January 24, 2014 | by Kim Proescholdt
Stomach cancer (also called gastric cancer) can develop in any part of the stomach. If left undetected, it can penetrate the stomach wall, progress to adjacent lymph nodes and spread to nearby organs. The cause is unknown but has been associated with dietary factors, Helicobacter pylori (H. pylori) infection, smoking and alcohol consumption.
Here Joseph Kim, M.D., a City of Hope surgical oncologist and head of upper gastrointestinal surgery, talks about how people can lower their risk for stomach cancer and why he, as a Korean-American, has a personal crusade in conquering this disease.
How common is stomach cancer?
Stomach cancer is the fourth-leading cause of cancer death worldwide, with the highest incidence occurring in Asian and Latin American countries. Although less common here in the United States, there are still approximately 24,000 Americans who learn annually they have cancer of the stomach. Fortunately, for reasons not entirely known, U.S. incidence has been dropping steadily since the 1950s.
Who gets stomach cancer, and why?
Like most other forms of cancer, stomach cancer occurs more frequently in people age 55 or older. Researchers think the reasons for a higher incidence of stomach cancer in Asian and Latin American countries is because diets commonly consumed there include many foods preserved by drying, smoking, salting or pickling. Eating foods preserved in this way may raise someone's risk for developing stomach cancer. Also, people who smoke cigarettes may be at higher risk of developing stomach cancer.
It’s worth noting that there is a sizable population of Asian and Latin American immigrants living in the Southern California area. We here at City of Hope recognize this and know that even though the incidence of stomach cancer may be low overall in the U.S., it is still a very common problem locally here in Southern California.
What are risk factors for stomach cancer and how can one lower their risk?
Stomach cancer is thought to have two primary risk factors. One is chronic infection with H. pylori bacteria, which infects the inner lining of the stomach causing inflammation and peptic ulcers. It is endemic in Asian countries and developing countries, but is treatable with antibiotics.
Diet is another risk factor. Fermented, pickled, dried and salted foods are part of one’s everyday diet in certain cultures. For example, Koreans see a higher incidence of stomach cancer because their diet consists of foods preserved with nitrates and nitrites.
But in other countries where stomach cancer is very common, screening programs are being adopted. This has helped to detect the cancer early, thus lowering death rates. Screening for stomach cancer involves an endoscopy which is a simple camera exam. We need to implement a screening program here in the U.S., especially in Southern California where we have many, many patients from these cultures living right in our back yard.
What are some of the signs and symptoms of stomach cancer?
At first, stomach cancer may not cause any symptoms. So when it does eventually cause symptoms, they are often mistaken for less serious stomach problems such as indigestion, heartburn or a virus. Therefore, it can be difficult to find stomach cancer early, which makes it more challenging to treat. I’ve had multiple gastric cancer patients who have initially visited their family physician complaining of mid-to-upper gastric pain. Their symptoms were downplayed. Then six to 12 months later when they finally undergo an endoscopy exam, their cancer is diagnosed. That’s unfortunately a common story that I hear. As a stomach cancer expert, I can’t stress enough that if someone has persistent, ongoing pain in the mid-to-upper region, press for an endoscopy to assure it’s not stomach cancer.
What’s new in stomach cancer research and treatment?
There are ongoing studies with monoclonal antibodies that are effective in treating stomach cancer. These monoclonal antibodies attach exclusively to certain molecules that cancer cells make. This causes the body’s immune system to rise up against the targeted cancer cell. It’s very promising research.
Here at City of Hope, we also offer an aggressive operation called a cytoreductive (debulking) surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), which has been shown to be an effective option for treating advanced stomach cancer. City of Hope is one of a few centers in the country offering it.
The technique is a two-step process. First, any visible tumor or cancer is surgically removed. Then a heated chemotherapy solution is circulated in the abdominal cavity to treat any cancer cells that may remain. The combination of heat and chemotherapy is believed to be more effective than standard chemotherapy treatment for certain patients because it can access and kill more cancer cells than can be found with the naked eye. Recently, we treated two female patients in their 30s with this procedure. While we continue to monitor them, neither currently shows any evidence of the disease.
What inspires you to do the work you do?
I’m very passionate about treating stomach cancer. As a Korean-American male, I know and understand all too well that stomach cancer is the No. 1 cancer for Korean men. So I feel a personal connection and lead the crusade in fighting this disease.
I also know that many older generation Koreans feel much more comfortable being treated by Korean physicians. I always have a desire to reach out to any one with stomach cancer, but especially other Koreans because I have a personal stake.
Do you think the United States should have recommended screening programs for stomach cancer? Let us know your thoughts by commenting below. To learn more about City of Hope's stomach cancer diagnosis and treatment options, visit http://cityofhope.org/stomach-cancer.