Stomach Cancer (cont.)

MEMBER QUESTION:
I have reflux caused from a hiatal hernia. Should I be concerned about possibly getting stomach cancer?

MACDONALD:
That's also a good question. There is one form of stomach cancer and lower esophageal cancer (and that means the lower part of the esophagus where it attaches to the stomach) that appears to be associated with reflux. That's called an adenocarcinoma of the distal esophagus and proximal stomach. Some of these patients have had a history of reflux symptoms of gastritis and esophagitis. They frequently undergo endoscopy to monitor the condition of the reflux and sometimes tumors are detected.

MEMBER QUESTION:
I was diagnosed with GERD and have been taking Prilosec for approximately eight years. I was on Pepcid for eight or nine years before that. My question pertains to pain in my stomach about 6 inches below the breast bone. I have it every day and it is much worse after eating. Recently even small amounts of food will cause pain and I feel very full for a long time, with a lot of nausea. I have talked to my primary care doctor several times and all she wants to do is switch the Prilosec for something else, which I have done a few times already. The pills help with the heartburn but not the other symptoms. I am F/43/280 lbs/5'7" and always trying to lose weight. Should I be checked for stomach cancer?

MACDONALD:
It would be quite helpful for someone with your symptoms to have an upper endoscopy, which is, of course, a scope being passed down into the stomach so a doctor can see the symptoms of what is causing the difficulty in eating and the persistent pain in the upper area of the stomach and/or esophagus. People who have chronic GERD can sometimes develop something called Barrett's esophagus , which is a change in the lining of the esophagus that can make cancer more likely. So having an upper endoscopy would probably be a wise thing to do.

MEMBER QUESTION:
My concern is that two of my relatives have had this cancer and it seems that by the time it is found it is too late. Is it that it cannot be detected, the symptoms are not understood too well or that people wait?

MACDONALD:
I think all those things can be true in regard to stomach cancer. Because it is relatively uncommon, it's not one of the first things that either the patient or doctor would think of, and many of the symptoms, intermittent change in appetite for example, or change of weight loss, are nonspecific and don't direct the patient or doctor to think of stomach cancer as the cause.

Now with relatives with stomach cancer, it's important to be sure whether or not the patient had gastric carcinoma or some other tumor in the abdomen. Frequently family members will say something like my mother died of stomach cancer and in a sense that was true, but the tumor was not a gastric carcinoma but rather a tumor that occurred in the abdomen from some other organ, like the liver or pancreas. It's important that the family member had gastric carcinoma and indeed, not some other form of cancer.

MEMBER QUESTION:
I understand stomach cancer to be rare, but often fatal. What are the options if you are diagnosed?

MACDONALD:
The primary treatment of stomach cancer is to surgically remove the portion of the stomach with the cancer in it. If you can do that you have the potential of curing the patient. If a patient's stomach cancer has already spread to the point where it can't be completely removed surgically, the vast majority of those patients have incurable cancer. People with advanced stomach cancer that has spread to other organs can be helped with chemotherapy and can live longer because of chemotherapy, but cannot be cured.

"The primary treatment of stomach cancer is to surgically remove the portion of the stomach with the cancer in it. If you can do that you have the potential of curing the patient."

MEMBER QUESTION:
What's involved in a gastrectomy?

MACDONALD:
The total gastrectomy means the surgeon completely removes the stomach. He or she cuts the stomach off at the lower esophagus and at the lower end of the stomach or the duodenum. The stomach is therefore completely removed and a small pouch is surgically produced from the bowel to become a new stomach. Partial gastrectomy is an operation in which only part of the stomach with the tumor is removed and not the whole stomach.

MEMBER QUESTION:
My brother was diagnosed with stomach cancer in November 2004 after severe bleeding from his mouth. He underwent complete gastrectomy on December 12, 2004. The tumor grew though the stomach wall and penetrated into surrounding fat layer. In addition, eight lymph nodes were removed and three of those turned out to be involved. He was told that his cancer is at stage 3. He is undergoing a fairly standard preventive chemotherapy plus radiation treatment. My brother still has two more sessions of chemo (the next will start in a couple days). From what I read, the chances of complete remission with the treatment that my brother is getting are pretty low, and I want to find out whether more targeted and successful treatments are available.

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