Country Singer Toby Keith sheds light on stomach cancer

Country powerhouse Toby Keith revealed recently that he had been diagnosed with stomach cancer last autumn. He spent six months doing a regime that included chemotherapy, surgery and radiation, a common treatment for this type of cancer, said Oncologist Peter Ward, MD at the Davenport-Mugar Cancer Center at Cape Cod Hospital.

Stomach cancer, also called gastric cancer, is a disease that begins when the cells in the stomach start to grow out of control. The American Society of Clinical Oncology estimates that there will be about 26,380 new cases of stomach cancer in 2022, with 15,900 diagnoses in men and 10,480 in women. In the same time period, there will be about 11,090 deaths from stomach cancer (6,690 men and 4,400 women), so men are more at risk than women.

Stomach cancer mostly affects older people. The average age of a diagnosis is 68 and about six out of 10 people with stomach cancer each year are age 65 or older, making Toby Keith a little on the young side, at 60. Famous people who have died of stomach cancer include Fred Rogers, Liz Claiborne and John Wayne, who were all in their 70s when they died.

Despite those unfortunate cases, the cancer is treatable, especially when caught in the early stages, Dr. Ward said.

“Stage one and stage two cancers are curable, and even stage three, but the chance of cure is a little less as you go from stage one to stage two to stage three,” he said. “If it’s caught early, it can be treated with surgery and sometimes chemotherapy is given before surgery and after surgery. Sometimes radiation is recommended also if it has spread to the lymph nodes.”

Stage four or metastatic cancer is generally treated with chemotherapy, Dr. Ward said, but sometimes radiation can help with pain if there are painful metastases.

There have been some advances in the treatment of stomach cancer in the past 10 years, Dr. Ward said. The HER2 protein that is sometimes expressed in breast cancer patients and can also be detected in a small percentage of people with stomach cancer.

“If someone is HER2 positive, their treatment may include both chemotherapy and Herceptin, which is an antibody therapy that targets the HER2 protein,” he said. “It’s a small proportion of gastric cancers, but if they do test positive for the HER2 protein they can certainly help enhance the response of the chemotherapy.”

One of the newest treatments is immunotherapy. It’s currently being used mostly in the metastatic setting with patients who have a high expression of a protein called PD-L1 on their tumor cells, said Dr. Ward. Those patients are treated with Keytruda. If the protein expression is high, those patients may be given those drugs by themselves. If the expression of the PD-L1 protein is intermediate or low, sometimes the immunotherapy drugs can be given with chemotherapy.

“There are definitely treatment options and the goal of the treatment of metastatic disease is more palliative, meant to try to reduce the cancer symptoms and keep the cancer in remission for as long as possible,” he said. “But unfortunately, we are not at the point where we can cure patients with metastatic disease.”

Part of the problem with diagnosing stomach cancer is the symptoms are vague and can easily be misconstrued by patients as something less serious, like a stomach bug or heartburn.

Dr. Ward lists the following symptoms of stomach cancer:

• Unexplained weight loss;
• Early satiety, where you get full quickly while eating;
• Abdominal pain;
• Trouble swallowing;
• Unexplained nausea or vomiting;
• Bloating; and
• Prolonged heartburn.

Even though stomach cancer is not very common, the typical type of stomach cancer Dr. Ward sees is at the gastro-esophageal junction of the body. Those cancers are related to acid reflux in a lot of cases. People with obesity have a higher tendency to suffer from acid reflux, putting them at higher risk.

“It’s definitely important to get acid reflux treated and if it’s not responding to the usual antacid medications or things like esomeprazole, seeing a gastroenterologist and having an endoscopy is the next step, Dr. Ward said.

Risk factors of stomach cancer include:

• Obesity;
• Smoking cigarettes;
• Eating food preserved with salt;
• Eating smoked foods and cured meats; and
• Alcohol.

There is evidence that fruits, vegetables and fiber are all protective factors against the disease, making a plant-based diet the best insurance, Dr. Ward said.