1. Cancers that arise in the stomach or along the tube that goes from the mouth to the stomach are sometimes difficult to distinguish. Both esophageal and gastric cancers usually begin in the cells that line the upper gastrointestinal tract, and they can produce some of the same symptoms: declining appetite, belly pain, trouble swallowing or a feeling of fullness after eating a small meal.
Jason Wallen, MD
2. Distinguishing between esophageal and gastric cancer is important because the treatments of these cancers differ.
3. Treatment for esophageal and gastric cancers can be highly complex and highly variable.
4. Many of these cancers are advanced by the time they are discovered. They tend to spread to the liver and the lungs.
5. Because of where esophageal and gastric cancers are located, surgery may require approaches from the chest and from the abdomen. Having doctors who specialize in each area as part of the care team means they draw on one another’s expertise.
Not all medical centers have the expertise and equipment to manage cancers of the stomach and esophagus.
Upstate does.
Ajay Jain, MD
A new patient at Upstate’s gastric and esophageal cancer program typically undergoes an endoscopic procedure or laparoscopic surgery to locate and “stage” his or her tumor. This is the process of confirming the location of the tumor and determining the severity of the cancer.
“We’re looking for how are we going to be able to remove this tumor and, more importantly, how are we going to be able to put things together again once it’s out?” explains Jason Wallen, MD, the chief of thoracic surgery, who co-directs the gastric and esophageal cancer program with Ajay Jain, MD, the chief of surgical oncology.
While the surgeons work closely together, Wallen or another chest surgeon usually cares for the patients with esophageal cancer. Jain or one of his abdominal surgery partners usually handles those with stomach cancer.
Chest and abdominal surgeons collaborate with medical oncologists, pathologists, radiation oncologists, radiologists, gastroenterologists and nurse navigators who make up a care team for patients with gastric or esophageal cancers. Each patient’s case is discussed among the team. In a majority of cases, the team members end up agreeing on a recommendation. But not always.
“When you have different specialists around the table, and something comes up that no one is sure about, it ultimately always leads to better care for our patients,” Wallen says. He related one situation in which the team could not agree, so specimens from the patient were sent to the National Cancer Institute for additional analysis, and further review by the Upstate team.
The team might recommend surgery, but maybe not if tests reveal microscopic disease in the abdomen, or if distant lymph nodes are involved. Surgery might come later.
Wallen explains: “One of the reasons we do chemotherapy and sometimes even radiation up front is that it’s so likely these cancers have spread beyond what we see at the point of diagnosis that we really need to take care of that disease that has spread beyond the initial area of the tumor.
“That’s what is really dangerous. People don’t die from cancers in their stomach or esophagus. They die from the cancers that have spread to other parts of their body. So that becomes the treatment priority.”
Jain says that surgery might be effective if a tumor has grown into surrounding tissue, but shrinking the tumor first may give the patient a better outcome. It depends on many factors.
“These distinctions can be subtle, as to whether you should do chemotherapy first or surgery first,” he says. “You really do need an experienced group of people putting their heads together to come up with an individualized plan.”
Patients interested in Upstate’s gastric and esophageal cancer program can call 315-464-HOPE (4673.)
This article appears in the spring 2018 issue of Cancer Care magazine.