Diseases and Disorders
Although the incidence of gastric cancer is declining, it is still a major problem with over 21,000 individuals diagnosed with the disease in 2011. The typical gastric cancer is an adenocarcinoma, similar to esophageal cancer. Over the decades true gastric cancer has continued to decline but cancers of the junction between the esophagus and stomach are increasing. These latter tumors appear to be more similar to esophageal cancers rather than true gastric cancer.
- Extensive experience in the management of gastric cancer with one of the largest volumes in the region
- Tailoring the operation to the individual patient’s circumstances
- Unique surgical approaches such as minimally invasive surgery when appropriate
- Endoscopic therapy for early cancers
- High-volume referral center with knowledgeable thoracic surgeons, nurses, and staff that directly translates into superior outcomes
- Access to multidisciplinary care through Norris Cancer Center with expert oncologists with experience in the adjuvant treatment of gastric cancer
Mechanism of Disease
Gastric adenocarcinoma is associated with chronic infection of the stomach by a bacterium known as Helicobacter pylori. This infection does not cause major symptoms, and most people do not know they have it. It is extremely common in developing countries around the world, but has become less prevalent in Western countries as the quality of water and food have improved. Moreover, certain types of food are associated with greater risk for gastric cancer, such as pickled or salted and cured foods.
The symptoms of gastric cancer are nonspecific. Patients can experience getting full more easily, loss of weight, and anemia. The main modality of diagnosis is upper endoscopy and biopsies. USC thoracic surgeons typically perform the endoscopy themselves in order to assess how much of the stomach is involved for surgical planning.
Once the diagnosis of gastric cancer is made, the next step is staging, or determining the extent of disease. This is typically done with a CT scan, which will show whether the tumor has spread to other areas of the body.
The mainstay of therapy of gastric cancer is complete surgical resection. The amount of stomach removed depends on the size and location of the tumor. Surgery also removes as much of the lymph node tissue surrounding the stomach as possible to remove all potential regional sites of tumor spread and maximize the chance of cure. The alimentary tract is reconstructed with use of the small intestine.[FIGURE] When appropriate, minimally invasive techniques may be applied for the operation.
Chemotherapy is often combined with surgery in the treatment of gastric cancer. The utilization of chemotherapy is selective, and may be used before or after surgery. On occasion, radiation therapy may also be necessary. The decision to use multiple modes of therapy is personalized and based on the stage of the cancer and the results of the endoscopy, CT scan, or pathology of the surgical specimen. The thoracic surgeons at USC play a very active role in determining the use of these therapies and communicate directly with the oncologists in order to coordinate the best treatment plan for the patient.
One of the major principles of gastric cancer surgery is to adequately remove the lymph nodes surrounding the stomach. Because USC thoracic surgeons are experienced in this regard due to the treatment of esophageal cancer, this area of the operation is not compromised. Multiple studies have shown that a more extensive lymph node dissection results in improved survival.