• Esophageal Submucosal Lesions
• Esophageal Cancer
• Barrett's Esophagus
• Celiac Disease
• Gastric Malignancies
• GERD
• Non-Cancerous Stomach Conditions

Stomach cancer, also known as gastric cancer, begins in the cells lining the innermost, or mucosal, layer of the stomach and spreads outward. It is relatively rare in the U.S. but the second most common cause of cancer-related deaths in the world.

• Gastric Cardia Cancer occurs in the top portion of the stomach near the junction of the esophagus
• Non-Cardia Gastric Cancer is found in all other areas of the stomach

While the incidence of non-cardia gastric cancer is decreasing due to better diet and food refrigeration, plus the use of antibiotics to treat helicobacter pylori bacteria infection, cardia gastric cancer has been increasing for reasons still unclear.

For more information on stomach (gastric) cancer, including symptoms and risk factors, visit our Health Library.

Diagnosis

If gastric cancer is suspected, an upper endoscopy will be performed using a gastroscope (a special type of endoscope) to help detect abnormalities. If cancer is confirmed, endoscopic ultrasound can precisely determine the stage of cancer by gauging the cancer's depth and whether it has spread. Other tests often given include high resolution computed tomography (CT or CAT) scans and positran emission tomography (PET) scans.

Treatment

A combination of surgery, chemotherapy and radiation therapy gives patients the best chance of recovery, or controlling the disease and extending life.

Surgery

Specializing in minimally invasive techniques, surgeons at NewYork-Presbyterian/Weill Cornell Center for Advanced Digestive Care may perform a subtotal or partial gastrectomy - removal of part of the stomach containing the cancer - or a total gastrectomy - removal of the entire stomach, in which the esophagus is connected to the small intestine. Both procedures are performed laparoscopically.

Removal of stomach polyps and gastrointestinal stromal tumors (GIST), rare and slow-growing types of gastric tumors that begin in the lining of the stomach (or lung), involve a combination of endoscopy and laparoscopy. This minimally invasive method allows shorter post-operative recovery time than an open surgical procedure.

Chemotherapy

Chemotherapy can be used:

• Before or during surgery to shrink a tumor and make it easier for doctors to surgically remove it (neoadjuvant therapy)
• After surgery in a separate procedure, to kill any remaining cancer cells too small to be removed by surgeons (adjuvant therapy).

With advanced (metastatic) gastrointestinal cancers, physicians generally surgically remove as much of the tumor as possible, then use a chemotherapy infusion to kill any remaining cancer cells. In this procedure, chemotherapy is first heated and then administered into the abdomen either during the surgery to remove the tumor or in a separate surgery afterward. Heating certain anti-cancer drugs both increases their potency and improves their uptake by cancer cells, thereby increasing their cancer-killing effects.

To treat gastrointestinal stromal tumors, physicians often administer imatinib (Gleevec), a molecularly targeted oral chemotherapy that has been shown to be extremely effective in treating this type of cancer.

Radiation Therapy

Physicians may also combine chemotherapy with radiation to destroy any remaining cancer cells following surgery. This often takes the form of intra-operative brachytherapy.