The State of The Fight
State of the Fight: Stomach Cancerby Dr. Nita Ahuja
Gastric cancer – also known as cancer of the stomach or digestive tract – is the second-leading cause of cancer death worldwide, with about 1 million new cases and approximately 750,000 deaths per year. In the United States, 21,000 new cases are diagnosed per year, with nearly 10,500 deaths annually. On the positive side, stomach cancer incidence in United States has declined since the 1950s due to factors such as refrigeration and an understanding of the role of bacterial infection by Helicobacter pylori. However, in recent years there has been a troubling, increasing incidence of aggressive gastric cancer at the Gastro-Esophageal (GE) junction, which can affect younger people. While researchers are attempting to identify the cause of the increase, surgery for these cancers is often complex and requires multidisciplinary care including chemotherapy and radiation therapy.
I am among the many doctors worldwide committed to fighting back against gastric and other cancers. I serve as a member of the Stand Up To Cancer Dream Team led by Dr. Stephen Baylin and Dr. Peter Jones entitled “Bringing Epigenetic Therapy to the Forefront of Cancer Management.” I have been on faculty at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center since 2003, where I am an Associate Professor of Surgery and Oncology and Chief of the Section on Gastrointestinal Oncology. My clinical practice has focused on treatment of complex gastrointestinal malignancies such as metastatic colorectal cancers, gastric cancers and retroperitoneal sarcomas. In addition, I run a laboratory focused on translational research where my goal is to develop novel therapies and biomarkers for early detection and prognosis of cancers.
As part of the SU2C Dream Team, we have been studying epigenetic changes that occur in gastric cancer on a genome-wide basis in the laboratory. In the words of our team leader, Dr. Jones, “Epigenetics describes the way in which cells take different parts of the genetic information within them and package them in such a way that certain genes are used in one tissue and other genes are used in other tissues.” We have shown that epigenetic changes are more common than genetic changes in colorectal cancer and could result from environmental and dietary factors. The exciting part is that these epigenetic changes are reversible, which is what attracted me to the field of epigenetics over 15 years ago.
Our goal is to develop better biomarkers – measurable characteristics that can be used as an indicator of disease or a disease state – for early detection and to develop novel therapies. We have also been working on using bodily fluids to detect early stages of cancer. Finally, we are trying to understand differences in cancers related to ethnic background in order to individualize treatments in the future. Gastric cancer appears to have ethnic variations with blacks and Asians having an increased risk of the disease. This is likely related to biologic factors and is an important area of future research.
In the meantime, progress is being made in in the fight against stomach cancer. A combination of aggressive chemotherapy and surgical options allows long overall survival in some cases. One patient who presented with Stage 4 gastric cancer was treated with chemotherapy then taken to surgery a year later when his disease remained confined to his stomach and inside lining of his abdomen. We took him to the operating room and removed his stomach cancer along with cancer in his peritoneum and gave him additional chemotherapy to his peritoneum in the operating room. Two years later, he is alive and well with no further chemotherapy.
Still, there is much work to be done. If you or someone you know has been diagnosed with stomach cancer, encourage them to participate in clinical trials, since we can only find better treatments by studying them in clinical trials. Seek out access to centers that can provide the multidisciplinary treatment for such cancers. Gastric cancer surgery is complex and requires performing the right operation and taking out the appropriate lymph nodes around the stomach that may have cancers, so be sure to obtain a second opinion before an operation.
The biggest challenge we face is the lack of large-scale research studies in gastric cancer and the lack of good therapies for these aggressive cancers. Research funding – both at the federal level and through organizations like Stand Up To Cancer – is critically needed. Recently, research has identified that subsets of gastric cancer can have over-expression (or increased expression) of Her2/neu and can be treated by a targeted agent called Herceptin, which is commonly used for breast cancer patients. The finding that the drug can now be used in about 15% of gastric cancers is very exciting. Research funding made this sort of novel, targeted therapy for gastric cancers possible; it’s up to all of us to ensure it continues.
Dr. Nita Ahuja is the Chief of the Section on Gastrointestinal Oncology at Johns Hopkins Hospital and Associate Professor of Surgery and Oncology. She has a laboratory focused on development of novel therapies and biomarkers for gastrointestinal cancers. Dr. Ahuja is involved in leading a trial on colorectal cancer using epigenetic therapy for the SU2C. Dr. Ahuja is a graduate of Duke University School of Medicine and received her general surgical training followed by a surgical oncology fellowship at Johns Hopkins. She currently serves on numerous editorial boards for scientific journals and is recognized internationally for her research work on epigenetic biomarkers. Dr. Ahuja’s laboratory has been funded by AACR, NIH, American College of Surgeons-Society of University Surgeons, Society of Surgical Oncology, Susan G. Komen Breast Cancer foundation, Lustgarten foundation and the Mary Kay Ash foundation.