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Gastric Cancer

Clinical Description

Gastric (stomach) cancer usually begins in the tissues that line the stomach. Gastric cancer has become far less common over the past 60 years in the United States and Western Europe, however over 21,000 Americans will be diagnosed with the disease this year.

Symptoms of Gastric (Stomach) Cancer

Stomach cancer is most often not recognized until the disease has spread. This is primarily due to the absence of symptoms during the early stages of cancer development in the stomach. When symptoms do become evident, they may be mistaken for other less serious stomach problems such as gas or ulcer disease. Symptoms may include discomfort or pain in the stomach region, bloating, nausea, vomiting, heartburn, weight loss, loss of appetite, or feeling tired.

Risk Factors for Gastric (Stomach) Cancer

Infection with the Helicobacter pylori bacterium, and a diet high in red meat, or smoked and salted foods are among the risk factors for stomach cancer.

How Gastric (Stomach) Cancer is Diagnosed

Diagnosis usually involves a combination of physical exam, blood tests, imaging studies, and endoscopy.

The interior lining of the stomach may be evaluated using a thin tube with a camera at the end called an endoscope. Tissue samples may be removed from the stomach during this procedure and examined for cancer cells.

Once the diagnosis is made, it is important to determine if the cancer has spread and, if so, how far. This process is called staging and it is important in guiding what treatment would be most helpful to the patient. Computed tomography (CT) and Positron Emission Tomography (PET) are often used for staging. Endoscopic ultrasound may also be used. Endoscopic ultrasound involves insertion of a special endoscope equipped with an ultrasound probe through the mouth into the stomach. Surgical examination of the abdominal using laparoscopy, a minimally invasive surgical technique, may also be used for staging. During laparoscopy, a thin probe with a camera on its tip is inserted into the abdomen through a small incision, allowing the surgeon to look at the inside of the abdomen and to remove tissue samples to be tested for cancer cells.

Treatment Options for Gastric (Stomach) Cancer at Tufts Medical Center

Treatment of stomach cancer depends on the stage of disease (the size of the tumor, how deeply it invades different layers of the stomach and whether it has spread to nearby organs, lymph nodes or other parts of the body, and on the patient’s general health.

Surgery

Surgery is the most common treatment for stomach cancer. Surgery can be used in any stage of the disease. Depending on the extent of cancer spread, recommended surgeries may include:

Partial (Subtotal) Gastrectomy – Part of the stomach is removed. Additional tissues or parts of organs such as the liver, pancreas, small intestine or spleen may also be removed together with the stomach if the tumor has invaded them.

Total Gastrectomy – The entire stomach is removed, along with the lower part of the esophagus, part of the small intestine (duodenum), and the surrounding lymph nodes. The remaining esophagus will be connected to the small intestine to allow the patient to eat.

Chemotherapy

Chemotherapy can be used to treat gastric cancer, either by itself or in combination with surgery and/or radiation therapy. It may be given before surgery (neoadjuvant therapy) to shrink the tumor size, or it may be given after surgery (adjuvant therapy) to help destroy any remaining cancer cells.

Drugs commonly used to treat stomach cancer are 5-Fluorouracil, Irinotecan, Cisplatin, epirubicin and Docetaxel. Most are given intravenously so they go to all parts of the body. A combination of these medications may be used. Chemotherapy may help control symptoms related to cancer and to delay cancer recurrence or spread.

Radiation Therapy

High-energy radiation is directed at the area of the tumor to destroy cancer cells or prevent their growth. Radiation therapy is commonly used in combination with chemotherapy to increase the effects of both.

Programs + Services


Gastrointestinal Cancers Program

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Doctors + Care Team

Roger Graham, MD

Roger Graham, MD

Title(s): Chief, Division of General Surgery; Chief, Surgical Oncology; Director, Breast Health Center; Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Surgical Oncology
Appt. Phone: 617-636-8270
Fax #: 617-636-9095

General surgery, surgical oncology, thyroid surgery, breast cancer

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Joel V. Weinstock, MD
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Joel V. Weinstock, MD

Title(s): Chief, Division of Gastroenterology/Hepatology; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4505

Gastroenterology, inflammatory bowel diseases, mucosal immunity, general gastroenterology, GI bleeding, endoscopy

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Andrew G. Plaut, MD
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Andrew G. Plaut, MD

Title(s): Gastroenterologist; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4207

Gastroenterology, digestive diseases, gastrointestinal infections and parasitic disease, inflammatory bowel disease, diagnostic evaluation of unexplained pain or diarrhea

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Barbara J. Weinstein, MD

Barbara J. Weinstein, MD

Title(s): Staff Pathologist; Assistant Professor, Tufts University School of Medicine
Department(s): Pathology and Laboratory Medicine
Appt. Phone: 617-636-5829
Fax #: 617-636-8302

General surgical pathology, cytopathology, gastrointestinal pathology

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E. Kent Yucel, MD

E. Kent Yucel, MD

Title(s): Radiologist-in-Chief; Ettinger–Dreyfus Chair and Professor of Radiology, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-0040
Fax #: 617-636-0041

Interventional radiology, general radiology

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Gary M. Strauss, MD, MPH

Gary M. Strauss, MD, MPH

Title(s): Medical Director, Lung Cancer Program; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Lung cancer, melanoma, breast cancer, genitourinary cancer, solid tumors

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Harmony Allison, MD
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Harmony Allison, MD

Title(s): Gastroenterologist; Clinical and Research Instructor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-1480

Gastrointestinal motility, inflammatory bowel disease, general GI and endoscopy, diarrhea, constipation, celiac sprue and limited LFT abnormalities

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Hoon Ji, MD, PhD

Hoon Ji, MD, PhD

Title(s): Chief of Body MRI; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-4916
Fax #: 617-636-2578

Body MRI, general radiology

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Judith F. Katz, MD

Judith F. Katz, MD

Title(s): Chief of Ultrasound; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-7818
Fax #: 617-636-1499

Ultrasound, nuclear medicine, body CT, mammography, general radiology

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Kathleen Viveiros, MD
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Kathleen Viveiros, MD

Title(s): Director, Gastroenterology/Hepatology Fellowship Program
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4207

Hepatology, pre- and postliver transplant, hepatitis, chronic liver disease, general gastroenterology

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Kathryn Huber, MD, PhD

Kathryn Huber, MD, PhD

Title(s): Radiation Oncologist; Assistant Professor, Tufts University School of Medicine
Department(s): Radiation Oncology
Appt. Phone: 617-636-6161
Fax #: 617-636-6131

Radiotherapy for cancers of the lung and gastrointestinal tract

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Kevin Daly, MD

Kevin Daly, MD

Title(s): Interventional Radiologist, Cardiovascular and Interventional Radiology; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-3004
Fax #: 617-636-1149

Diagnostic and interventional radiology, general radiology

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Laurence H. Brinckerhoff, MD

Laurence H. Brinckerhoff, MD

Title(s): Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Thoracic Surgery
Appt. Phone: 617-636-5589
Fax #: 617-636-9095

Thoracic surgical oncology, minimally invasive surgery, clinical trials, tumor immunology

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Lori B. Olans, MD, MPH
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Lori B. Olans, MD, MPH

Title(s): Gastroenterologist; Assistant Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-8615

General gastroenterology

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Martin D. Goodman, MD

Martin D. Goodman, MD

Title(s): Surgeon; Director, Peritoneal Surface Malignancy Program; Assistant Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Surgical Oncology
Appt. Phone: 617-636-9248
Fax #: 617-636-9095

General surgery, advanced abdominal tumors, peritoneal surface malignancies, hepatobiliary/pancreatic/colorectal minimally invasive surgical oncology

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Moises Guelrud, MD
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Moises Guelrud, MD

Title(s): Gastroenterologist; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4505

Gastroenterology, sphincter of Oddi manometry in children and adults, ERCP (diagnosis and therapeutic) in children and adults, ECRP (diagnosis and therapeutic) in children and adults, endoscopic diagnosis and treatment of Barrett's esophagus, magnification endoscopy and chromoendoscopy, pancreatic diseases

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Nayer Nikpoor, MD

Nayer Nikpoor, MD

Title(s): Chief of Nuclear Medicine; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-6342
Fax #: 617-636-9109

Nuclear medicine

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Neil J. Halin, DO, FSIR

Neil J. Halin, DO, FSIR

Title(s): Chief, Cardiovascular and Interventional Radiology; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-3004
Fax #: 617-636-1449

Peripheral vascular disease, biliary and urinary obstruction, thrombo-embolic disease, vascular disease, general radiology

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Robert Martell, MD, PhD

Robert Martell, MD, PhD

Title(s): Medical Oncologist; Associate Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Phase I clinical trials, GI oncology, breast cancer, head and neck malignancies, liver tumors

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Wasif M. Saif, MD

Wasif M. Saif, MD

Title(s): Director, GI Oncology Program; Leader, Experimental Therapeutics; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Chemistry and pharmacology of folate antagonist, experimental therapeutics, clinical trial design (Phase I and II), cancers treated include pancreas, gall bladder, cholangiocarcinoma (bile duct), anal, colon (including Rectum), neuroendocrine (carcinoid), psedomyxoma peritonei, esophagus, gastroesophageal (including Stomach), liver, unknown primary, GIST, adrenal, peritoneum, phase I clinical studies of novel cancer drugs and/or combinations

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