Gastric Cancer


Esophageal and gastric cancers are occurring with increasing frequency in the United States. Risk factors for both cancers include smoking, alcohol, and a history of gastritis or reflux disease.

Presenting symptoms for cancers of the esophagus and stomach can include dysphagia (difficulty swallowing due to pain or obstruction), nausea, vomiting, hemetemesis (vomiting blood), and weight loss. Patients who have any of the above symptoms should notify their physicians so that further evaluation can ensue.

The diagnosis of esophageal or gastric carcinoma is usually made with an upper endoscopy. This is when a camera is introduced into the esophagus and beyond into the stomach. Any abnormalities in the mucosa can be biopsied at the time of endoscopy. The two main cell types of esophageal cancer include squamous cell carcinoma and adenocarcinoma. Most gastric cancers are adenocarcinomas.

Once a diagnosis of esophageal or gastric cancer is made great efforts must be made to properly stage the cancer. Staging studies often include an Endoscopic Ultrasound (EUS), PET/CT scan, and sometimes an MRI to establish surgical respectability.

Appropriate treatment for a new diagnosis of esophageal cancer depends on a number of factors including size and location of the primary tumor, presence of metastases to lymph nodes or other organs, and the general health of the patient.

Very early tumors with no spread to lymph nodes can be treated with surgery alone. It is very important, however, that extensive staging studies be performed prior to surgery to avoid operating on more advanced tumors that are not going to be cured with surgery alone.

More advanced tumors are often treated with a combination of chemotherapy and radiation followed by a re-evaluation for surgical resectability.

A course of radiation for esophageal or gastric cancer generally lasts between 5 and 7 weeks and is usually given with concurrent chemotherapy. Side effects of radiation for esophageal or gastric cancer include pain or burning with swallowing, swelling of the esophagus causing obstruction, nausea, vomiting, upper abdominal pain, and weight loss.

Due to the expected symptoms making it difficult to maintain nutrition, the treating radiation oncologist may recommend placement of a feeding tube into the stomach prior to or during treatment to avoid malnutrition and weight loss. Your radiation oncologist and medical oncologist will monitor your symptoms and nutritional status closely during the course of treatment and prescribe medications as needed.