Stomach

Published by Andy LoCascio at July 6, 2018

Stomach Cancer

Stomach Cancer Overview

Stomach Cancer, also called Gastric Cancer, is cancer that occurs in the stomach- the muscular sac located in the upper middle of the abdomen, just below the ribs.

Virtually all stomach cancers (90-95%) are adenocarcinomas: cancer that begins in the glandular tissue that lines the inside of the stomach. Adenocarcinomas are further classified as either intestinal or diffuse.

Stages and Treatments of Stomach Cancer

Stage 0: Limited to the inner lining of the stomach. Treatment includes endoscopic mucosal resection, gastrectomy and lymphadenectomy.

Stage IA: The cancer is confined to the stomach and may have invaded the inner layer of the stomach wall but has not spread to any lymph nodes or other organs. Treatment includes surgery, including removal of the omentum.

Stage IB: The cancer has grown into the inner layers of the stomach wall and has spread to one or two lymph nodes, or the cancer has grown into the outer muscular layers of the stomach but has not spread to the lymph nodes or other organs. Treatment includes surgery, chemotherapy and radiation therapy.

Stage IIA: The cancer has invaded the inner layer of the stomach and has spread to three to six lymph nodes; or the cancer has invaded the outer layers of the wall and has spread to one to two lymph nodes; or the cancer has grown through all the layers of muscle into the connective tissue outside the stomach but has not penetrated the peritoneal lining or spread to any lymph nodes or to surrounding organs. Treatment includes surgery, chemotherapy and radiation, sometimes with additional neoadjuvant chemotherapy.

Stage IIB: The cancer has invaded the inner layers of the wall of the stomach and spread to six or seven lymph nodes; or has invaded the outer layers and spread to three to six lymph nodes; or has spread to the connective tissue outside the stomach but has not penetrated the peritoneum and has spread to one or two lymph nodes; or has penetrated the peritoneum but not spread to any lymph nodes. Treatment includes surgery, chemotherapy, and radiation, sometimes with neoadjuvant chemotherapy.

Stage IIIA: The cancer has invaded the outer muscular layers of the stomach and has spread to six or more lymph nodes; or has grown through all the muscular layers of the stomach, has not penetrated the peritoneum, but has spread to three to six lymph nodes; or the cancer has penetrated the peritoneum and has spread to one to two lymph nodes but not to other organs. Treatment is the same as Stage 11.

Stage IIIB: The cancer has grown through all the layers of the muscle into the connective tissue outside the stomach, has not penetrated the peritoneal lining, but has spread to seven or more lymph nodes; or the cancer has grown through all the layers of muscle, has penetrated the peritoneal lining and has spread to three to six lymph nodes; or the cancer has grown through all the layers of muscle into the connective tissue outside the stomach, has invaded nearby organs or structures and may or may not have spread to one to two lymph nodes. Treatment includes surgery, chemotherapy and radiation.

Stage IV: The cancer has spread to nearby tissues and more distant lymph nodes, or has metastatized to other organs. Treatments include surgery, and/or stents, chemotherapy by drugs such as 5-fluorouracil, cisplatin, epirubucun, etoposide, docetaxel, oxaliplatin, capecitabine, and irinotecan. Some drug therapies used in stomach cancer treatment include 5-FU, capecitabine, BCNU, methyl-CCNU, doxorubicin, Mitomycin C, cisplatin and taxotere.

New chemotherapy drugs are being studied in stomach cancer. S-1 is an oral chemotherapy related to 5-FU that is being used for stomach cancer but not yet approved in the United States. Other clinical studies are testing the best ways to combine chemo with radiation therapy, targeted therapies, or immunotherapy.

Targeted Therapies: Some stomach cancers have an overexpression of the HER2 protein on the surface of their cells, which helps their growth. Trastuzumab (Herceptin) is approved for the treatment of stomach cancers. Other drugs that target HER2, such as lapatinib (Tykerb), pertuzumab (Perjeta), and trastuzumab emtansine (Kadcyla) are being studied in clinical trials.

EGFR is another protein found on some stomach cancer cells. Panitumumab (Vectibix) is an approved drug that targets EGFR. Sorafenib (Nexavar) and apatinib are being studied in clinical trials.

New Treatments for Stomach Cancer: Recently, the FDA has approved ramucirumab (Cyramza) to treat patients with advanced or metastatic gastric cancer or gastroesophageal junction adenocarcinoma. Ramucirumab is a type of targeted therapy (treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival) that blocks a process called angiogenesis. Angiogenesis is the formation of new blood vessels. Because a tumor needs the nutrients delivered by these blood vessels to grow and spread, the goal of stopping angiogenesis is to essentially “starve” the tumor.

Ramucirumab is a recombinant monoclonal antibody of the IgG1 class that binds to the vascular endothelial growth factor receptor-2 (VEGFR-2) and blocks the activation of the receptor.

Types of Stomach Cancers

Types of Stomach Cancers

Proximal (Cardia) stomach cancer – Affects the upper part of the stomach and may extend up into the gastroesophageal junction.

Non-cardia stomach cancer – Affects any other parts of the stomach and may develop from prolonged periods of inflammation. This type of stomach cancer is commonly associated with chronic infection with Helicobacter pylori bacteria and commonly progresses from chronic gastritis to malignancy. (H. pylori is associated with gastric ulcers and chronic atrophic gastritis, which may explain the high incidence of gastric cancer in patients infected with H. pylori. However, the exact role of H. pylori in the development of gastric cancer remains unclear. It is theorized that H. pylori causes a gastritis or inflammation of the stomach, which can lead to a loss of secretory cells in the stomach, also known as strophic gastritis. It is believed that this process of atrophy can lead to gastric cancer. H. pylori has also been linked to lymphomas of the stomach).

Diffuse stomach cancer – Grows within the stomach wall as scattered cells without forming a distinct tumor, does not begin with a pre-malignant condition, and does not appear to be related to environmental factors such as diet or smoking, although infection with Helicobacter pylori raises the risk of this disease as well. The most important factor in diffuse gastric cancer is a genetic mutation that silences a gene called E-cadherin. Approximately one half of patients with this type of stomach cancer have this gene mutation. There is also a hereditary form of diffuse gastric cancer (HDGC) which is caused by the loss of function in the CDH1 gene.

Gastrointestinal stromal tumor (GIST) – Abnormal growth of the connective tissues of the stomach wall.

Lymphoma – Uncontrolled growth of the immune cells of the stomach.

Carcinoid tumors – About 35 of stomach cancers are carcinoid tumors, which arise from the hormone-producing cells of the stomach. Most of these tumors do not spread to other organs.

Linitis Plastica – Also called Gastic Scirrhous Carcinoma, a rare type of stomach cancer that begins in the lining of the stomach and spreads to the muscles of the stomach wall. This causes the wall of the stomach to become thick, hard, and rubbery, which causes digestive problems.

Clinical Trial Resources for Stomach Cancers

National Cancer Institute (NCI) Trials
The NCI, part of the National Institutes of Health, is the federal agency that provides funding for most U.S. cancer clinical trials. This site provides information on both open and closed cancer clinical trials that are funded by the government, as well as many sponsored by pharmaceutical companies, medical centers, and some international organizations.
http://www.cancer.gov/clinicaltrials

Center for Information and Study on Clinical Research Participation (CISCRP).
CISCRP offers an online clinical trials search engine at SearchClinicalTrials.org. In addition, they provide a toll-free number where patients can receive help locating a clinical trial.
www.SearchClinicalTreials.org

Centerwatch
This site helps people connect with clinical trials by offering a list of institutional review board (IRB)-approved clinical trials.
www.centerwatch.com

ClinicalTrials.gov
This database of publicly and privately supported clinical trials is maintained by the National Library of Medicine at the NIH.
www.clinicaltrials.gov

Coalition of Cancer Cooperative Groups
This organization provides resources and information in order for patients to search for clinical trials.
www.cancertrialshelp.org

EmergingMed Navigator
This organization helps to identify clinical trial options that match a patient’s specific diagnosis, stage and treatment history. Clinical trial specialists can also provide telephone support to help connect eligible patients with IRB-approved study sites that are enrolling new participants.
www.emergingmed.com

WHO International Clinical Trials Registry Platform Search Portal
The World Health Organization (WHO) coordinates health matters within the United Nations. This database allows people to search clinical trial registration information from many countries’ registries.
http://www.who.int/ictrp/en/

Educational Resources for Stomach Cancers

Cancer Progress from American Society of Clinical Oncology
http://www.cancerprogress.net/timeline/stomach

Gastric Cancer Foundation
http://www.gastriccancer.org

Debbie’s Dream Foundation
http://www.debbiesfream.org

No Stomach For Cancer
http://www.nostomachforcancer.org