Stomach cancer is a disease in which cancer cells grow in the stomach. It is also called gastric cancer.
The most common type of stomach cancer is called adenocarcinoma.
Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach.
The most common type is also known as adenocarcinoma.
Board-certified medical oncologist and hematologist, Joseph Chao, MD is here to explain the diagnoses and possible treatments available for these cancers.
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The Latest Research for Stomach and Esophageal Cancer
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Dr. Chao earned his medical degree at the University of Illinois at Chicago, then continued his training at Harbor-UCLA Medical Center.
Named one of the “Top Doctors” for oncology by Pasadena magazine in 2011, Dr. Chao is among the first medical professionals to be certified by City of Hope's STAR (Survivorship, Training, and Rehabilitation) program which ensures our patients receive the most up-to-date, evidence based rehabilitation services available.
Learn more about Joseph Chao, M.D
Joseph Chao, MD
A Board-certified medical oncologist and hematologist, Joseph Chao, M.D. Joined City of Hope in 2007 as a Fellow and advanced rapidly to Staff Physician and Assistant Clinical Professor.Dr. Chao earned his medical degree at the University of Illinois at Chicago, then continued his training at Harbor-UCLA Medical Center.
Named one of the “Top Doctors” for oncology by Pasadena magazine in 2011, Dr. Chao is among the first medical professionals to be certified by City of Hope's STAR (Survivorship, Training, and Rehabilitation) program which ensures our patients receive the most up-to-date, evidence based rehabilitation services available.
Learn more about Joseph Chao, M.D
Transcription:
The Latest Research for Stomach and Esophageal Cancer
Melanie Cole (Host): More than 18,000 Americans are diagnosed with esophageal cancer each year and timely diagnosis and intervention can make a dramatic difference in improving survival odds and quality of life. My guest today is Dr. Joseph Chao. He's an assistant clinical professor in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Chao. Tell us about esophageal and stomach cancer. Who is at risk for these?
Dr. Joseph Chao (Guest): There are so many know epidemiologic risk factors such as, obesity, chronic gastroesophageal reflux, smoking and alcohol are certainly also well-known risk factors for esophageal cancer development. Then, related to stomach cancer, there's h pylori, which is actually a bacterial infection can be related to dietary exposure and factors, but at least the latter in terms of h pylori it has reduced due to better refrigeration and food preservation. These are well-known risk factors for both esophageal and stomach cancer involvements.
Melanie: What are the symptoms? These kinds of cancers affect the quality of life so much. People are worried about disfigurement, if they have to have surgery; and eating something, of course; and talking. So, tell us about symptoms that people might notice that would send them to see you in the first place.
Dr. Chao: So, if I think, what we would call dysphagia, difficulty with swallowing, having food go down, that certainly would be symptoms in which you should seek a medical professional for evaluation. Involuntary weight loss, in spite of trying to eat normally and regularly. Unfortunately, at least in the United States, there are no effective screening programs for detection of early stage esophageal and stomach cancer. As long as you are very mindful as far as symptoms of ongoing gastroesophageal reflux in spite of taking antacids or proton pump inhibitors, such as Prilosec or Prevacid--ongoing symptoms. Then, certainly if you're a male above the age of 50, those will all be things in which you should be prompted to undergo an endoscopy by an gastroenterologist to have work ups to ensure that there isn't esophageal or stomach cancer responsible for ongoing symptoms.
Melanie: Now, you mentioned screening and endoscopy and, just as colonoscopy is preventive screening for colon cancer, do you envision a day when endoscopy is going to be considered part of a well screening to look for these?
Dr. Chao: So, not necessarily endoscopy in its current form. The issue with that is due to still, thankfully in many ways, esophageal and stomach cancers being lower in incidence in the United States versus other countries outside of the United States, such as in Asia, in which there's actually a much higher incidence of stomach and esophageal cancer in which public health screening programs are very cost-effective. There actually are a lot of novel endoscopic approaches being looked at to try and, essentially, increase the cost effectiveness for screening. So, hopefully, as these approaches are better developed, also better detection of, potentially even DNA changes at an early stage in your normal esophagus and stomach, hopefully, measures can lead to more effective screening strategies. So, yes, it will be then implemented regularly to allow for us to find earlier stage diseases as opposed to a lot of times, currently, cancers being presented at late stages.
Melanie: What happens if someone is diagnosed with one of these types of cancers? What is the outlook, or prognosis? Do they, then, have to be worried about being able to eat or talk or all of these kinds of quality of life issues?
Dr. Chao: So, it definitely depends in terms of the stage of the cancer that's found. If it's an early stage cancer, prognosis actually can still be very good with a combination of chemotherapy and sometimes radiation therapy, but most importantly, surgery for early stage esophageal and stomach cancers. So, speaking really isn't something that should be affected, but, yes, eating definitely. In terms of having part of your esophagus removed or your stomach removed, there can be adjustments made in terms of eating more frequent, smaller meals. Also, in terms of insuring that you’re staying hydrated. There certainly are measures that can be taken to adjust for the surgical outcomes in terms of having your stomach and esophagus removed. With time, after surgery to remove your stomach, things do re-expand in terms of if there's a remnant stomach left over and long-term quality of life actually still can be maintained. Actually, there's also a lot of research trying to look at long-term quality of life outcomes.
Melanie: If someone is subject to Barrett's Esophagus, is this a pre-cursor for this type of cancer?
Dr. Chao: So, Barrett's, yes. It is certainly known to be a pre-cursor for esophageal cancer, though not every case of esophageal adenocarcinoma is necessarily due to Barrett's, and, actually, still a very small proportion of Barrett's does develop into esophageal cancer. So, certainly there are approaches to ablate a Barrett's to try and prevent early stage disease or prevent progression into cancer. So, actually that is part of the screening efforts for esophageal cancer.
Melanie: Dr. Chao, tell us about Precision Medicine Initiative and how does this have to do with cancer and the treatments you provide at City of Hope.
Dr. Chao: Because of, unfortunately, a lot of cases of esophageal and stomach cancer being at late stages, Stage IV, usually that eliminates surgery as being an effective treatment option. So, we are mainly looking at chemotherapy. We are also finding out with cancers in general, not every single cancer is exactly the same. You know, we have the tools now to really look at every cancer in terms of their respective genetic code, their DNA mutations. We know that cancer is a disease, in terms of gene mutation, that leads to abnormal growth of cancer cells. So, in terms of being able to look at the genetic code, there actually are many different target therapies that can essentially go after a certain genetic alteration in the cancer. Actually, there is precision medicine being practiced at the moment for esophageal and stomach cancer with targeting of this gene called HER2. So, the latter is actually a gene that was initially discovered to be very important in breast cancer treatments, so a lot of the drugs used in breast cancer, targeted drugs such as Herceptin, actually have been found to be very effective in stomach and esophageal cancer. So, this is still only one targeted drug at the moment for stomach and esophageal cancer. We definitely want to continue to expand further on that and so actually in terms of the clinical trials that we have ongoing at City of Hope, we're looking at the genetic code of each person's individual cancer to then see, can we find a clinical trial that matches up to that genetic code of the cancer? And, essentially being more precise with our treatment.
Melanie: Is there a genetic component to these types of cancers?
Dr. Chao: So, in terms of known genetic, inherited mutations, it's still only a very small proportion, probably 1% of stomach cancers, in which we can point to a gene mutation. There is ongoing research to try and see if we can find more gene mutations that can be inherited and predispose someone to developing stomach and esophageal cancer. But, this is still, again, a very small proportion, but in terms of the genetic code of the cancer, I mean, there can be what we call "somatic mutations" in which, it's independent of the genes that you inherited. The big question is why do these changes happen in the first place? Those are also very important questions that we hope to address in future research studies.
Melanie: In the last few minutes, what's going on that's very exciting and gives hope to patients that have been diagnosed with esophageal or stomach cancer at City of Hope?
Dr. Chao: So, we are finding that immunotherapy, essentially trying to get your own immune system to attack the cancer. These are treatments that have already shown a lot of progress and improvement in the treatment and quality of life for patients with melanoma and lung cancer. There actually have been early studies in stomach and esophageal cancers in which these treatments seem to work as well for patients with Stage IV disease. The issue, though, is that still only a small proportion, maybe 10% or so, of patients in which it looks like these types of immunotherapies that are letting go of the brakes, so to speak, on the immune system to attack the cancer--it's still a very small proportion. So, if anything, ongoing research efforts are trying to see if we can harbor this treatment with the immune system in more than just 10% of our patients with Stage IV esophageal and stomach cancers. So, we are doing studies to try and see if we can find blood markers that may help predict for a response to these types of therapies. We're also in the process of planning a clinical trial to try and see if we can combine radiation treatment and immunotherapies to essentially bring out the immune system more against the cancer, and then, hopefully, get better quality of life and better survival for all our patients.
Melanie: That's absolutely fascinating, Dr. Chao, and I applaud all the great work that you're doing at City of Hope. Thank you so much for being with us today. 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 Research for Stomach and Esophageal Cancer
Melanie Cole (Host): More than 18,000 Americans are diagnosed with esophageal cancer each year and timely diagnosis and intervention can make a dramatic difference in improving survival odds and quality of life. My guest today is Dr. Joseph Chao. He's an assistant clinical professor in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Chao. Tell us about esophageal and stomach cancer. Who is at risk for these?
Dr. Joseph Chao (Guest): There are so many know epidemiologic risk factors such as, obesity, chronic gastroesophageal reflux, smoking and alcohol are certainly also well-known risk factors for esophageal cancer development. Then, related to stomach cancer, there's h pylori, which is actually a bacterial infection can be related to dietary exposure and factors, but at least the latter in terms of h pylori it has reduced due to better refrigeration and food preservation. These are well-known risk factors for both esophageal and stomach cancer involvements.
Melanie: What are the symptoms? These kinds of cancers affect the quality of life so much. People are worried about disfigurement, if they have to have surgery; and eating something, of course; and talking. So, tell us about symptoms that people might notice that would send them to see you in the first place.
Dr. Chao: So, if I think, what we would call dysphagia, difficulty with swallowing, having food go down, that certainly would be symptoms in which you should seek a medical professional for evaluation. Involuntary weight loss, in spite of trying to eat normally and regularly. Unfortunately, at least in the United States, there are no effective screening programs for detection of early stage esophageal and stomach cancer. As long as you are very mindful as far as symptoms of ongoing gastroesophageal reflux in spite of taking antacids or proton pump inhibitors, such as Prilosec or Prevacid--ongoing symptoms. Then, certainly if you're a male above the age of 50, those will all be things in which you should be prompted to undergo an endoscopy by an gastroenterologist to have work ups to ensure that there isn't esophageal or stomach cancer responsible for ongoing symptoms.
Melanie: Now, you mentioned screening and endoscopy and, just as colonoscopy is preventive screening for colon cancer, do you envision a day when endoscopy is going to be considered part of a well screening to look for these?
Dr. Chao: So, not necessarily endoscopy in its current form. The issue with that is due to still, thankfully in many ways, esophageal and stomach cancers being lower in incidence in the United States versus other countries outside of the United States, such as in Asia, in which there's actually a much higher incidence of stomach and esophageal cancer in which public health screening programs are very cost-effective. There actually are a lot of novel endoscopic approaches being looked at to try and, essentially, increase the cost effectiveness for screening. So, hopefully, as these approaches are better developed, also better detection of, potentially even DNA changes at an early stage in your normal esophagus and stomach, hopefully, measures can lead to more effective screening strategies. So, yes, it will be then implemented regularly to allow for us to find earlier stage diseases as opposed to a lot of times, currently, cancers being presented at late stages.
Melanie: What happens if someone is diagnosed with one of these types of cancers? What is the outlook, or prognosis? Do they, then, have to be worried about being able to eat or talk or all of these kinds of quality of life issues?
Dr. Chao: So, it definitely depends in terms of the stage of the cancer that's found. If it's an early stage cancer, prognosis actually can still be very good with a combination of chemotherapy and sometimes radiation therapy, but most importantly, surgery for early stage esophageal and stomach cancers. So, speaking really isn't something that should be affected, but, yes, eating definitely. In terms of having part of your esophagus removed or your stomach removed, there can be adjustments made in terms of eating more frequent, smaller meals. Also, in terms of insuring that you’re staying hydrated. There certainly are measures that can be taken to adjust for the surgical outcomes in terms of having your stomach and esophagus removed. With time, after surgery to remove your stomach, things do re-expand in terms of if there's a remnant stomach left over and long-term quality of life actually still can be maintained. Actually, there's also a lot of research trying to look at long-term quality of life outcomes.
Melanie: If someone is subject to Barrett's Esophagus, is this a pre-cursor for this type of cancer?
Dr. Chao: So, Barrett's, yes. It is certainly known to be a pre-cursor for esophageal cancer, though not every case of esophageal adenocarcinoma is necessarily due to Barrett's, and, actually, still a very small proportion of Barrett's does develop into esophageal cancer. So, certainly there are approaches to ablate a Barrett's to try and prevent early stage disease or prevent progression into cancer. So, actually that is part of the screening efforts for esophageal cancer.
Melanie: Dr. Chao, tell us about Precision Medicine Initiative and how does this have to do with cancer and the treatments you provide at City of Hope.
Dr. Chao: Because of, unfortunately, a lot of cases of esophageal and stomach cancer being at late stages, Stage IV, usually that eliminates surgery as being an effective treatment option. So, we are mainly looking at chemotherapy. We are also finding out with cancers in general, not every single cancer is exactly the same. You know, we have the tools now to really look at every cancer in terms of their respective genetic code, their DNA mutations. We know that cancer is a disease, in terms of gene mutation, that leads to abnormal growth of cancer cells. So, in terms of being able to look at the genetic code, there actually are many different target therapies that can essentially go after a certain genetic alteration in the cancer. Actually, there is precision medicine being practiced at the moment for esophageal and stomach cancer with targeting of this gene called HER2. So, the latter is actually a gene that was initially discovered to be very important in breast cancer treatments, so a lot of the drugs used in breast cancer, targeted drugs such as Herceptin, actually have been found to be very effective in stomach and esophageal cancer. So, this is still only one targeted drug at the moment for stomach and esophageal cancer. We definitely want to continue to expand further on that and so actually in terms of the clinical trials that we have ongoing at City of Hope, we're looking at the genetic code of each person's individual cancer to then see, can we find a clinical trial that matches up to that genetic code of the cancer? And, essentially being more precise with our treatment.
Melanie: Is there a genetic component to these types of cancers?
Dr. Chao: So, in terms of known genetic, inherited mutations, it's still only a very small proportion, probably 1% of stomach cancers, in which we can point to a gene mutation. There is ongoing research to try and see if we can find more gene mutations that can be inherited and predispose someone to developing stomach and esophageal cancer. But, this is still, again, a very small proportion, but in terms of the genetic code of the cancer, I mean, there can be what we call "somatic mutations" in which, it's independent of the genes that you inherited. The big question is why do these changes happen in the first place? Those are also very important questions that we hope to address in future research studies.
Melanie: In the last few minutes, what's going on that's very exciting and gives hope to patients that have been diagnosed with esophageal or stomach cancer at City of Hope?
Dr. Chao: So, we are finding that immunotherapy, essentially trying to get your own immune system to attack the cancer. These are treatments that have already shown a lot of progress and improvement in the treatment and quality of life for patients with melanoma and lung cancer. There actually have been early studies in stomach and esophageal cancers in which these treatments seem to work as well for patients with Stage IV disease. The issue, though, is that still only a small proportion, maybe 10% or so, of patients in which it looks like these types of immunotherapies that are letting go of the brakes, so to speak, on the immune system to attack the cancer--it's still a very small proportion. So, if anything, ongoing research efforts are trying to see if we can harbor this treatment with the immune system in more than just 10% of our patients with Stage IV esophageal and stomach cancers. So, we are doing studies to try and see if we can find blood markers that may help predict for a response to these types of therapies. We're also in the process of planning a clinical trial to try and see if we can combine radiation treatment and immunotherapies to essentially bring out the immune system more against the cancer, and then, hopefully, get better quality of life and better survival for all our patients.
Melanie: That's absolutely fascinating, Dr. Chao, and I applaud all the great work that you're doing at City of Hope. Thank you so much for being with us today. 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.