Stomach cancer is less common in the U.S. than it used to be — that’s the good news. The catch is when stomach or gastric cancer occurs, it’s often not caught until it’s dangerously advanced. Unlike breast cancer or colon cancer, there’s no routine screening for stomach cancer. People can overlook or dismiss subtle symptoms and delay seeing a doctor.
More than 26,000 Americans will develop stomach cancer this year, according to the Centers for Disease Control and Prevention. Once cancer begins to spread, survival rates are roughly 30 percent at five years, although each patient is different. Here’s what you should know about recognizing and preventing stomach cancer, and what’s being done to expand research and improve outcomes:
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
“People should be on the alert because signs and symptoms are vague,” says Debbie Zelman, founder of Debbie’s Dream Foundation: Curing Stomach Cancer. Eight years ago she learned she had stage 4 stomach cancer. “I didn’t have any pain,” she says. “I just had trouble swallowing — I’d feel like something was getting stuck. I had black, tarry stools, which people don’t know means you have blood in your stool.”
Unexpected weight loss is another clue to stomach cancer, Zelman notes. “So we should all get checked out,” she says. “Be an advocate for yourself, and go seek out medical attention.”
Bacterial infection is often the culprit behind stomach cancer, says Dr. Raymond Wadlow, a medical oncologist with a specialty in gastrointestinal cancer. The bacteria, called Helicobacter pylori, are commonly found in the lining of the stomach. H. pylori is a major risk factor for peptic ulcers and is a carcinogen. About two-thirds of the world’s population harbors H. pylori, according to the CDC.
Most people infected with H. pylori do not go on to develop stomach cancer. However, it’s possible a recent rise in stomach cancer rates among young adults — specifically young Hispanics and other minorities — could be due to higher rates of H. pylori infection, says Wadlow, who is with Virginia Cancer Specialists, part of The US Oncology Network.
“If people have symptoms of acid reflux or certainly symptoms of abdominal pain, they should see their gastroenterologist,” Wadlow says. Evidence of blood loss is another red flag. “When you bleed in the stomach, blood in the stool commonly doesn’t look bright red,” he says. Instead, people report maroon or black, tarry stools, called melena. “Or they can bleed microscopically, so you can’t really see it all.”
Anemia symptoms, such as pale skin tone, light-headedness, shortness of breath and fatigue are also telling signs. If treatment doesn’t relieve symptoms, Wadlow says, patients should undergo an endoscopy exam.
“If the endoscopy reveals evidence of inflammation, tests are done to look for infection with H. pylori,” he says. “And if it’s caused in an early stage, it can definitely be treated and eradicated.”
[See: 7 Reasons to Choose a Plant-Based Diet.]
Older adults and men are at higher risk for stomach cancer. African-Americans, Asian-Americans and Hispanics also face greater risk than whites. One rare form of stomach cancer, called diffuse-type gastric cancer, is genetic. Smoking is a well-established factor for stomach cancer (as well as other types of cancer). Heavy daily drinking, eating red and processed meats and obesity all contribute to higher risk.
In April, the World Cancer Research Fund International made recommendations to lower stomach cancer risk, such as being physically active, keeping a healthy weight, drinking little or no alcohol and eating more grains, vegetables, fruits and beans. Limiting red meat is another recommendation — in particular, avoiding processed meats.
“There’s no doubt that certain foods with nitrates, so things in cured meats — bacon, salami, hot dogs, that kind of stuff — increase the risk of gastric cancer,” Wadlow says. The latest U.S. Dietary Guidelines address food choices for cancer prevention.
When Zelman was diagnosed in 2008, she was dismayed by stagnant treatment options. “It was the realization that, ‘Oh, my goodness — this is the newest treatment you have?'” she says. “And it’s 30 years old. And it’s the standard chemotherapy that has been around for decades.”
In 2009, Zelman started her foundation to help fund research, improve diagnosis and speed up development of more effective treatments.
There have been advances. Studies are looking at immunotherapy drugs called “monoclonal antibodies,” like pembrolizumab , to treat advanced stomach cancer. In February, immunotherapy was named the 2016 Advance of the Year by the American Society of Clinical Oncology.
“One of the things that allows a cancer to become a cancer is that it disguises itself from the immune system,” Wadlow explains. “Specifically, the T-cells, the T-lymphocytes of the immune system. And immunotherapy basically takes the brakes off by uncovering the cancer cells — removing the disguise, so to speak, so that the circulating T-cells become again aware that cancer cells are foreign and they can be recognized as such and eliminated.”
Some of the investigational drugs have shown early promising data, Wadlow says, with “moderate to significant activity” for some study patients.
Targeted treatment for a specific type of stomach cancer is “probably the most significant advancement in recent years,” says Dr. Edith Mitchell, a clinical professor of medicine and medical oncology at Thomas Jefferson University and director of the Center to Eliminate Cancer Disparities at Sidney Kimmel Cancer Center.
Stomach cancers with increased levels of a protein called HER2 can now be identified by pathology and treated with a monoclonal antibody called trastuzumab, or Herceptin, she says. The American Cancer Society explains how targeted treatments work.
Mitchell is a member of the blue-ribbon panel for the Cancer Moonshot. Launched in January by the Obama administration and supported by the National Cancer Institute, the goal of Moonshot is to accelerate cancer research.
[See: 7 Health Risks of Binge-Drinking.]
“It’s really very important that research continues and actually should increase in the whole spectrum of the treatment of the patient with gastric cancer,” Mitchell says. “That involves identification of individuals at high risk, preventive strategies, early detection and diagnosis, treatment and therapeutic interventions, and the care of the patient post-treatment as well as survivorship research.”
Zelman, who is now on immunotherapy, continues to lead Debbie’s Dream Foundation’s efforts to improve outcomes for others with stomach cancer. “I am eight years out , and I’m a patient every day,” she says. “So I’m having a recurrence now. And how am I doing? I tell people, ‘I’m here. So I’m happy that I’m here.’ But every day is a struggle.”
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Stomach Cancer: Awareness and Advances Needed originally appeared on usnews.com
