Tag Archive for: stomach cancer staging

Empowering Patients and Families Facing a Stomach Cancer Diagnosis

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Patient Empowerment Network (PEN) is committed to helping educate and empower patients and care partners in the gastric cancer (stomach cancer) community. Gastric cancer research and treatment options are evolving, and it’s essential for patients and families to educate themselves about clinical trials, risk factors, barriers to and disparities in care. With this goal in mind, PEN continues to build on to its [ACT]IVATED Gastric Cancer program, which aims to inform, empower, and engage patients to stay updated about the latest in gastric cancer care.

Gastric cancer awareness needs more visibility for multiple reasons. Gastric cancer incidence is higher in immigrant BIPOC groups as well as specific Asian, Hispanic, and other groups. And with research discoveries, screening guidelines need to be updated in the U.S.

PEN is proud to add information about gastric cancer to educate more patients and their families about this rising health concern. Cancer survivor Lisa Hatfield interviewed expert Dr. Jun Gong from Cedars-Sinai Medical Center and Dr. Joo Ha Hwang from Stanford Medicine as part of [ACT]IVATED Gastric Cancer.     

Gastric cancer patient Hoon also shared his personal journey with cancer, the HIPEC treatment he received after a recurrence, lessons learned, and his notable experience as how his journey began. “As a fit man at age 38, my symptoms started with stomach pains and bloating that wouldn’t go away. My primary care doctor prescribed antacids that worked temporarily until I stopped taking them. My doctor then ordered an endoscopy that revealed an ulcer. I felt emotional relief temporarily, but then I had a biopsy that showed cancer that was eventually diagnosed as stage IV gastric cancer after further testing. I thought to myself, how could this happen to me when I run 2 miles every day?”

Gastric Cancer Risk Factors

 Gastric cancer has strong links to risk factors for some certain population groups like Asian and Hispanic population groups, so it’s essential for patients to educate themselves about risk factors for early detection and treatment. Dr. Jun Gong from Cedars-Sinai Medical Center discussed a known risk factor for gastric cancer. “…there’s been growing evidence that H. pylori infection affects both Asians and Hispanics and is one of the more pivotal risk factors to address on a systematic level. Here, there have been ongoing research where they’re just identifying H. pylori as a procedure and eradicating it with treatment.” 

As gastric cancer research expands, additional risk factors have been discovered. Dr. Jun Gong discussed some beyond Asian and Hispanic groups. “But here on the West, we tend to see more of risk factors related to the Western lifestyle. Here, gastritis or chronic gastritis, heartburn, longstanding inflammation is a risk factor. Heavy smoking, heavy alcohol use, and obesity are emerging risk factors for stomach cancer as well.”

And even though East Asia is a well-known high-risk population for gastric cancer, research has uncovered other population groups as well. Dr. Joo Ha Hwang from Stanford Medicine discussed what research has unveiled. ”… the research community in general, is one, trying to identify patients who are at particularly high risk for developing gastric cancer. And we have a pretty good idea on who that is. And it’s essentially recent immigrants from high-risk areas such as East Asia, Eastern Europe, Western, South America.”

Gastric Cancer Disparities and Challenges

Dr. Joo Ha Hwang discussed challenges in early diagnosis. “Well, the key challenge in detecting early gastric cancer is that there are no symptoms or the symptoms are very generalized. You can have some vague abdominal pain, your appetite might change a little bit, but we don’t see symptoms until the later stages of gastric cancer when it’s no longer curable. So the real key challenge is to diagnose it at an early stage when it’s still curable and what we’re doing in terms of our research…”

Gastric cancer experts have also noticed some disparities in care access. Transportation barriers and challenges to receiving caregiver support are a couple challenges. Dr. Jun Gong discussed some additional challenges that he’s seen with his patients. “There are several challenges that we see in our routine care of patients that are of Hispanic or Asian ethnicity with regards to access to treatment to stomach cancer. This often involves language barriers where, at least here geographically in Los Angeles, it’s a culturally diverse population, large metropolitan center where patients often speak non-English language. And this is often a barrier to communicating and getting timely access. Other concepts that we’ve come into as well is fear of insurance coverage denials in seeing the subspecialists or access to timely diagnostics and approval of treatments through insurance.”

Gastric cancer challenges encompass other factors as well. Dr. Jun Gong shared another phenomenon  that he’s witnessed. “Cultural beliefs have a huge impact on access to care in stomach cancer, and I think we can do better with addressing cultural barriers to care.”

Gastric Cancer Care Solutions and Successes

Patient advocates and others working toward closing disparity gaps have made some strides in improving care. Diversity and inclusion research and strategies have made an impact. Dr. Jun Gong discussed some efforts that have shown success. “ think one of the innovations here at our center is that we have a center of community outreach and a disparities core here where we recognize that certain cultures and this can expand beyond Asians and Hispanics into all racial groups, that there’s a heavily…there’s an important influence of church in this sector here.

And so what we do is we actively engage leaders in the churches, in the local churches for Asians, Hispanics, and a lot of different other subgroups. And we find this a great, great relationship and partnership to have for promoting awareness and educating patients about resources that we have within a culturally specific location where patients and family members find a great deal of trust in the church.”

Receiving second or even third opinions can be particularly helpful in optimizing gastric cancer care. Dr. Jun Gong discussed the successes of remote consultations.  “…I actually am okay with virtual medicine consultations for those who are…who find it difficult to travel to an in-person visit. Again, I can’t speak for all other cancer centers or oncologists, but we at least offer this ability to do that, to help with that barrier of transportation. And when they are connected with us sometimes if we are able to, we can even follow peripherally, almost like an extra care partner with the main local doctor who’s driving more of the day-to-day, and we’re providing our recommendations as an extension from an urban medical center.

I know it’s specific to certain institutions and certain centers, but I actually am okay with virtual medicine consultations for those who are…who find it difficult to travel to an in-person visit, again, I can’t speak for all other cancer centers or oncologists, but we at least offer this ability to do that, to help with that barrier of transportation. And when they are connected with us sometimes if we are able to, we can even follow peripherally, almost like an extra care partner with the main local doctor who’s driving more of the day-to-day, and we’re providing our recommendations as an extension from an urban medical center.”

[ACT]IVATED Gastric Cancer Program Resources

The [ACT]IVATED Gastric Cancer program series takes a three-part approach to inform, empower, and engage both the overall gastric cancer community and gastric cancer patient groups who experience health disparities. The series includes the following resources:

Though there are gastric cancer disparities, patients and care partners can be proactive in educating themselves to help work toward optimal care. We hope you can take advantage of these valuable resources to aid in your gastric cancer care for yourself or for your loved one.

[ACT]IVATED Gastric Cancer Patient Plan

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Thank you for taking this assessment. By answering the questions below, a custom patient plan featuring a collection of vetted resources will be emailed to you within 5 minutes. If you don’t see it, please be sure to check your spam. Stay [ACT]IVATED.

 

[ACT]IVATED Gastric Cancer North American Specialist Treatment Centers

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ACTIVATED Gastric Cancer Toolkit_North American Specialist Treatment Centers

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[ACT]IVATED Gastric Cancer Toolkit Checklist

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Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients

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Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients from Patient Empowerment Network on Vimeo.

What are stomach cancer basics for newly diagnosed patients to know? Expert Dr. Jun Gong from Cedar-Sinai Medical Center explains stomach cancer staging, where the cancer occurs, and advice for patients.

[ACT]IVATION Tip

“…ask the physician or care provider, ‘What is my stage of stomach or gastric cancer?’ and we will do our best to explain the stage.”

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See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Early Phase Gastric Cancer Trials Are Showing Promise?

 How Is Gastric Cancer Screening and Care Impacted by Culture?

 Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Transcript:

Lisa:

Dr. Gong, how do you explain stomach cancer to your newly diagnosed patients and care partners? And really important too, how do you explain disease staging to them?

Dr. Jun Gong:

So the way I explain stomach cancer or gastric cancer, is another term for this disease, to my patients is that we all are familiar somewhat with our organ that is the stomach. This is the organ that helps digest and process our foods. And it’s the organ that connects to the esophagus and then to the small bowel. And unfortunately, cancers can arise from this organ. And this is where it’s a little bit unique in the sense that unlike other cancers, the stomach is almost like a tube. It’s a hollow structure.

Unlike breast cancer, for example, where you can have a discrete mass where you can actually draw on a caliper and say this is 2 centimeters or 3 centimeters in dimension, stomach cancer tends to grow along the walls of this tube infiltrating to the inside of the lumen. Or it can even spread to the outside of the stomach as well. 

And so this is how the staging is a little bit different for stomach or gastric cancer. And the way, instead of measuring by size, we measure how the depth of the infiltration of the tumor is along the thickness of the wall. And so the staging is similar to other cancer types where there’s a stage I, II, III, or IV connotation. And stage IV means that the cancer has spread outside the stomach and into distant sites such as the liver or lungs, while tumors of the stomach that are confined to the stomach and even to the lymph nodes around the stomach are still classified as I, II, or III. So this is a little bit about, a background, about how we explain what stomach cancer is and how the staging system works.

My activation tip for patients and care partners who are newly diagnosed with gastric or stomach cancers and are unsure about their stage is that it is always more than appropriate to ask the physician or care provider, “What is my stage of stomach or gastric cancer?” and we will do our best to explain the stage. And, of course, this is dependent oftentimes on the availability of information from a diagnostic workup. And how we stage the patient is usually dependent on imaging such as CT or MRIs or PET scans. And it’s often combined with ultrasound or endoscopic procedures such as an upper endoscopy or an endoscopic ultrasound, which is a specialized procedure that allows you to look within the thickness of the stomach to see how deep or how depth of the invasion of the stomach cancer is.

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How Is Gastric Cancer Diagnosed and Staged?

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How Is Gastric Cancer Diagnosed and Staged? from Patient Empowerment Network on Vimeo.

What tests are involved in gastric cancer diagnosis and staging? Dr. Yelena Janjigian explains key testing and considerations that are used to determine gastric cancer staging for optimal care.

Dr. Yelena Janjigian is Chief of Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center. 

See More From INSIST! Gastric Cancer

Related Programs:

How Do Biomarker Test Results Impact Gastric Cancer Treatment Options?

How Do Biomarker Test Results Impact Gastric Cancer Treatment Options?

 Factors to Consider When Choosing a Gastric Cancer Treatment Approach

Factors to Consider When Choosing a Gastric Cancer Treatment Approach

 How Can Gastric Cancer Patients Insist on Better Care?

How Can Gastric Cancer Patients Insist on Better Care?

Transcript:

Katherine Banwell:

Could you tell us what tests are used to diagnose gastric cancer? 

Dr. Janjigian:

Most of our patients, when they come in to see me, by then the diagnosis of cancer has been made because I’m on oncologist.  

In clinical practice, patients often present with vague symptoms or no symptoms at all. And that’s an important point for our clinicians to understand. In patients who have chronic acid reflux or have, for example, other risk factors such as H. pylori infection, often they end up getting endoscopy at the time, for example, for their first colonoscopy. So, the age of colonoscopy, the first colonoscopy has is getting earlier and earlier with each update, because colon cancer is increasing in incidents in younger adults.

So, sometimes patients present and get first endoscopy, for example, which is an upper test with a camera when they’re getting their colonoscopies. In other patients, unfortunately, they present with more progressive symptoms. Often, it’s difficulty swallowing, regurgitation of food, and weight loss, which is obviously very dramatic.  

And so they end up getting an endoscopy because of that and referred by their doctors.  

Katherine:

How is gastric cancer staged? And what do the stages mean? 

Dr. Janjigian:

Yeah. So, the most important part of the staging of gastric cancer and what patients ask me, “What is my risk of cancerous recurrence? What is my stage?” Really what it comes down to is the depth of invasion. So, it’s not only the size of the tumor, but how deep is it going into the muscle of the stomach, because stomach and your esophagus are basically a muscular bag, right? And so how deep is the invasion of the tumor into the wall? And also how likely are the lymph nodes to being involved?

So, we assess it based on clinical symptoms such as swallowing difficulty and so forth. But in some patients, because the tumor is lower down in their stomach, they may not have very many symptoms, because there’s a lot more give in this muscular bag that our stomach is.  

And so we test the endoscopic ultrasound to look at the depth of an invasion and also other X-ray type imaging such as a PET scan, a P-E-T scan or a CAT scan, which gives us a sense of tumor location whether or not we think the lymph nodes may be involved. And ultimately the final way to assess, especially in patients who are undergoing surgery, is their microscopic involvement of the lymph nodes? Because that often drives the likelihood of cancer coming back after surgery.  

Katherine:

And how do the stages work for gastric cancer? 

Dr. Janjigian:

So, in gastric cancer it’s either early, intermediate, or late stage. And this goes from stage I to IV. So, stage IV  tumors is where most of the cancers are present. Over probably 50 percent of our patients present already at the time of diagnosis with more advanced stages. 

Biologically this cancer just tends to move quickly. So, even in between endoscopies in patients who get endoscopies frequently, often it goes from 0 to stage III or IV because of the lymph node involvement and also spread of microscopic cells, right? Tiny, tiny cells before we even see them, they spread through the bloodstream to other organs or lymph nodes outside of your abdomen. So, that’s considered to be stage IV. And then early, early stage disease is stage I. Those usually that we can just scoop them out using endoscopic procedures. They don’t even need to have full surgery. And then stage II and III is usually if there’s some involvement of the tumor through the muscle or into the muscle of the stomach and also some lymph node involvement. But that’s how we stage it.