In a bold and unprecedented initiative, Yanghee Woo, MD, Director of the Center for Global Excellence in Gastric Cancer Care, is working to transform the face of a disease that has not received a great deal of public attention in this country. Having trained with the best in the field and become a highly regarded expert internationally, she is now aiming for nothing short of resetting the standards for treating gastric (stomach) cancer: to achieve early detection of gastric cancer in the U.S. and to cure gastric cancer worldwide.*
Frequently related to H. pylori infection, stomach cancer is much less common in the U.S. than in countries such as Japan, Korea, Chile, Brazil, Iceland, and other countries with strong traditions of salted, pickled, and smoked foods. Though it may be less common here, it is far more deadly. In Asia and South America, physicians have much greater experience in diagnosing and treating stomach cancer than they do here in the U.S. With that familiarity, they are far better able to detect it at earlier stages when it is curable. Dr. Woo explains that in Japan and Korea, where she trained, a surgeon will treat 300-600 patients per year with gastric cancer; whereas in the U.S., a center is considered "high volume" if it performs ten gastric cancer surgeries per year.
The Holy Grail: Early Detection
The only cure for gastric cancer is to surgically remove the stomach. That option is available if the cancer is found in early stages or in more advanced stages but confined to a localized area. In the U.S., more than 60% of cases are diagnosed when it is too late for surgery. Despite the use of chemotherapy and radiation, the five-year survival rate is less than 50% in the U.S., with about half of patients dying within the year they were diagnosed.
"Of the approximately 21,000 people diagnosed with gastric cancer every year in our nation, most could be spared the risk of death through early detection," says Dr. Woo. In Japan, Korea, Singapore, and Taiwan, screening programs are in place just like mammography is routine in the U.S. But here, where the incidence of gastric cancer is relatively low, widespread screening is economically unfeasible.
To find a way around the financial impediment to screening every adult, Dr. Woo is zeroing in on those at highest risk. Studies show that certain patients are at higher risk for developing gastric cancer than others, and Dr. Woo is using that data to find ways to target surveillance endoscopy to those who most need to be screened. Asian Americans are at highest risk, followed by black, Hispanic, and Caucasian Americans. In addition to ethnicity, the most important risk factors are infection with H. pylori and chronic swelling and inflammation of the stomach (atrophic gastritis). Other risk factors include a family history of stomach cancer, presence of a polyp larger than two centimeters, pernicious anemia, smoking, family cancer syndromes such as HNPCC, male gender, and age over 65.
With her multidisciplinary team at NewYork-Presbyterian/Columbia, Dr. Woo is currently developing a protocol to launch an early detection program for patients at higher risk for atrophic gastritis and H. pylori infection. "The goal of the early detection program is to identify those at highest risk of developing gastric cancer and to offer them endoscopy," explains Dr. Woo. Endoscopy is the gold standard for detecting the disease at earlier stages. The center is running this early detection program in collaboration with surgeons at the Department of Surgery at São Paolo University, Brazil.
In addition to the above-mentioned factors, there is one known gene that increases the risk for gastric cancer: mutation of the CDH1 gene. People with this genetic defect have close to a 100% chance of developing gastric cancer. A database in New York is currently gathering data on patients with this genetic disorder.
Minimally Invasive Robotically Assisted Surgery
In addition to the early detection initiative, the center at NYP/Columbia has established a robotic surgery program for the treatment of gastric cancer. Having done specialized training in robotic surgery for gastric cancer with the world's foremost experts, Dr. Woo has brought robotically assisted lymph node dissection to NYP/Columbia, where it is now a standard of care. In lieu of a large abdominal incision, the use of robotic technology allows surgeons to use minimally invasive approaches to excise cancerous tissue. This is particularly valuable in cases where she must operate near blood vessels.
According to Dr. Woo, procedures requiring removal of the lymph nodes around the stomach are particularly challenging. Not only must the surgeon remove the nodes adjacent to the stomach, but those in the second layer out as well (called second tier). "Using the robot allows for more precision during this surgery," says Dr. Woo. Very few centers in the U.S. are able to offer this procedure; Dr. Woo has not only trained extensively in the surgical treatment of gastric cancer, but has researched and published extensively on its benefits to patients.
"It allows us to do more complicated surgeries with better magnification, less blood loss, fewer transfusions, better precision and accuracy, and better ability to control the whole operation," Dr. Woo says. Compared to open surgery, laparoscopic surgery benefits patients with decreased pain, fewer pulmonary complications, and a faster recovery.
The Center for Global Excellence in Gastric Cancer Care is a multidisciplinary center that includes leading experts in gastrointestinal oncology, medical oncology, surgical oncology, nurse practitioners, nutritionists, family support staff, and others. For more information or to request an appointment at the gastric cancer center, please call 212.305.0374.
*Stomach (gastric) cancer is also frequently called adenocarcinoma, which is the most common form of gastric cancer.