David Ilson, MD, PhD, reflects on the role of molecular testing in the treatment of metastatic gastric/gastroesophageal junction cancer and its impact on prognosis and clinical decision making.

Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach.[11] Most cases of stomach cancers are gastric carcinomas, which can be divided into a number of subtypes including gastric adenocarcinomas.[2] Lymphomas and mesenchymal tumors may also develop in the stomach.[2] Early symptoms may include heartburn, upper abdominal pain, nausea and loss of appetite.[1] Later signs and symptoms may include weight loss, yellowing of the skin and whites of the eyes, vomiting, difficulty swallowing and blood in the stool among others.[1] The cancer may spread from the stomach to other parts of the body, particularly the liver, lungs, bones, lining of the abdomen and lymph nodes.[12]

The most common cause is infection by the bacterium Helicobacter pylori, which accounts for more than 60% of cases.[2][3][13] Certain types of H. pylori have greater risks than others.[2] Smoking, dietary factors such as pickled vegetables and obesity are other risk factors.[2][4] About 10% of cases run in families, and between 1% and 3% of cases are due to genetic syndromes inherited from a person's parents such as hereditary diffuse gastric cancer.[2] Most of the time, stomach cancer develops in stages over years.[2] Diagnosis is usually by biopsy done during endoscopy.[1] This is followed by medical imaging to determine if the disease has spread to other parts of the body.[1] Japan and South Korea, two countries that have high rates of the disease, screen for stomach cancer.[2]

A Mediterranean diet lowers the risk of stomach cancer, as does the stopping of smoking.[2][5] There is tentative evidence that treating H. pylori decreases the future risk.[2][5] If stomach cancer is treated early, it can be cured.[2] Treatments may include some combination of surgery, chemotherapy, radiation therapy and targeted therapy.[1][14] If treated late, palliative care may be advised.[2] Some types of lymphoma can be cured by eliminating H. pylori.[15] Outcomes are often poor, with a less than 10% five-year survival rate in the Western world for advanced cases.[6] This is largely because most people with the condition present with advanced disease.[6] In the United States, five-year survival is 31.5%,[7] while in South Korea it is over 65% and Japan over 70%, partly due to screening efforts.[2][8]

Globally, stomach cancer is the fifth leading type of cancer and the third leading cause of death from cancer, making up 7% of cases and 9% of deaths.[16] In 2018, it newly occurred in 1.03 million people and caused 783,000 deaths.[10] Before the 1930s, in much of the world, including most Western developed countries, it was the most common cause of death from cancer.[17][18][19] Rates of death have been decreasing in many areas of the world since then.[2] This is believed to be due to the eating of less salted and pickled foods as a result of the development of refrigeration as a method of keeping food fresh.[20] Stomach cancer occurs most commonly in East Asia and Eastern Europe.[2] It occurs twice as often in males as in females
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#stomach_cancer
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FREE Stomach Cancer Education Webinar

Topic: Caring For Young Patients With Gastric Cancer: Successively Younger Generations

Speaker: Jennifer Zikria, MD of Memorial Healthcare System (Hollywood, FL)

Webinar presentations focus on cutting-edge advancements being made that inform new treatment models, pharmaceutical development, and research taking place. In addition, webinars feature experts in stomach cancer research, clinical trials, oncology, and surgery.

Archives of the webcasts will be posted on our website year-round along with question and answer sessions with expert responses.

Geoffrey Y. Ku, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses the role of durvalumab in the treatment of patients with gastric cancer.

Two types Gastric cancers
Intestinal Type
Diffuse type

Video generously donated by
Dr. Waddah B. Al-Refaie, MD, FACS
John S. Dillon Professor & Regional Chief of Surgical Oncology
MedStar Health and Georgetown University
Washington, DC

I will tell you about our upcoming trial of Endoscopic surveillance comparing 30 versus 88 random biopsies