Stomach Cancer

Although the incidence of stomach cancer has declined during the last several decades, 24,000 new cases per year are diagnosed in the United States, and the disease causes about 13,000 deaths. Worldwide, more than half a million deaths result from stomach cancer, which is much more common in Asia and Latin America. Stomach cancer (also called gastric cancer) can develop in any part of the stomach. It begins in the inner lining and can spread throughout the stomach, penetrate the wall and progress to the adjacent lymph nodes. The cause is unknown but has been associated with dietary factors, Helicobacter pylori infection, smoking and alcohol consumption. Current research on the molecular genetics of stomach cancer points toward prevention and early detection of the disease.

Diagnostic Tests

Unlike in Japan, where the incidence of stomach cancer is high and aggressive screening for the disease is undertaken, diagnosis of early gastric cancer in the United States remains uncommon. Nonspecific symptoms such as vague abdominal pain, indigestion or black stools (from bleeding) often are attributed to peptic ulcer disease or other more common problems, and the diagnosis of stomach cancer often is delayed.

Diagnosis is made by biopsy using flexible fiberoptic endoscopy, in which a light tube is introduced through the mouth, esophagus, stomach and first part of the small intestines. Suspicious areas are sampled by biopsy and examined under the microscope by the pathologist. Anyone in whom stomach cancer is suspected should undergo this examination. Upper gastrointestinal series is another test occasionally used to diagnose stomach cancer. Further imaging can determine the extent and stage of the cancer before surgery. Helical CT scan is used to see whether advanced or metastatic disease is present. Kimmel Cancer Center physicians use endoscopic ultrasound, which determines the depth of penetration of the tumor and whether local lymph nodes are enlarged. Such valuable information can aid the surgeon in planning the best therapeutic approach.

Current Treatments

Surgery is the mainstay of curative therapy for stomach cancer. If preoperative studies demonstrate the disease is confined to one area, an operation is recommended. Typically, surgery involves removing most of, and occasionally all of, the stomach to achieve safe removal of all cancer. An extended lymphadenectomy (removal of a wide area of lymph nodes in the area of the cancer) may increase the potential for cure. Such radical operations are being performed in selected patients by the surgeons at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Chemotherapy and radiation therapy also are used to treat stomach cancer. Currently, the cancer center is participating in a national study using radiation and chemotherapy after surgery for stomach cancer.

New Treatment Approaches

Our physicians are participating in large national study groups to examine new drugs for the treatment of early-stage disease after successful surgical resection. For advanced stomach cancer, our doctors are investigating novel drug therapies as well as new biological therapies -- a form of treatment that helps the body's immune system attack and destroy cancer cells.

New Treatment Approaches

Physicians at the Kimmel Cancer Center have remained at the forefront of the diagnosis and treatment of liver, bile duct, and gall bladder cancers through extensive research. New studies track the role environmental factors play in the development of bile duct and gallbladder cancers. Other studies continue to examine the role that estrogen plays in the development of these tumors. Physicians research the cause and prevention of gallstones, a major risk factor for gallbladder cancer and the reason this tumor occurs more often in women. New robotic methods of delivering treatments and gene therapy are on the horizon.