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School of Medicine
Worldwide, more than half a million deaths result from stomach cancer, which is much more common in Asia and Latin America than in the United States. 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.
Susannah Yovino, M.D.
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. Experts 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.
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 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.
Survivors of cancer of the stomach and esophagus may find many changes to their bodies from their cancers and treatments. Some side effects such as fatigue, loss of appetite, joint pain, numbness and tingling of the hands and feet (peripheral neuropathy), and anemia can linger after treatment; fatigue can last for up to a year. Be patient and allow your body time to heal and adjust. Always discuss any health concerns and symptoms with your doctor.
Pain levels can vary after treatments. Pain following surgery generally is short term, while some patients also experience chronic pain. Your doctor can help prescribe the pain-relieving medication that is right for you. Some patients find holistic methods like acupuncture, meditation, yoga or hypnosis helpful.
Surgery and treatments affecting the digestive tract impact the body's gastrointestinal function. Following surgery, many patients do not feel as well after eating some foods or large meals. Energy levels usually return slowly, partly because of anemia and partly because the body may not have the ability to properly digest food and extract the nutrition needed to keep you active.
Survivors who have had a gastrectomy or esophagectomy should follow a special diet, called a postgastrectomy diet, to help slow down the rate at which food travels through the gastrointestinal tract. This gives the body more time to digest food and pull out the nutrients you need.
As you recover, take charge of your health by eating healthy, exercising and reducing stress. Avoid tobacco and limit alcohol intake. Keep up with screenings for other cancers, like mammographies and colonoscopies.
Experts with the Esophageal Cancer Program at Johns Hopkins Kimmel Cancer Center treat more esophageal cancer patients than any other local medical center. Our researchers are covering new ground in the treatment of all types of cancer, including esophageal cancer. The staff at Johns Hopkins are experts, in many cases nationally and internationally known, in esophageal cancer and how to treat it. The Johns Hopkins Cancer Surgery Second Opinion Program offers people recently diagnosed with esophageal or gastric cancer the ability to consult with some of the leading experts in cancer surgery.
There are a variety of national support groups for both esophageal and stomach cancer survivors. The Esophageal Cancer Awareness Association's website has information and resources about esophageal cancer, including a section for survivors. The Esophageal Cancer Action Network,, founded by a Johns Hopkins patient and his family, provides support and resources for esophageal cancer patients, caregivers and survivors.
No Stomach for Cancer provides information and support for stomach cancer patients and their caregivers. Debbie's Dream Foundation: Curing Stomach Cancer, is a 501(c)(3) non-profit organization dedicated to raising awareness about stomach cancer, advancing funding for research, and providing education and support internationally to patients, families, and caregivers. DDF seeks as its ultimate goal to make the cure for stomach cancer a reality.