Greg and Kristie Myers of California City, California, are proud of their deep military roots. Two uncles and a grandfather served in Vietnam. There are Navy Seals in the family. Greg, a software engineer, has worked for the Air Force since 1998. Kristie is a project manager for defense contractor Northrup Grumman. Son Tyler attended the Air Force Academy. Daughter Kori served 10 years as an Air Force loadmaster.
They love sharing their unique bond at family get-togethers like Thanksgiving and Christmas, although Kori does express one minor complaint:
“Mom makes way too much food!” she says, laughing.
Hidden in that innocuous remark is a hint to another, more recent bond they now share. Greg, Kori and Tyler don’t eat big meals anymore, but that’s OK. They know they are all here and healthy because of a genetic test and surgery to remove their stomachs, which likely saved their lives.
It started with Dad, when he was 49 years old.
He and Kristie (“We met in kindergarten,” he shares proudly) had never had any serious health problems. Both were three-sport athletes in school, growing up in California’s Central Valley farm country. But in early 2021, Greg began to experience difficulty swallowing. “It hurt down deep,” he recalled.
A Stomach Cancer Diagnosis at 49
His family doctor prescribed antacids and sent Greg to a gastroenterologist. An endoscopy detected a 3-centimeter mass where the stomach meets the esophagus. A biopsy confirmed Greg had stomach cancer, a malady that strikes an estimated 26,000 Americans each year.
“I was in disbelief at first,” he said. “I’d always had this iron gut. I thought it must be something else.”
The shock reverberated through the family.
“It felt surreal,” recalled Kristie. “He had no history of this. And he was so young.” Indeed, the median age for gastric cancer is 68, nearly two decades older than Greg at the time.
“Dad had always been the rock of the family,” added Kori. “He took it so well, but it was really hard to see him in such pain.”
While Greg took a stoic “whatever happens, happens” approach, Kristie, who has a degree in kinesiology, dove into the research. She didn’t like what she found. If caught early, gastric cancer has a 75% survival rate. But if the disease spreads beyond the stomach, the number drops to 35%. Looking at her husband’s weakened condition and the pain he was enduring, Kristie was convinced he had advanced disease. She didn’t tell him.
The Myers were referred to City of Hope’s Antelope Valley facility, where they met oncologist Amartej Merla, M.D. They hit it off immediately, especially when Dr. Merla told them matter-of-factly that he was going to treat Greg, “like he’ll be here for 20 years.”
“He was weak,” recalled Dr. Merla, assistant clinical professor in the Department of Medical Oncology & Therapeutics Research. “He’d lost significant weight because he had difficulty swallowing and couldn’t eat.”
FLOT Chemotherapy Treatment
Typically, stomach cancer patients receive four cycles of a chemotherapy combo known as FLOT — fluorouracil, leucovorin oxaliplatin and docetaxel — followed by surgery to remove the cancer, then another four rounds of FLOT. Greg’s cancer was Stage 2A, not as dire as Kristie had predicted. Greg was hoping to get away with as minimal a surgery as possible.
But Dr. Merla had a suspicion, given Greg’s relatively young age. He arranged for genetic screening. (City of Hope prioritizes applying this personalized medicine approach to patient care, sometimes also called “precision medicine.”)
Greg took part in City of Hope’s INSPIRE (“Implementing Next-generation Sequencing for Precision Intervention and Risk Evaluation”) program, a research project offering genetic counseling to any patient who wants it. Since its inception, over 30,000 patients have participated, and researchers have identified some 150 mutations that point to a variety of inherited cancers.
“Information is empowering,” said genetic counselor Elyssa Zukin, M.S., CGC. “It can be hard to give someone bad news. But being able to find out can be really important, especially when the results are actionable and they can reduce their risk.”
Genetic Testing for Gastric Cancer
Greg was found to carry a mutation in the CDH1 gene, which puts people at extremely high risk for a rare and aggressive form of stomach cancer known as hereditary diffuse gastric cancer. This ended all talk of “minimal” surgery. Greg would need to have his stomach removed.
Worse, there was also a 50% chance that Kori or Tyler — or both — also carried the CDH1 mutation.
Both children agreed to be tested. Both came up positive. Kori was 27, Tyler 25.
“Suddenly, my kids were on this gastric cancer journey with me,” said Greg. “This was ripping my world apart.”
The children had a monumental decision to make. Neither had any symptoms. But that would almost certainly change, eventually. What to do now? Keep a super close watch for anything suspicious? Or have their stomachs removed as well, just to be certain?
“I just started crying when I got the results,” said Kori. I was really torn up about it. It didn’t feel real.”
“This was a real punch in the gut,” recalled Tyler, no pun intended. “And really scary. I was dumbfounded. It was a big shock. I started asking a lot of questions.”
World-class stomach cancer surgeon Yanghee Woo, M.D., had answers.
“You can live very well without a stomach,” said Dr. Woo, associate professor in the Division of Surgical Oncology, Department of Surgery. “Most food nutrients are actually absorbed by the small bowel.” The stomach makes it possible to consume large amounts of food at once — like a big Thanksgiving dinner — which is then slowly broken down physically and chemically. Without a stomach, you learn to eat small portions, multiple times a day.
Greg pushed forward toward his surgery date with Dr. Woo, set for late December 2021. Those early rounds of FLOT chemo were tough, especially one side effect: extreme sensitivity to cold. “The first time I grabbed something out of the freezer, it lit me up with pain like I’d never had before,” he said.
“That’s typical, especially with oxaliplatin,” explained Dr. Merla. “We tell our patients to avoid cold foods and wear gloves.”
The chemo did its job, shrinking Greg’s tumor and increasing the chances of successful surgery.
The actual procedure, expected to take six hours, turned into an 18-hour marathon because of difficulties attaching Greg’s esophagus, weakened by cancer and chemo, to his small intestine. Dr. Woo brought in a full thoracic team to help, at one point deflating a lung to better enable making the connection. “I was thankful for the incredibly talented team that took care of me during such an arduous procedure.” Greg said.
Dr. Woo also removed dozens of lymph nodes. She found cancer in nine of them. That post-op course of FLOT would definitely be necessary.
Greg spent 11 days in the hospital. At home, a psychological side effect emerged.
“Looking at certain foods on TV made me sick. Especially burgers,” he said. “It was really bad for a while.”
Not surprising, said Dr. Woo.
“Some people become very hungry, some have no appetite at all. Some become afraid to eat because they think something bad will happen to them.” It can take as long as a year for things to settle down.
A Gastrectomy Decision
Meantime, Tyler and Kori had each independently arrived at the same decision: to have Dr. Woo perform prophylactic stomach removal surgery (called a gastrectomy) right away, rather than, as Tyler put it, “wait for the other shoe to drop.”
“Screenings aren’t good enough yet,” said Kori. “This cancer is hard to find. It hides, and it gets missed all the time. I don’t want to worry that every ache and pain is cancer. I’m thinking about my future self, my own well-being and comfort for the rest of my life.”
Ultimately, Kori had two surgeries, in August and December 2022. The second procedure was a double mastectomy, because CDH1 also carries a high risk of lobular breast cancer, which forms in the milk-producing glands. She handled both operations well, and no cancer was found.
Tyler’s surgery, however, ran into complications, which required follow-up procedures. Also, a small number of Stage 1 cancer cells were found. Nevertheless, Dr. Woo feels optimistic about both young patients.
“Tyler has less than a 2% chance of recurrence,” she said. “And Kori? She’s cured.”
Dad is still dealing with challenges. His cancer returned in February 2023, this time in the peritoneum, meaning the disease had progressed to Stage 4. He underwent additional rounds of chemo, plus five rounds of HIPEC: surgery combined with heated chemotherapy pumped into his abdominal cavity. (HIPEC is a leading-edge procedure not offered at the average hospital, and City of Hope is considered a high-volume performing center.) After round five, scans showed no cancer. Just recently, however, some "microtumors" have been detected. Greg is currently undergoing another round of chemo while remaining upbeat.
All in all, the Myers consider themselves extremely fortunate to be together and with much of their cancer journey behind them. This is the first Thanksgiving since Greg's diagnosis when the family will dine fully healed from their procedures and adjusted to their new way of eating. "We used to be gorgers. Now we're grazers," Kori said. With smaller portions, they can celebrate Thanksgiving for a week: leftovers will stretch that much longer! They can’t say enough about their doctors and the entire City of Hope team. And they’ve left quite an impression themselves.
“Greg never lost hope,” said Dr. Merla. “Every time we’d meet, he’d have a smile on his face, always optimistic, telling me he looked forward to being cured. I learned from them how positive people can really be.”
The last word goes to Greg.
“If you find yourself at City of Hope, you’re in the right place. Sure, you’ll have your ups and downs. Don’t let the downs deter you. I’ve been through the ringer. But I’m still truckin’!”