptoms can be subtle.
JOHN MACDONALD, MD: Many people with stomach cancer will first just begin to lose weight, not really have a reason for why they're doing that. There's a symptom called early satiety, where we eat a little bit and we feel full, and that can be a sign. Other times, there can be some nausea, vomiting.
MANISH A. SHAH, MD: Later, if the cancer progresses a little bit, there might be some oozing of blood that could lead to fatigue or tiredness. Sometimes, you can get a skin rash or things like that, but most often you wouldn't have any symptoms.
ANNOUNCER: A diagnosis of gastric cancer usually depends on an endoscopy.
JOHN MACDONALD, MD: The best test, by far, is what's called an upper endoscopy and that's an endoscopic procedure where the doctor puts down a lighted tube and looks into the stomach, and he or she can see whether there's any abnormality in the stomach. If there's an abnormality, they can biopsy right through that scope and take tissue and make the diagnosis.
The next steps are to decide whether or not the patient is a good candidate for major surgery. Then after that, after you think the patient may be a candidate, you want to do scans, typically CAT scans of the chest, abdomen and pelvis, to make sure there's no evidence that the cancer has already spread.
ANNOUNCER: A cancer specialist called an oncologist will then rate how far the disease has progressed.
JOHN MACDONALD, MD: Like many cancers, it's important to understand the stages of stomach cancer, because that gives you some information on prognosis. The earliest stage is when the tumor is just in the stomach and hasn't spread into the wall of the stomach and that would be called a stage I. As the tumor spreads through the wall of the stomach, you get to stage II. When you begin to have lymph node involvement, you get to stage III. And if the tumor spreads to other organs, you have stage IV stomach cancer.
ANNOUNCER: Early stage gastric cancer can often be cured.
JOHN MACDONALD, MD: Gastric cancer can definitely be cured, if it's caught early enough. If you look at patients sort of across the board who have stomach cancers, and when they're surgically removed there's no involvement of the lymph nodes, then at least 50 percent of those patients are cured with the surgery alone.
MANISH A. SHAH, MD: Surgery for stomach cancer comes in two main forms. One is a total gastrectomy, which is a removal of the entire stomach, or a partial gastrectomy, which is removing part of the stomach. The partial gastrectomy is known also as a subtotal gastrectomy, less than total.
ANNOUNCER: For early stage gastric cancer, surgery is considered the main treatment. But not for later stages when the cancer has spread to other organs.
MANISH A. SHAH, MD: For stage IV stomach cancers, we think of chemotherapy as the main treatment. There are many different types of drugs that are chemotherapy that are active in the disease. Just to name a few drugs that we think of currently: cisplatin; fluorouracil; docetaxel, which is also known as Taxotere; and irinotecan, which is also known as Camptosar or CPT-11.
So the good news is that there are many different drugs that are active. We've historically combined the drugs into combinations of either two or three drugs, and the effectiveness of two or three drugs is much better than one and we're learning how to manage the side effects so that people can both treat the cancer but maintain a quality of life.