Stomach Cancer Care (Gastric Cancer)
Stomach cancer (also called gastric cancer) is a curable disease with effective treatment options. When discovered in its early stages, stomach cancer can be eliminated with complete removal 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 Irving Medical Center is committed to providing the highest quality of care through early detection initiatives and multidisciplinary collaborative care. Our specialized teams can perform the following diagnostic and treatment services, including robotic surgical options not offered elsewhere:
- Diagnostic endoscopy, endoscopic ultrasound
- Endoscopic biopsy
- Endoscopic mucosal resection (EMR)
- Endoscopic mucosal dissection (ESD)
- Wedge resection
- Total gastrectomy
- Subtotal gastrectomy (also known as partial gastrectomy)
- Robotic gastrectomy
- Limited lymph node dissection
- Extended lymph node dissection
- Minimally invasive approach
- Neoadjuvant chemotherpary
- Perioperative chemotherapy
- Intraperitoneal hyperthermic chemoperfusion
- Adjuvant chemotherapy
- Hormone receptor therapy
- Clinical Trials
For more information about the Gastric Cancer Care Program or to request an appointment, please contact one of our doctors below.
Sam S. Yoon, MD
Phone: (212) 305-0273
Dr. Yoon is the Chief of the Division of Surgical Oncology. He was recruited from Memorial Sloan Kettering Cancer Center in 2021 and is an expert in the treatment of patients with gastric and gastroesophageal junction cancers, including the performance of robotic gastric surgery. Dr. Yoon is one of the highest volume stomach cancer surgeons in the US, having performed over 1000 stomach cancer surgeries and over 300 robotic surgeries. For patients with gastric adenocarcinoma, Dr. Yoon’s average number of nodes resected during gastric adenocarcinoma surgery is 40.
Beth A. Schrope, MD, PhD
Phone: (212) 305-9441
Dr. Schrope joined the faculty of the Department of Surgery in July of 2001. She is an expert in minimally invasive surgical techniques for benign and malignant conditions of the stomach, and she is the author of numerous publications in the field of GI surgery.
Gastroenterology ‒ Genetics
Fay Kastrinos, MD
Elana Levinson, MS, MPH
Basic Science Research
Stories & Perspectives
Generally found after the age of 69, and is more likely to strike men than women
What are the 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.
How Common is Stomach Cancer?
- It is the 6th leading cancer in the world and the 3rd leading cancer killer
- In the United States, over 27,000 people were diagnosed with gastric cancer in 2019.
- Over 11,000 will die from gastric cancer this year.
- The incidence of gastric cancer is highest in the Asian American population followed by Black, Hispanic, and White Americans.
- Unfortunately, in the United States, gastric cancer is often 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 survival.
What are the Symptoms of Stomach 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
What are the Risk Factors for Stomach 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.
- 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.
- 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.
- 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.
- 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.
If you or someone you know have any of the risk factors listed or have abdominal symptoms for the past three months, please contact the Gastric Cancer Care Program by calling one of the doctors aboveto assess your risk of having or developing gastric cancer.
How do you Diagnose Stomach Cancer?
The gold standard for diagnosing stomach 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 stomach 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.
Treatment and prognosis of patients with stomach 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).
In the United States, stomach cancer often carries a poor prognosis for two main reasons:
- Frequently, the tumor is not detected until it has reached an advanced stage, limiting curative therapy.
- 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 32%. At the Gastric Cancer Care Program of NewYork-Presbyterian/Columbia University Irving Medical Center, we are committed to changing this statistic through the promotion of early detection initiatives and providing the highest quality of care through our multidisciplinary team of experts.
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 laparoscopic approaches and robotic assistance.
Similar to laparoscopic surgery, robotic surgery enables surgeons to operate through a few small incisions (cuts) instead of a large open incision. However unlike laparoscopic surgery, robotic surgery uses a higher definition camera and more advanced instruments that have a greater range of motion than the human hand. The camera and instruments are attached to a 4-arm robot, and the robot arms are controlled by the surgeon using a robotic console.
Treatment for Advanced Cancers
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.
FAQs about Stomach Cancer
What is stomach cancer?
Stomach cancer is cancer of the stomach. It may also be referred to as gastric cancer. Adenocarcinoma, an abnormal growth on the inner lining of the stomach wall, is the most common form of gastric 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).
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 stomach cancer?
Stomach cancer is curable if it is detected in early stages and removed. If it is not found until advanced stages, surgery may no longer be possible. The overall survival rate in the US is about 32% 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.
Which stomach cancers are best suited for robotic surgery?
The patients with stomach cancer that benefit most from robotic surgery are obese patients with smaller tumors. Obese patients require larger open incisions so the difference in incision sizes between open and robotic surgeries is the greatest for larger patients. The resected tumor and surrounding stomach must be removed through an incision. Thus even for robotic surgery, one of the small incisions must be enlarged to accommodate removal of the surgical specimen. The advantages of robotic surgery are thus diminished for a very large tumor or for a total gastrectomy.
Gastrointestinal stromal tumors and neuroendocrine tumors (a.k.a. carcinoid tumors) are less common forms of stomach cancer. Many of these tumors can also be removed using robotic surgery.
What are the benefits of robotic surgery for stomach cancer?
Benefits of robotic surgery include:
- Reduced pain
- Lower risk of infection or other complications
- Less blood loss (fewer transfusions)
- Shorter hospital stays
- Less scarring due to smaller incisions
- Faster return to normal activities (e.g. work and daily activities)
Division of Surgical Oncology
For appointments at any location, call (212) 305-0273
Milstein Hospital Building, 7-002
177 Fort Washington Ave
New York, NY 10032
1 Pondfield Road
Bronxville, NY 10708
Clinic hours on the 2nd and 4th Wednesdays of the month
- Hudson Valley
Corlandt Manor, NY 10567
Clinic hours on the 1st and 3rd Wednesdays of the month
Division of GI/Endocrine Surgery
For appointments, call (212) 305-9441
Herbert Irving Pavilion, Rm 828
161 Fort Washington Ave
New York, NY 10032
For more information about the Gastric Cancer Care Program or to request an appointment, please call one of the offices above.
For international patients, please contact the Global Services office at our partner hospital, NewYork Presbyterian.