Stomach (gastric) cancer starts in the cells that line the stomach. This type of cancer grows slowly and rarely causes symptoms in the early stages. Cancer in the lining of the stomach can spread to nearby tissues and organs, such as the liver or esophagus. At Memorial Sloan Kettering, our experts in stomach cancer have made major advances in diagnosis and treatment over the past several years. We see more people with this disease than any other center in the United States, and through our participation in clinical trials we offer patients access to promising new therapies before they are widely available.
There are many types of gastric cancer, and the prognosis varies by the type and stage of the disease. The most common type is adenocarcinoma. Other types include squamous cell carcinoma, adenocarcinoma of the serosal surface, and non-adenocarcinoma. The most common site of the disease is in the first part of the stomach, but it can also start in the pylorus or the gastroesophageal junction. Adenocarcinoma is more common in women than men, and the risk of developing this cancer increases with age. It is also more common in people of Hispanic or African American descent than in whites.
Early gastric adenocarcinoma that involves only the mucosa and submucosa of the stomach wall is highly curable, with a 5-year survival rate of 90 percent (1). However, cancer that has invaded deeper into the stomach wall or into adjacent structures is less curable (2). The prognosis varies with the grade of the tumor, whether or not lymph nodes are involved, and the extent of metastatic involvement (3).
Gastric adenocarcinoma can spread to distant parts of the body through multiple pathways: lymphatic dissemination by the lymph nodes of the stomach, the omentum, and the mesentery; direct invasion into other organs such as the lungs or esophagus; and transperitoneal spread along the perigastric ligaments or mesentery and through the hematogenous route (4). Accurate radiologic assessment of these features influences clinical staging with use of the TNM system, and identifies important factors that affect treatment and outcome (5).
The standard approach to treatment for gastric cancer is surgery combined with chemotherapy and radiation. At MD Anderson, we often give these treatments before surgery (neoadjuvant chemoradiation therapy). This helps kill more cancer cells and shrinks the size of the tumor so that it can be removed more easily.
In addition, we have a number of targeted therapy treatments that target specific parts of the cancer cell without harming normal cells. These include monoclonal antibodies and multikinase inhibitors. Several studies have shown that EGFR inhibitors can be used to improve the outcome of gastric cancer, especially in patients with high levels of EGFR expression (5).
We have a wide range of surgical techniques for removing the cancer and restoring the function of the stomach. Our team of surgeons is skilled at performing minimally invasive surgeries and minimizing complications. We use laparoscopy when appropriate and can offer patients a variety of surgical procedures, including robotic-assisted surgery (6).
