Thursday, May 25, 2006 | 7:14 a.m.
Prevalence: Worldwide, gastric (stomach) cancer is the second most common form of cancer.
Treatment: Surgery offers the best chance of a cure.
Genetics: Most inherited mutations (changes in genes) are accountable for only about 1 percent to 3 percent of cancers in individuals with strong family histories of gastric cancer.
How common is gastric (or stomach cancer)?
Worldwide, gastric (stomach) cancer is the second most common form of cancer. Although the total number of cases of gastric cancer has been decreasing in North America and Western Europe, it is still relatively common in parts of Asia and Latin America.
Who is at greatest risk?
In the general population, those between ages 50 and 59 are at higher risk.
Risk increases with the use of tobacco and alcohol. Individuals with two or more family members diagnosed with stomach cancer before the age of 50 are also at greater risk for hereditary gastric cancer.
How treatable is gastric cancer?
Gastric cancer is treatable if diagnosed in the early stages (the five-year survival rate is 90 percent). Unfortunately, most people do not receive a diagnosis until the cancer is more advanced, and that's because the cancer is difficult to detect in its early stages. The symptoms can mimic other conditions (ulcers), and by the time symptoms do occur, the disease is at a more difficult stage to treat.
What are the symptoms of gastric cancer?
The following symptoms are by no means exhaustive, but are representative of common signs of gastric cancer:
What's the standard treatment for gastric cancer?
Surgery offers the best chance of a cure, removing most or all of the stomach along with the surrounding lymph nodes. Over 50 percent of early stage cases are curable.
What are the changes individuals who have a stomach removal face?
Gastrectomy necessitates lifelong changes in dietary habits and nutritional supplementation.
What causes gastric cancer?
The exact causes of gastric cancer are still unknown. Some of the risk factors include increasing age (generally people over the age of 60), dietary factors, Helicobacter pylori infection, smoking, alcohol consumption and a disorder of the blood called pernicious anemia. Most inherited mutations (changes in genes) are accountable for only about 1 percent to 3 percent of cancers in individuals with strong family histories of gastric cancer. Most cancers develop as a result of sporadic mutations that occur in the body during a person's lifetime.
Additional information on stomach cancer can be found at
www.bccancer.bc.ca/PPI/TypesofCancer/Stomach/default.htm
Las Vegas is home to hundreds of conventions and reunions each year, but it has probably never hosted a gathering quite like this one.
Several members of a family predisposed to a deadly stomach cancer will meet in Las Vegas this weekend to share experiences about the surgery that probably saved their lives.
Some will be meeting each other for the first time. It will be the first meeting for all of them, however, with the doctor whose research identified the genetic mutation responsible for the strain of cancer they faced.
The 11 cousins chose to have a gastrectomy, or stomach removal, after it was determined they had a 75 percent chance of getting the cancer. While the cancer is treatable with early diagnosis, it is difficult to detect and is generally fatal in later stages.
Stomach removal surgery is not routine, and about one in 200 patients who has the procedure does not survive. But many have the surgery because of an accompanying illness, and when the procedure is performed on a person in generally good health, the likelihood of recovery increases greatly. In most cases, doctors replace the stomach with a small pouch fashioned from the intestine.
"It was a relatively easy decision for me to have the gastrectomy surgery given that the genetic dice were stacked against me," said Mike Slabaugh, a 52-year-old marketing executive from Dallas who will attend the reunion at the Aladdin.
"It's like a huge cloud has been lifted from my life."
He is one of six cousins who had their surgeries performed at the Stanford School of Medicine by Dr. Jeff Norton. The family is spread across the country, so the other five cousins had their surgery closer to their homes.
The first of the 11 cousins underwent surgery in 2004, and the last one was operated on two months ago.
The cancer was first diagnosed two generations ago in the family's grandmother, Golda Bradfield, who died from the disease. The illness became even more prevalent in the next generation as seven of her eight children inherited the genetic mutation. Six died from stomach cancer.
When one of Slabaugh's cousins was diagnosed with the fatal cancer, he decided that if he couldn't save himself, maybe he could prevent his cousins from suffering a similar fate. Three days before he died, a sample of his blood was sent to Dr. David Huntsman at the BC Cancer Agency in Vancouver, British Columbia.
The sample was critical because the mutation must be identified initially in someone with cancer. By using the sample, Huntsman was able to isolate the genetic mutation and begin testing family members.
Twelve of 19 family members tested had inherited it.
Huntsman said it is never easy to deliver such news, but that the response from the family was very encouraging.
"They know there's something going on in the family because of the history; all we are doing is providing them with the tools to deal with it," Huntsman said. "They've been very proactive and supportive of us and each other as they've gone through the process."
Huntsman is eager to meet with the cousins and their families this weekend. He has had contact with some through e-mails and has extensive knowledge of their medical records.
"I know them better inside than outside," he said.
Huntsman pointed out that most cancers have environmental causes, or are the result of a combination of environmental and genetic factors. The process used to identify this type of mutation is effective only with cancers that are strictly genetic, which he said represent less than 5 percent of all cancers.
For families such as the Bradfields, however, who have a genetic predisposition to a treatable form of cancer, the technology can be lifesaving.
Dr. Henry Lynch, a genetic oncologist at Creighton University who managed the care of several Bradfields, said the approach used with this disease could be a model for other genetic cancers.
"Absolutely, no question about it," Lynch said. "We use very similar strategies (with these types of cancer), and I believe so strongly in letting the patients know so they can make the best decisions for them and their families."
That was the role Lynch assumed with the Bradfield cousins, laying out the pros and cons of an elective gastrectomy. He pointed out that even with the genetic predisposition, it was possible some would not contract cancer.
All family members with the predisposition chose surgery, and Slabaugh said they had no regrets.
"I have had to make some changes, such as chewing my food a little longer," Slabaugh said. "But overall I'm very happy with the choice I made."
After the surgery, food is not softened as usual by stomach digestion and the filtering effect is removed. Patients have to be more careful about what, how and how much they eat at a time.
Surprisingly, absorption of food is not affected as much by stomach removal. The weight loss commonly associated with the procedure is usually the result of people taking smaller meals. Over time, people learn to eat more frequently and weight loss can be abated.
Golda Bradfield's grandchildren are alive and, for the most part, well - an achievement they consider remarkable given the family's history.
They will converge on Las Vegas from Michigan, Texas, Arizona, California, Washington and Oregon. One cousin will even come from South Africa to join the others in celebrating a new lease on life. All are paying their own way, as is Huntsman, the doctor who identified the genetic mutation.
They will also pay tribute to the cousin whose death contributed so greatly to their survival.
Slabaugh said family members had grown apart, and the shared experience had drawn them closer. He said the family chose Las Vegas for the celebration partly because they had a previous reunion here, but also for another reason:
"We all know that we truly beat the odds of this killer disease, so it just seemed appropriate."
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