Stomach (Gastric) and Esophageal Cancers
“Our team is dedicated to bringing the best of surgical innovation and medical science for the cure and care of patients with gastric and esophageal cancers. We are committed to ensuring that each patient receives a personalized treatment strategy with special attention given to the timing, extent and type of surgical approach, with preference for minimally invasive surgery.“
Yanghee Woo, M.D., associate professor and director, Gastroenterology Program
Currently, there are more than 26,000 new cases of gastric cancer and more than 21,000 new cases of esophageal cancer in the United States each year. These cancers affect more men than women, with higher rates of gastric cancer among Asian or Pacific Islander, Hispanic or Black populations, particularly in younger Hispanic men.
Because of its demographic diversity, the incidence of gastric cancer in the greater Los Angeles area is higher than the national average. However, half of California hospitals only perform three or fewer esophageal or gastric cancer surgeries yearly. City of Hope is a high-volume center for gastric and esophageal cancer surgeries, ranking among the top five in California.
Our multidisciplinary team of experienced surgical and thoracic oncologists includes experts in innovative surgical techniques and precision oncology. Our goal is to create individualized treatment plans combining the latest cancer care strategies, leading to optimal outcomes for patients with gastric, gastroesophageal junction and esophageal cancers.
Due to the complexity of some of these surgical procedures and the need to coordinate across different types of treatment, the best place to receive this kind of care is in a high-performing cancer center like City of Hope. Your care team works closely with you and your referring physician to create a personalized treatment strategy where surgical timing, extent and approach are individualized for precision cancer surgery.
A Pioneer in Minimally Invasive Robotic Surgery
Patient outcomes after robotic surgery are better than those for patients who undergo open surgery. However, many hospitals don’t have the expertise to perform robotic-assisted gastric and esophageal resections or to treat complex upper gastrointestinal cancers. City of Hope offers minimally invasive robotic approaches for early and advanced gastric and esophageal adenocarcinomas. In addition, we have high-volume expertise in performing the D2 lymphadenectomy, which is National Comprehensive Cancer Network-recommended for locally advanced gastric cancer. We perform:
- More than 75% of our complex gastrectomies (total and subtotal), two-field esophagogastrectomies, esophagectomies and associated procedures with robot-assisted minimally invasive surgery
- Robotic en-bloc multivisceral resection, including stomach, distal pancreas and spleen as needed for locally advanced gastric and gastroesophageal junction tumors
Leader in Peritoneal-Directed Chemotherapy
City of Hope is one of the few centers to offer hyperthermic intraperitoneal chemotherapy (HIPEC) in conjunction with minimally invasive surgery. We also perform the highest volume of HIPEC procedures among medical centers in Los Angeles County.
HIPEC allows targeted treatment of advanced cancers that have spread throughout the peritoneum in which there are fewer blood vessels to carry traditionally administered intravenous chemotherapy. In addition, we can deliver higher drug concentrations with fewer side effects because chemotherapy is confined to the peritoneal cavity.
Genetic Testing and Established Prophylactic Gastrectomy Program for High-Risk Individuals
Our patients can access comprehensive germline testing regardless of medical or family history. We also analyze suitable tumor samples using ultra-comprehensive, whole-exome and whole-transcriptome tumor sequencing with a best-in-class test for somatic mutations.
This state-of-the-art molecular profiling often yields information that is vital when determining treatment strategies. It can also uncover familial syndromes (e.g., Lynch syndrome). For example, individuals with pathogenic, highly penetrant CDH1 and CTNNA gene mutations have a greater risk of developing hereditary diffuse gastric cancer. Since there are more than a hundred CDH1 variants with known and unknown risks of gastric cancer development, we strongly recommend comprehensive genetic counseling and discussing the benefits of surveillance endoscopy and prophylactic surgery.
City of Hope offers multidisciplinary cancer risk assessment and robotic-assisted gastrectomy for high-risk individuals not offered at most hospitals.
Access to Investigational Treatments
When you come for treatment at City of Hope, you have access to our leading-edge investigational therapies and surgical approaches. Enrolling more than 800 clinical trials annually, our faculty members are leaders in translational research and committed to expediting the most promising treatments to their patients.
For instance, our physicians can now use a single-port (single-incision) robotic system approved for urologic and otolaryngologic procedures in abdominal surgeries, under a research protocol that includes patients with gastric cancer. Patients with gastric adenocarcinoma with metastases to the peritoneum may be eligible for laparoscopic hyperthermic intraperitoneal chemotherapy or a study investigating pressurized intraperitoneal aerosol chemotherapy (PIPAC). Both approaches are considered regional therapy, which means they are designed to control peritoneal disease with using concentrated, higher doses of chemotherapy, in order to minimize the side effects of targeting tumors that are otherwise resistant to systemic therapies.
“What really makes City of Hope unique is our holistic, patient-centered approach. We really try to listen to the patient and understand what are their goals, what do they want to achieve and what is important to them?"