Our Publications Visit PubMed for our journal articles from our gastric cancer experts 
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Our team of doctors (known as the Upper Gastrointestinal Disease Management Team) is made up of some 15 physicians, which include surgeons, medical oncologists, gastroenterologists, radiologists, radiation oncologists, and pathologists. The group specializes in cancers of the stomach, esophagus, and pancreas, as well as neuroendocrine tumors and tumors of the small intestine.
Members of the disease management team meet weekly to review and discuss each patient's case and treatment plan. They are joined by other specialists who work to meet the nonmedical needs of both patients and their caregivers, including those who provide psychosocial support.
Memorial Sloan-Kettering is an active member of the American College of Surgeons Oncology Group (ACOSOG), the Radiation Therapy Oncology Group (RTOG), and the Cancer and Leukemia Group B (CALGB). Through these cooperative groups, Memorial Sloan-Kettering participates in most national trials to improve the detection, treatment, and prevention of stomach cancer.
Individualized Treatment
If stomach cancer is suspected, a biopsy is performed by removing a tissue sample with a thin, tube-like instrument called an endoscope, and a diagnosis is made. (This may have been done before coming to Memorial Sloan-Kettering.) As a part of the initial evaluation at Memorial Sloan-Kettering, our pathologists will review the biopsy slides to confirm the diagnosis. A second endoscopy may be necessary if the diagnosis is unclear after the initial biopsy. Once the diagnosis has been established, a number of other tests may be recommended to determine the extent of the tumor -- this is a process called staging.
After the tumor has been staged, a treatment plan is developed. Multidisciplinary input is an important aspect of the treatment plan since many patients will receive more than one type of treatment. For stomach cancer, this may include some combination of surgery, chemotherapy, and/or radiation therapy. Having surgeons, medical oncologists, and radiation oncologists collaborating on treatment from the very beginning optimizes patient care.
Our Surgical Expertise
Many patients with stomach cancer require some form of surgery, and our surgeons are often able to completely remove such tumors using partial or total gastrectomy, an operation to remove a part or all of the stomach. Patients with more advanced cancers are offered chemotherapy first to shrink the tumor and make it more operable. When the tumor cannot be removed, we may employ laser techniques or stenting to relieve areas of obstruction that can cause pain and disability. Where appropriate, our surgeons will also use minimally invasive surgery to biopsy, stage, and treat many cancers and precancerous conditions of the stomach.1
For individuals who have already had surgery for stomach cancer, researchers at Memorial Sloan-Kettering have developed a tool called a nomogram to help predict which patients are more likely to have a recurrence following surgery.2 3
Multimodal Therapies
Recent studies suggest that different combinations of surgery, chemotherapy, and radiation therapy may improve survival compared to surgery alone. One of these approaches uses a regimen of chemotherapy before and after surgery4; the other uses a combination of radiation and chemotherapy following surgery5. These approaches have become two standards of care for patients with this disease.
Our doctors continue to evaluate new chemotherapeutic agents and drug combinations to treat patients with stomach cancer. Chemotherapy may be given before surgery (in a process known as neoadjuvant therapy) to shrink the tumor, or it may be given after surgery (known as adjuvant therapy) to kill any remaining cancer cells. When given alone or in combination with radiation therapy, chemotherapy may help alleviate symptoms related to stomach cancer symptoms or delay cancer recurrence and, thereby, extend survival, especially in patients whose cancers cannot be completely removed through surgery. 6 7
Find a Clinical Trial Find out about new research studies for gastric cancer
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Investigational Approaches
One of our main areas of research focuses on the identification of novel therapeutic drugs, as well as treatment modalities and programs to improve the care of patients with stomach cancer. To help guide therapeutic decisions, our investigators are also tracking molecular tumor markers (a substance that may be found in tumor tissue or released from a tumor into the blood or other body fluids -- a high level of a tumor marker may mean that a certain type of cancer is in the body) and using functional imaging such as positron emission tomography (PET) and computed tomography (CT) scans to potentially guide therapy more specifically for the individual patient.
In addition, we have established the Early Onset and Familial Gastric Cancer Registry for younger patients and patients with a family history of stomach cancer. This database will provide important information to help further our understanding of the genetic causes of gastric cancer. It will eventually be used to better guide how stomach cancer is diagnosed, treated, and monitored in patients who have the disease as well as for those who may be at an increased risk.
1E. C. Burke, M. S. Karpeh, K. C. Conlon, and M. F. Brennan, Laparoscopy in the management of gastric adenocarcinoma, Annals of Surgery 225(3), 1997: 262-7. [PubMed Abstract]
2A. R. Novotny, C. Schuhmacher, R. Busch, M. W. Kattan, M. F. Brennan, and J. R. Siewert, Predicting individual survival after gastric cancer resection: validation of a US-derived nomogram at a single high-volume center in Europe, Annals of Surgery 243(1), 2006: 74-81. [PubMed Abstract]
3M. W. Kattan, M. S. Karpeh, M. Mazumdar, and M. F. Brennan, Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma, Journal of Clinical Oncology 21(19), 2003: 3647-50. [PubMed Abstract]
4D. Cunningham, W. H. Allum, S. P. Stenning, J. N. Thompson, C. J. Van de Velde, M. Nicolson, J. H. Scarffe, F. J. Lofts, S. J. Falk, T. J. Iveson, D. B. Smith, R. E. Langley, M. Verma, S. Weeden, and Y. J. Chua, for the MAGIC Trial Participants, Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer, New England Journal of Medicine 355(1), 2006: 11-20. [PubMed Abstract]
5J. S. Macdonald, S. R. Smalley, J. Benedetti, S. A. Hundahl, N. C. Estes, G. N. Stemmermann, D. G. Haller, J. A. Ajani, L. L. Gunderson, J. M. Jessup, and J. A. Martenson, Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction, New England Journal of Medicine 345(10), 2001: 725-30. [PubMed Abstract]
6M. A. Shah, R. K. Ramanathan, D. H. Ilson, A. Levnor, D. D'Adamo, E. O'Reilly, A. Tse, R. Trocola, L. Schwartz, M. Capanu, G. K. Schwartz, and D. P. Kelsen, Multicenter phase II study of irinotecan, cisplatin, and bevacizumab in patients with metastatic gastric or gastroesophageal junction adenocarcinoma, Journal of Clinical Oncology 24(33), 2006: 5201-6. [PubMed Abstract]
7B. Brenner, M. A. Shah, M. S. Karpeh, M. Gonen, M. F. Brennan, D. G. Coit, D. S. Klimstra, L. H. Tang, and D. P. Kelsen, A phase II trial of neoadjuvant cisplatin-fluorouracil followed by postoperative intraperitoneal floxuridine-leucovorin in patients with locally advanced gastric cancer, Annals of Oncology 17(9), 2006: 1404-11. [PubMed Abstract]
Last Updated: Feb. 20, 2008
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