Stomach Cancer Care (Gastric Cancer)

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Programs & Services

Gastric cancer is a curable disease with effective treatment options. When discovered in its early stages, gastric cancer can be eliminated with complete resection of the tumor alone. Effective treatment of advanced gastric cancer requires a comprehensive strategy to achieve long-term survival and maintain a good quality of life.

The Gastric Cancer Care Program of NewYork-Presbyterian/Columbia University Medical Center is committed to providing the highest quality of care through early detection initiatives and multidisciplinary collaborative care, including expert teams in:

GI Oncology

  • Diagnostic endoscopy, endoscopic ultrasound
  • Endoscopic biopsy
  • Endoscopic mucosal resection (EMR)
  • Endoscopic mucosal dissection (ESD)

Surgical Oncology

  • Wedge resection
  • Total gastrectomy
  • Subtotal gastrectomy
  • Limited lymph node dissection
  • Extended lymph node dissection
  • Minimally invasive approach

Medical Oncology

  • Neoadjuvant chemotherpary
  • Perioperative chemotherapy
  • Intraperitoneal hyperthermic chemoperfusion
  • Adjuvant chemotherapy
  • Hormone receptor therapy
  • Clinical Trials

Redefining Gastric Cancer Treatment: An Interdisciplinary Approach

When gastric cancer is diagnosed in more advanced stages, patients may require a combination of treatments including surgery, chemotherapy, and radiation therapy.

  • Chemotherapy either prior to surgery or after surgery will be recommended depending on the tumor characteristics and patient factors.
  • Patients with large tumors, enlarged lymph nodes, or tumors near the esophagus will most likely benefit from chemotherapy before surgical resection. The goal of chemotherapy prior to surgery, also known as neoadjuvant treatment, is to shrink the tumor so that it can be removed entirely at the time of surgery and to decrease the chance that the tumor will come back.
  • Chemotherapy, radiation, or a combination of both may be needed after surgery to prevent recurrence of disease.
  • There are several kinds of chemotherapy, both oral and intravenous, and the exact chemotherapy regimen is determined based on the characteristics of each individual patient.

In some circumstances the tumor will be too extensive to be removed through surgery, especially when the cancer has already spread beyond the stomach to distant organs. In these cases, the patient’s medical team will evaluate options of chemotherapy and sometimes radiation in order to shrink the tumor and alleviate his or her symptoms such as pain or bleeding.

For more information about the Gastric Cancer Care Program of NewYork-Presbyterian/Columbia University Medical Center or to request an appointment, please visit columbiasurgery.org/gastric-cancer or call (212) 305-0374.

 

OUR TEAM

Surgical Oncology

John A. Chabot, MD, FACSJohn A. Chabot, MD
Phone: (212) 305-9468

Dr. Chabot has spent the duration of his career at NewYork-Presbyterian/Columbia since 1983, when he began his internship in transplantation. He has dedicated his career with resolute focus on the prevention, treatment, and cure for pancreatic cancer. Having progressed from intern, resident, and fellow to Professor, mentor, and Executive Director of the Pancreas Center at NewYork-Presbyterian/Columbia, Dr. Chabot intimately understands the culture and practice of medicine and surgery at the hospital. He is in a well-grounded position to lead ColumbiaDoctors in responding to the challenges associated with rapid innovation, advancing technology, and the highly informed patient.

In addition to serving as Executive Director of the Pancreas Center, Dr. Chabot is Chief of GI/Endocrine Surgery at NewYork-Presbyterian Hospital and the David V. Habif Professor of Surgery at Columbia University College of Physicians and Surgeons.

Beth A. Schrope, MD, PhDBeth A. Schrope, MD, PhD
Phone: (212) 305-9441

Dr. Schrope joined the faculty of the Department of Surgery in July of 2001 as a Clinical instructor after completing her residency with NewYork-Presbyterian Hospital. She is currently Associate Professor of Clinical Surgery.

She graduated with an M.D. degree from Temple University in 1996. Prior to joining the profession of medicine, she completed a Ph. D. in Biomedical Engineering at Drexel University in 1992, and won numerous federal grants as principle investigator for research work in medical ultrasound. She is the author of numerous publications in the fields of bariatric surgery, medical ultrasound and GI surgery. She is the sole editor of a new textbook on Surgical and Interventional Ultrasound.

Her research interests include novel applications of autologous pancreatic islet cell transplantation, pancreatic cysts and pancreatitis. She also employs minimally invasive surgical techniques for benign and malignant conditions of the stomach. Dr. Schrope is an active member of the American College of Surgeons, the American HepatoPancreaticoBiliary Association, and Society of Surgery of the Alimentary Tract. She is currently serving as Regional Medical Director of the Southern New York chapter of the National Pancreas Foundation.

Medical Oncology

Gulam A. Manji, MD, PhD
Gary K. Schwartz, MD

Radiation Oncology

David P. Horowitz, MD

Interventional Gastroenterology

Tamas A. Gonda, MD
David S. Lee, MD
Amrita Sethi, MD

Gastroenterology ‒ Genetics

Fay Kastrinos, MD
Elana Levinson, MS, MPH

Nutrition

Sabrina Toledano, RD, CSO, CDN

Palliative Care

Craig D. Blinderman, MD, MA
Shunichi Nakagawa, MD

Basic Science Research

Timothy C. Wang, MD


Stories & Perspectives

Gastric Cancer: A Concern for Baby Boomers

Generally found after the age of 69, and is more likely to strike men than women


ABOUT STOMACH CANCER

Types of Stomach Cancer

The majority of gastric cancers, (>90%) are adenocarcinomas, an abnormal growth of the inner lining of the stomach wall.

  • Proximal (Cardia) stomach cancer — Affects the first part of the stomach and may extend into the gastroesophageal junction. Risk factors for this type of cancer include obesity and gastroesophageal reflux disease.
  • Non-cardia stomach cancer — Affects any other parts of the stomach. May develop from prolonged periods of inflammation and irritation. Commonly associated with chronic infection with Helicobacter pylori bacteria.
  • Diffuse stomach cancer — Grows within the stomach wall as scattered cells without forming a distinct tumor. May have a genetic cause.

Other Cancers of the Stomach

  • Gastrointestinal stomal tumors (GISTS) — abnormal growth of the connective tissues of the stomach wall.
  • Lymphoma — uncontrolled growth of immune cells of the stomach.
  • Carcinoid tumors — cancer of the hormone-producing cells of the stomach.

Incidence of Gastric Cancer

  • Worldwide, 989,000 patients are diagnosed with gastric cancer each year, with higher rates in East Asia, Eastern Europe, South America, and the Middle East
  • It is the 4th leading cancer in the world and the 2nd leading cancer killer
  • In the United States 21,000 patients were diagnosed with gastric cancer in 2010.
  • Over 10,000 will die from gastric cancer this year.
  • It is the 14th most common cancer in the United States.
  • The incidence of gastric cancer is highest in the Asian American population followed by Black, Hispanic, and White Americans.
  • Unfortunately, in the United States like in China, gastric cancer is diagnosed at later stages (>60%), when the tumor may have:
    • Invaded deeper into the stomach wall.
    • Involve adjacent organs.
    • Spread to the lymph nodes, the linings of the abdomen.
    • Travelled to distant organs.
In Japan and Korea, where the incidence of gastric cancer is much higher, screening endoscopy is a national health policy which has improved gastric cancer free survival. More than 50% of patients are diagnosed at earlier stage of their cancers.

 

Symptoms of Gastric Cancer

Symptoms of earlier stage gastric cancers are usually vague and similar to those of minor stomach aches, indigestions and infections.

If you experience persistent symptoms listed below, please contact your doctor:

  • Abdominal pain or discomfort
  • Fullness or bloating after eating small amounts of food
  • Heartburn, indigestion
  • Difficulty swallowing
  • Loss of appetite
  • Nausea and vomiting
  • Bloody or dark stools
  • Constant fatigue
  • Unintentional weight loss

Risk Factors

Are you or someone you love at risk of developing gastric cancer? The following factors influence the risk of developing stomach adenocarcinoma.

Infection with Helicobacter Pylori Bacteria

  • Left untreated, infection with this bacteria leads to chronic inflammation of the inner layer of the stomach.
  • May possibly lead to the development of precancerous lesions.

Diet

  • Eating lots of highly preserved foods, such as smoked fish, salted meats, and pickled vegetables, has been shown to increase a person's chances of developing stomach cancer.
  • A diet which includes a substantial amount of fresh fruits and vegetables especially those high in beta-caratene and vitamin C have been shown to reduce the risk of gastric and other cancers.

Ethnic Background

  • Gastric cancer is a disease of racial disparity.
  • Koreans and Korean Americans are at highest risk among those living in the United States, followed by African American, Hispanic American, other Asian American ethnic minorities.

Gender/Age

  • Stomach cancer is more common in men than in women and most commonly diagnosed in people over the age of 65.

Smoking and Alcohol Abuse

  • Both smoking tobacco and excessive alcohol consumption has been linked to increased risk stomach cancer.

Previous Stomach Surgery

  • Removal of part of the stomach for ulcer, previous removal of stomach polyps.

Detection & Diagnosis

As is the case with all types of cancer, prevention is the most effective method to ensure long-term cancer-free survival. Successful treatment and long-term survival is associated with earlier diagnosis and proper treatment.

Early Detection of Stomach Cancer

The doctors at Columbia University Medical Center are dedicated to the early detection and curative treatment of patients with gastric cancer. If you or someone you know have any of the risk factors listed below or have abdominal symptoms for the past three months, please contact the Gastric Cancer Care Program of NewYork-Presbyterian/Columbia University Medical Center at (212) 305-0374 for a consultation to assess your risk of having or developing gastric cancer.

  1. History of or current infection with Helicobacter Pylori bacteria
  2. History of stomach ulcers, lesions or surgery
  3. History of pernicious anemia
  4. Diet high in salt or preserved foods, such as smoked fish or pickled vegetables
  5. Asian American or South American immigrant or descent
  6. Persistent abdominal symptoms for past three months

Other Conditions

  • Family cancer syndromes, such as hereditary nonpolyopsis colorectal cancer (HNPCC) and Li Fraumeni Syndrome, which increase risk of colorectal cancer and slightly increase stomach cancer risk
  • Family history of stomach cancer
  • Family history of breast cancer; people carrying mutations of the inherited genes BRCA1 and BRCA2 may also have a higher rate of stomach cancer

During the consultation, your physician will determine whether or not you will require simple blood work, endoscopic evaluation by a gastroenterologist or other imaging studies.

Diagnosing Gastric Cancer

All evaluation for patients who come to our Gastric Cancer Center includes:

  • A thorough evaluation of medical history including determination of exposure to risk factors.
  • Review of all relevant exams previously performed.
  • Complete physical exam.

Diagnostic test of choice for gastric cancer is an upper endoscopy, or an esophagogastroduodenscopy.

  • While you are under sedation, a small tube with a light and camera is inserted into the mouth and directed into the stomach.
  • The doctors can examine the inner lining of the stomach and identify abnormal areas.
  • The areas can be biopsied and evaluated for presence or absence of cancer or precancerous conditions.

Endoscopic Ultrasound (EUS)

  • Sometimes performed to determine the depth of the ulceration or tumor.
  • Some patients may be eligible for nonsurgical removal of their tumor. See Gastric Cancer treatment section.

Once you are confirmed to have gastric cancer, other diagnostic tools may be used to determine the extent of your cancer:

  • CT scan of the abdomen and pelvis.
  • PET scan.

How Is Gastric Cancer Diagnosed?

Gastric cancer is hard to detect in early stages because symptoms are uncommon and nonspecific. When symptoms do occur, they can easily be mistaken for more common ailments such as a stomach virus. Gastric cancer symptoms may include a loss of appetite, indigestion, nausea, stomach discomfort, heartburn, black stool, vomiting, unintentional weight loss, feeling full earlier than normal, and pain after eating.

The gold standard for diagnosing gastric cancer is an upper endoscopy or esophagogastroduodenoscopy (EGD). A gastroenterologist will guide a small camera and light into the stomach to visually inspect the stomach. If the doctor sees anything abnormal, the doctor will take a sample (a biopsy) of it and send it to a pathologist for evaluation. The pathologist will evaluate the sampled tissue under a microscope to look for abnormalities including cancer cells, H. pylori infection, and inflammatory or precancerous changes. If gastric cancer is confirmed, additional diagnostic procedures such as an endoscopic ultrasound (EUS) may be requested. During an EUS, a special endoscopic equipment using sound waves will be employed to determine the depth of tumor invasion and identify lymph nodes around the stomach, which may harbor cancer cells.

Further work-up of gastric cancer includes CT of the abdomen and pelvis, CXR, and at times, PET scan. These non-invasive imaging tests will provide additional necessary information about the extent of tumor, whether or not it has spread to the lymph nodes or distant organs such as liver or peritoneum. A multidisciplinary team led by one of the physicians will then review all of the information and recommend the best treatment for each individual patient.

For more information about the Gastric Cancer Care Program of NewYork-Presbyterian/Columbia University Medical Center or to request an appointment, please visit columbiasurgery.org/gastric-cancer or call (212) 305-0374.

 

Treatment of Gastric Cancer

Treatment and prognosis of patients with gastric cancer depends on multiple factors. The stage of gastric cancer at the time of your diagnosis provides good information about the nature of the gastric cancer. The stage of gastric cancer is determined by the depth of the tumor in the stomach wall (T-stage), involvement of the lymph nodes (N-stage), and the presence or the absence of distant disease (M-stage).

Curative treatment requires complete endoscopic or surgical removal of the cancer and most of the times, the lymph nodes that drain the stomach. This is possible for patients with early stage cancers and locally advanced cancers. In some cases, surgery can be performed using minimally invasive approaches and robotic assistance.

How is Gastric Cancer Treated?

In the United States, gastric cancer often carries a poor prognosis for two main reasons:

  1. Frequently, the tumor is not detected until it has reached an advanced stage, limiting curative therapy.
  2. Only about 35% of the treatment facilities have a multidisciplinary approach where a coordinated team of specialists can offer a comprehensive treatment plan.

On average the long-term survival rate in the United States is 25% with approximately half of all gastric cancer patients dying within a year of diagnosis. At The Gastric Cancer Care Program of NewYork-Presbyterian/Columbia University Medical Center, we are committed to changing those statistics through the promotion of early detection initiatives and providing the highest quality of care through our multidisciplinary team of experts.

Treatment Options

The three main treatment options for gastric cancer are surgery, chemotherapy, and radiation. Hormonal therapy may be an option for a small percent of patients with a certain type of tumor biology. Surgery, however, remains the primary option for curative therapy.

Small early gastric cancers (less than 2cm) involving only the first two layers of the stomach wall can be cured with endoscopic removal of the abnormal tissue. Since some early cancers have minimal chance of spreading to other areas, a trained endoscopist can perform either an Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD), two procedures that remove the cancerous tissues in a non-surgical, minimally invasive way. The procedures offer a curative removal of the tumor without the need for open surgery.

Advanced gastric cancers are most commonly treated by surgery. Surgery involves removing part or all of the stomach as well as the lymph nodes, which aid in the body’s clearing of infections, toxins, and more. Subtotal distal gastrectomy, the removal of two-thirds of your distal stomach, is performed for tumors in the lower portions of the stomach. A total gastrectomy, removal of the entire stomach, is performed for tumors, which are in the upper portion of the stomach. The extent of lymph node removal during the operation depends on the depth of tumor invasion of the stomach wall. In many cases, this can be performed using minimally invasive approaches and robotic assistance.

FAQs

What is gastric cancer?

Gastric cancer is cancer of the stomach. Adenocarcinoma, an abnormal growth on the inner lining of the stomach wall, is the most common form of gastric cancer.

What are the risk factors for gastric cancer?

Gastric cancer is strongly associated with heliobacter pylori (H. pylori) infection, chronic swelling and inflammation of the stomach (atrophic gastritis) and the consumption of salted, pickled, and smoked foods.

Other risk factors include:

  • Asian or South American Ethnicity
  • Family history of stomach cancer
  • Presence of a polyp larger than 2 cm
  • Pernicious anemia
  • Smoking
  • Male gender
  • Age over 65
  • Family cancer syndromes, such as hereditary nonpolyopsis colorectal cancer (HNPCC) and Li Fraumeni Syndrome, which increase risk of colorectal cancer and slightly increase stomach cancer risk
  • Family history of breast cancer; people carrying mutations of the inherited genes BRCA1 and BRCA2, may also have a higher rate of stomach cancer.

Who is at highest risk of developing gastric cancer?

The highest rate of gastric cancer occurs in Japan, Korea, Singapore, Taiwan, Chile, Brazil, and Iceland (and among natives of those countries even if they no longer live there). About 21,000 people in the U.S. are diagnosed with stomach cancer each year.

Is gastric cancer passed through families?

People in families with family cancer syndromes such as hereditary nonpolyopsis colorectal cancer (HNPCC) and Li Fraumeni Syndrome are at higher risk of colorectal cancer and gastric cancer. A family history of breast cancer, including presence of the BRCA1 and BRCA2 genes, also increases the risk of stomach cancer. People with defects of the CDH1 gene have close to a 100% chance of developing gastric cancer.

How serious is gastric cancer?

Gastric cancer is curable if it is detected in early stages. If it is not found until advanced stages, and surgery is no longer possible, the survival rate is about 50% at five years after diagnosis.

How is stomach cancer treated?

Gastric cancer is treated by surgical removal of the stomach and the nodes adjacent to the stomach. In some cases, surgery can be performed using minimally invasive approaches and robotic assistance.

CONTACT

The Gastric Cancer Care Program of
NewYork-Presbyterian/Columbia University Medical Center

Division of GI/Endocrine Surgery
Columbia University College of Physicians and Surgeons
Herbert Irving Pavilion Comprehensive Cancer Center
161 Fort Washington Ave, 828
New York, NY 10032

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