If you have been diagnosed with gastric cancer or a precancerous condition in the stomach, talk to us.
City of Hope is a recognized leader in stomach cancer treatment and research. It is ranked as one of America's Best Hospitals for cancer by U.S. News & World Report with numerous physicians recognized as Top Cancer Doctors by Newsweek.
City of Hope's gastric cancer patients receive unsurpassed diagnostic, treatment and supportive care from our multidisciplinary team, which includes gastroenterologists, surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, supportive care specialists and other health professionals — all working together to bring the most advanced, innovative and effective therapies.
Our primary goal is to ensure that every patient and their loved ones can live a life free of gastric cancer. Yanghee Woo, MD is here to help you learn how City of Hope can help.
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The Latest Treatments for Stomach Cancer
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Learn more about Yanghee Woo, M.D
Yanghee Woo, MD
Yanghee Woo, M.D., is a surgeon scientist specially trained and internationally recognized in robotic surgery and gastric cancer. She has particular expertise in complex procedures such as D2 lymphadenectomy for locally advanced gastric cancer. Dr. Woo offers her patients completely laparoscopic and robotic surgeries (for stomach and pancreas tumors) with optimal oncologic outcomes while preserving patients' quality of life. She is one of very few surgeons who treat gastric cancer and pancreatic cancer using minimally invasive methods.Learn more about Yanghee Woo, M.D
Transcription:
The Latest Treatments for Stomach Cancer
Melanie Cole (Host): If you’ve been diagnosed with gastric cancer or a pre-cancerous condition in the stomach, City of Hope is a recognized leader in stomach cancer treatment and research. Gastric cancer patients receive unsurpassed diagnostic treatment and supportive care from our multidisciplinary team. The primary goal is to ensure that every patient and their loved ones can live a life free of gastric cancer. My guest today is Dr. Yanghee Woo. She’s a world renowned stomach cancer specialist at City of Hope. Welcome to the show, Dr. Woo. Tell us about the incidence of stomach cancer.
Dr. Yanghee Woo (Guest): Stomach cancer is an uncommon cancer in the United States. It’s about 26,000 patients who are diagnosed each year with stomach cancer. However, in the world, there are about a million patients diagnosed each year with gastric cancer and it is the third leading cause of cancer deaths. In the United States it is the eighth leading cause of cancer deaths and less than 25% of patients who are diagnosed with gastric cancer in the United States survive five years. So, it is a deadly cancer for some patients who are diagnosed with late stages. Unfortunately, diagnosing gastric cancer in its early stages is a major challenge.
Melanie: Tell us some of the risk factors. Who is at risk for this type of cancer?
Dr. Woo: Sure. There are two general groups. Only 10% of the patients who develop gastric cancer have a genetic predisposition. The most well-known genetic predisposition is the CDH-1 gene which causes the hereditary diffused gastric cancer. However, other mutations are known like the BRCA 1 and 2 mutation does give you a predisposition to gastric cancer and if you have Lynch Syndrome, you’re also at a genetic risk for gastric cancer. However, 90% of gastric cancer patients do not have a known genetic risk. So, what are the risk factors? Many of the risk factors are modifiable. You can divide it into two categories: modifiable risk factors and non-modifiable risk factors. The modifiable risk factors, obviously, include a long standing infection with H. pylori. H. pylori is a bug that grows and lives in your stomach and can put you at anywhere between 3-12 times risk of developing gastric cancer over a long period of time. Smoking is also a risk factor for developing gastric cancer as it is a risk factor for many cancers. Men are twice as likely to develop gastric cancer or be diagnosed with gastric cancer than women. The average age of diagnosis of gastric cancer in the United States is in the late 60’s, which is different from other countries and, depending on the ethnic minority groups, the incidence actually differs. You are at a higher risk of developing gastric cancer if you are a Korean American, Asian American, African American or Hispanic American compared to other non-Hispanic whites.
Melanie: People hear stomach cancer. It’s a very scary diagnosis. Are there some symptoms? Patients always want to know what symptoms they might pay attention to that would send up red flags, Dr. Woo.
Dr. Woo: Sure. Unfortunately, this is the biggest challenge to detecting gastric cancer in its early stages is its lack of specific symptoms for gastric cancer. In early stage of gastric cancer, 80% of our patients are asymptomatic or have symptoms that are non-specific. For example nausea, abdominal pain, discomfort, or reflux symptoms of heartburn – these are all nonspecific symptoms that you cannot attribute specifically to gastric cancer. Unfortunately, the concerning symptoms of gastric cancer of significant weight loss, persistent abdominal pain, feeling full with eating very little, loss of appetite, feeling like something is getting stuck in your throat like dysphagia--these symptoms do not occur that often. They may persist less than 3 months and it takes, sometimes, up to 3 to 12 months of these symptoms persisting for the patient or even the physician to feel that there is something going on in the stomach. It may be not addressed in an appropriate manner because the symptoms are non-specific.
Melanie: So, how is it diagnosed then?
Dr. Woo: Sure. The gold standard for diagnosing gastric cancer is with an upper endoscopy and a biopsy of any abnormalities in the inner lining of the stomach for analysis of cancer cells. An upper endoscopy is performed by a gastroenterologist with a scope. I think most patients are familiar with a colonoscopy. However, this is a scope that is introduced through your mouth that goes into your esophagus, evaluates the stomach lining and can see any mucosal abnormalities. If there is such abnormality, than the gastroenterologist will take a biopsy of these areas and it will be tested for histological evaluation to look for cancer cells or pre-malignant cells. There is no blood test to diagnose gastric cancer or a serum biomarker for gastric cancer detection. This is one of the limitations that we have. Decreased levels of red blood cells in our body called “anemia” can be a sign of G.I. cancers, including gastric cancer. It may lead our physicians to have our patients get an upper endoscopy. There are no specific physical signs of gastric cancer until its late stages. The diagnosis can be made only by an upper endoscopy and a biopsy.
Melanie: So, Dr. Woo, once the cancer has been diagnosed and staged, there must be a lot to think about when considering these treatments. Speak about the first treatment – first line of defense--and then go into how a listener would, or a patient, would deal with this type of cancer as a different normal.
Dr. Woo: Sure. The diagnosis of gastric cancer for most of our patients and their families can be devastating but there are absolutely treatment options for gastric cancer. Gastric cancer is curable in its early stages and in locally advanced gastric cancer when cancer has maybe gone through some of the lining of the stomach wall and spread to the lymph nodes in the region, is also curable but, at that point, will require a multi-modality treatment. For early stage gastric cancer that is confined to the inner lining of the stomach, it’s surgically curable. I want people to understand that in its early stages, gastric cancer is curable and 95% of the patients can live a normal life without cancer even with the diagnosis of gastric cancer. However, locally advanced gastric cancer that involves the stomach and sometimes its draining lymph nodes will require a multi-modality treatment. This means that, for the best available treatment options we need to combine surgery, the most proper surgery--that is the removal of the stomach, its cancer in the stomach and the lymph nodes that drain the stomach. And then, combine that with systemic treatments such as chemotherapy and, at times, radiation treatment. It is very important that each patient that comes and is diagnosed with gastric cancer be evaluated completely and meet with, not just the surgeons, but the medical oncologists and the radiation oncologists and some of the support staff that we have to create a comprehensive treatment plan from the beginning so that the patient and the family know exactly what is expected in terms of their treatment and what the best strategy is to ensure long life without cancer and the best quality of life. There are many different options that can be provided to the patient and their families in terms of the surgical approach, the different types of chemotherapy and when and how all these are combined to give them the best outcome.
Melanie: What about life after stomach cancer treatments? Is there a big change in diet? What’s the quality of life left? We don’t have a lot of time but speak about the quality of life.
Dr. Woo: Sure. After the stomach surgery that is required for removal of the cancer and for cure, requires that we remove either two-thirds of the stomach or the entire stomach. Many patients ask me “How can I live without a stomach?” and “How will it affect my life afterwards?” People can live without the stomach very, very well. The stomach function can be eliminated and be taken over by other parts of the G.I. tract. The stomach is not required for life. However it is a major component of the way we enjoy our food and how our nutrition is processed. After surgery, patients will have to change their eating habits. When patients change their eating habits, it also changes the way they think about food and how they socialize with family and friends. Smaller portions must be taken in at each meal. They have to eat multiple meals a day and it will take about 3-6 months up to a year to adjust to the changes that occur. Patients will lose at least 10% of their body weight initially from the stress of surgery but also from having taken in less calories. Much more attention needs to be taken in evaluating what kind of foods that we eat--the calories, the content – higher proteins, higher fat content, less of sugar. Sugar is really bad for cancer. Also, this nutritional support that we give to our patients is necessary in terms of guidance and counseling over time. This is one of the biggest challenges. To maintain your body weight and actually maintain good body weight with higher muscle mass, it also requires that patients exercise and keep up energy because surgery and chemotherapy can make patients very tired and fatigued from the treatments.
Melanie: Dr. Woo, please wrap it up for us. This such important information. Tell us what is exciting at City of Hope and why patients should come there for their care.
Dr. Woo: Sure. Treatment for gastric cancer at City of Hope is amazing as I am a part of a multidisciplinary team. We are here to provide the best available treatment in the most timely manner. It includes personalized treatment, patient tailored, involving all our resources of medical oncology, radiation oncology. All the, research that is being done for gastric cancer on campus, we hope to bring to our patients. In practice there are a couple of things that we do very well here. Other than the multidisciplinary therapy, one of the strategies that we will create for every individual patient and their family members robotic surgery for surgically resectable gastric cancer patient. Robotic surgery is performed in less than 2.5%-5% of the time for gastric cancer in the United States. It’s a novel innovative approach to gastric cancer patients. It affords them the benefit of minimally invasive approach which is early return to normal life, meaning less pain after surgery; early ability to eat faster than open operation; patients go home sooner. There is much less blood loss during the operation. We are here to provide the best surgical outcome for our patients and one of the methods that we are using is new technology and innovation in robot surgical platforms. We have some clinic trials that are going on here at the City of Hope. One is for diagnosis of patients with HER2 positive disease using a novel radio tracer tagged to an antibody for HER2, which is a PET imaging study. Lastly, multiple new targeted antibody therapies for more advanced gastric cancer patients. One of the most exciting things that we are doing here in terms of research is novel treatments using vironcolytic therapy to target gastric cancer advancements--metastatic gastric cancer--or diseases that have spread beyond the stomach to the peritoneum and the liver. These are in pre-clinical studies meaning they’re not in humans right now but we hope in the next couple of years, it will get to helping cure and care for our gastric cancer patients.
Melanie: Wow. Thank you so much for being with us. Such great information, Dr. Woo. Thank you so much. You’re listening to City of Hope Radio and for more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.
The Latest Treatments for Stomach Cancer
Melanie Cole (Host): If you’ve been diagnosed with gastric cancer or a pre-cancerous condition in the stomach, City of Hope is a recognized leader in stomach cancer treatment and research. Gastric cancer patients receive unsurpassed diagnostic treatment and supportive care from our multidisciplinary team. The primary goal is to ensure that every patient and their loved ones can live a life free of gastric cancer. My guest today is Dr. Yanghee Woo. She’s a world renowned stomach cancer specialist at City of Hope. Welcome to the show, Dr. Woo. Tell us about the incidence of stomach cancer.
Dr. Yanghee Woo (Guest): Stomach cancer is an uncommon cancer in the United States. It’s about 26,000 patients who are diagnosed each year with stomach cancer. However, in the world, there are about a million patients diagnosed each year with gastric cancer and it is the third leading cause of cancer deaths. In the United States it is the eighth leading cause of cancer deaths and less than 25% of patients who are diagnosed with gastric cancer in the United States survive five years. So, it is a deadly cancer for some patients who are diagnosed with late stages. Unfortunately, diagnosing gastric cancer in its early stages is a major challenge.
Melanie: Tell us some of the risk factors. Who is at risk for this type of cancer?
Dr. Woo: Sure. There are two general groups. Only 10% of the patients who develop gastric cancer have a genetic predisposition. The most well-known genetic predisposition is the CDH-1 gene which causes the hereditary diffused gastric cancer. However, other mutations are known like the BRCA 1 and 2 mutation does give you a predisposition to gastric cancer and if you have Lynch Syndrome, you’re also at a genetic risk for gastric cancer. However, 90% of gastric cancer patients do not have a known genetic risk. So, what are the risk factors? Many of the risk factors are modifiable. You can divide it into two categories: modifiable risk factors and non-modifiable risk factors. The modifiable risk factors, obviously, include a long standing infection with H. pylori. H. pylori is a bug that grows and lives in your stomach and can put you at anywhere between 3-12 times risk of developing gastric cancer over a long period of time. Smoking is also a risk factor for developing gastric cancer as it is a risk factor for many cancers. Men are twice as likely to develop gastric cancer or be diagnosed with gastric cancer than women. The average age of diagnosis of gastric cancer in the United States is in the late 60’s, which is different from other countries and, depending on the ethnic minority groups, the incidence actually differs. You are at a higher risk of developing gastric cancer if you are a Korean American, Asian American, African American or Hispanic American compared to other non-Hispanic whites.
Melanie: People hear stomach cancer. It’s a very scary diagnosis. Are there some symptoms? Patients always want to know what symptoms they might pay attention to that would send up red flags, Dr. Woo.
Dr. Woo: Sure. Unfortunately, this is the biggest challenge to detecting gastric cancer in its early stages is its lack of specific symptoms for gastric cancer. In early stage of gastric cancer, 80% of our patients are asymptomatic or have symptoms that are non-specific. For example nausea, abdominal pain, discomfort, or reflux symptoms of heartburn – these are all nonspecific symptoms that you cannot attribute specifically to gastric cancer. Unfortunately, the concerning symptoms of gastric cancer of significant weight loss, persistent abdominal pain, feeling full with eating very little, loss of appetite, feeling like something is getting stuck in your throat like dysphagia--these symptoms do not occur that often. They may persist less than 3 months and it takes, sometimes, up to 3 to 12 months of these symptoms persisting for the patient or even the physician to feel that there is something going on in the stomach. It may be not addressed in an appropriate manner because the symptoms are non-specific.
Melanie: So, how is it diagnosed then?
Dr. Woo: Sure. The gold standard for diagnosing gastric cancer is with an upper endoscopy and a biopsy of any abnormalities in the inner lining of the stomach for analysis of cancer cells. An upper endoscopy is performed by a gastroenterologist with a scope. I think most patients are familiar with a colonoscopy. However, this is a scope that is introduced through your mouth that goes into your esophagus, evaluates the stomach lining and can see any mucosal abnormalities. If there is such abnormality, than the gastroenterologist will take a biopsy of these areas and it will be tested for histological evaluation to look for cancer cells or pre-malignant cells. There is no blood test to diagnose gastric cancer or a serum biomarker for gastric cancer detection. This is one of the limitations that we have. Decreased levels of red blood cells in our body called “anemia” can be a sign of G.I. cancers, including gastric cancer. It may lead our physicians to have our patients get an upper endoscopy. There are no specific physical signs of gastric cancer until its late stages. The diagnosis can be made only by an upper endoscopy and a biopsy.
Melanie: So, Dr. Woo, once the cancer has been diagnosed and staged, there must be a lot to think about when considering these treatments. Speak about the first treatment – first line of defense--and then go into how a listener would, or a patient, would deal with this type of cancer as a different normal.
Dr. Woo: Sure. The diagnosis of gastric cancer for most of our patients and their families can be devastating but there are absolutely treatment options for gastric cancer. Gastric cancer is curable in its early stages and in locally advanced gastric cancer when cancer has maybe gone through some of the lining of the stomach wall and spread to the lymph nodes in the region, is also curable but, at that point, will require a multi-modality treatment. For early stage gastric cancer that is confined to the inner lining of the stomach, it’s surgically curable. I want people to understand that in its early stages, gastric cancer is curable and 95% of the patients can live a normal life without cancer even with the diagnosis of gastric cancer. However, locally advanced gastric cancer that involves the stomach and sometimes its draining lymph nodes will require a multi-modality treatment. This means that, for the best available treatment options we need to combine surgery, the most proper surgery--that is the removal of the stomach, its cancer in the stomach and the lymph nodes that drain the stomach. And then, combine that with systemic treatments such as chemotherapy and, at times, radiation treatment. It is very important that each patient that comes and is diagnosed with gastric cancer be evaluated completely and meet with, not just the surgeons, but the medical oncologists and the radiation oncologists and some of the support staff that we have to create a comprehensive treatment plan from the beginning so that the patient and the family know exactly what is expected in terms of their treatment and what the best strategy is to ensure long life without cancer and the best quality of life. There are many different options that can be provided to the patient and their families in terms of the surgical approach, the different types of chemotherapy and when and how all these are combined to give them the best outcome.
Melanie: What about life after stomach cancer treatments? Is there a big change in diet? What’s the quality of life left? We don’t have a lot of time but speak about the quality of life.
Dr. Woo: Sure. After the stomach surgery that is required for removal of the cancer and for cure, requires that we remove either two-thirds of the stomach or the entire stomach. Many patients ask me “How can I live without a stomach?” and “How will it affect my life afterwards?” People can live without the stomach very, very well. The stomach function can be eliminated and be taken over by other parts of the G.I. tract. The stomach is not required for life. However it is a major component of the way we enjoy our food and how our nutrition is processed. After surgery, patients will have to change their eating habits. When patients change their eating habits, it also changes the way they think about food and how they socialize with family and friends. Smaller portions must be taken in at each meal. They have to eat multiple meals a day and it will take about 3-6 months up to a year to adjust to the changes that occur. Patients will lose at least 10% of their body weight initially from the stress of surgery but also from having taken in less calories. Much more attention needs to be taken in evaluating what kind of foods that we eat--the calories, the content – higher proteins, higher fat content, less of sugar. Sugar is really bad for cancer. Also, this nutritional support that we give to our patients is necessary in terms of guidance and counseling over time. This is one of the biggest challenges. To maintain your body weight and actually maintain good body weight with higher muscle mass, it also requires that patients exercise and keep up energy because surgery and chemotherapy can make patients very tired and fatigued from the treatments.
Melanie: Dr. Woo, please wrap it up for us. This such important information. Tell us what is exciting at City of Hope and why patients should come there for their care.
Dr. Woo: Sure. Treatment for gastric cancer at City of Hope is amazing as I am a part of a multidisciplinary team. We are here to provide the best available treatment in the most timely manner. It includes personalized treatment, patient tailored, involving all our resources of medical oncology, radiation oncology. All the, research that is being done for gastric cancer on campus, we hope to bring to our patients. In practice there are a couple of things that we do very well here. Other than the multidisciplinary therapy, one of the strategies that we will create for every individual patient and their family members robotic surgery for surgically resectable gastric cancer patient. Robotic surgery is performed in less than 2.5%-5% of the time for gastric cancer in the United States. It’s a novel innovative approach to gastric cancer patients. It affords them the benefit of minimally invasive approach which is early return to normal life, meaning less pain after surgery; early ability to eat faster than open operation; patients go home sooner. There is much less blood loss during the operation. We are here to provide the best surgical outcome for our patients and one of the methods that we are using is new technology and innovation in robot surgical platforms. We have some clinic trials that are going on here at the City of Hope. One is for diagnosis of patients with HER2 positive disease using a novel radio tracer tagged to an antibody for HER2, which is a PET imaging study. Lastly, multiple new targeted antibody therapies for more advanced gastric cancer patients. One of the most exciting things that we are doing here in terms of research is novel treatments using vironcolytic therapy to target gastric cancer advancements--metastatic gastric cancer--or diseases that have spread beyond the stomach to the peritoneum and the liver. These are in pre-clinical studies meaning they’re not in humans right now but we hope in the next couple of years, it will get to helping cure and care for our gastric cancer patients.
Melanie: Wow. Thank you so much for being with us. Such great information, Dr. Woo. Thank you so much. You’re listening to City of Hope Radio and for more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.