Country star Toby Keith is a powerhouse in his field. The 60-year-old has had more than 40 top 10 hits and over 30 songs that have gone to No. 1 on the charts. This week, Keith took to Instagram to tell his fans about a health condition he’s kept private for the past 6 months:
“Last fall I was diagnosed with stomach cancer. I’ve spent the last 6 months receiving chemo, radiation and surgery. So far, so good. I need time to breathe, recover and relax.”
While Keith was on tour for his new album, Peso in My Pocket, at the time of the announcement, upcoming tour dates have been removed from his website.
Keith has long been a supporter of pediatric cancer patients. He founded a non-profit called Ally’s House in Oklahoma in 2004, after the death of a bandmate’s child from cancer. In 2006, he started the Toby Keith Foundation, which runs the OK Kids Korral — a free housing and support center for pediatric cancer patients and their families.
In addition, Toby Keith has performed for more than 250,000 armed service members in 17 countries for the USO, including shows in Iraq and Afghanistan.
According to the World Health Organization, gastric cancer is the sixth most common cancer and the third most common cause of cancer-related deaths worldwide. In the United States, it is estimated that there will be 26,380 new cases and 11,090 deaths from gastric cancer in 2022. The lifetime risk of developing stomach cancer is approximately 0.8%.
Although the stomach is part of the digestive tract, cancer in the stomach is, in general, different than cancer in the intestines, colon, and rectum. The stomach is made up of five parts. The proximal stomach consists of the cardia (closest to the esophagus), fundus, and body (or corpus, the main part of the stomach). The distal stomach consists of the antrum, where food mixes with gastric juice, and the pylorus, which acts as a valve to control the stomach emptying into the small intestine.
The wall of the stomach is made up of three layers of tissue: the mucosal (innermost) layer, the muscularis (middle) layer, and the serosal (outermost) layer. Gastric cancer begins in the cells lining the mucosal layer and spreads through the outer layers as it grows.
Several types of cancers are found in the stomach:
- The vast majority (90% to 95%) of gastric cancers are adenocarcinomas. This cancer develops from the cells that form the mucosa.
- Gastric lymphomas account for about 4% of stomach cancers. Most of these cancers of the lymph system are are mucosa-associated lymphoid tissue gastric lymphoma or diffuse large B-cell lymphoma of the stomach.
- Gastrointestinal stromal tumors (GIST) are rare tumors that seem to start in cells in the wall of the GI tract, called interstitial cells of Cajal. Although GIST can be found anywhere in the digestive tract, most occur in the stomach (60%) and small intestine (25%).
- Carcinoid tumors are tumors that start in hormone-producing cells of the stomach. Most of these tumors do not spread to other organs. About 3% of stomach cancers are carcinoid tumors.
There are two distinct types of gastric adenocarcinoma: intestinal and diffuse. The intestinal variety are well-differentiated, with cells tending to arrange into tubular or glandular structures, giving rise to the designation as tubular, papillary, or mucinous. Rarely, adenosquamous cancers can occur.
Diffuse adenocarcinomas are undifferentiated or poorly differentiated and lack a gland formation. This type of adenocarcinoma can infiltrate the gastric wall (i.e., linitis plastica).
Some tumors can have mixed features of intestinal and diffuse types.
What are the risk factors for gastric cancer?
Acknowledged risk factors for gastric cancer include:
- Helicobacter pylori gastric infection
- Advanced age
- Male gender
- Diet low in fruits and vegetables
- Diet high in salted, smoked, or preserved foods
- Chronic atrophic gastritis
- Intestinal metaplasia, a condition in which the normal stomach lining is replaced with the cells that line the intestines
- Pernicious anemia
- Gastric adenomatous polyps
- Family history of gastric cancer
- Cigarette smoking
- Ménétrier disease (giant hypertrophic gastritis)
- Epstein-Barr virus infection
- Familial syndromes, including familial adenomatous polyposis
What are the symptoms of gastric cancer?
Unfortunately, the early symptoms of gastric cancer can be caused by many common ailments and are often dismissed as such. Because of this, the majority of patients have symptoms of advanced stage disease at the time of presentation.
In the early stages of gastric cancer, the following symptoms may occur:
- Indigestion and stomach discomfort
- A bloated feeling after eating
- Mild nausea
- Loss of appetite
In more advanced stages of gastric cancer, the following signs and symptoms may occur:
- Blood in the stool
- Weight loss for no known reason
- Stomach pain
- Trouble swallowing
Prognosis and Survival
According to the National Cancer Institute:
“The prognosis of patients with gastric cancer is related to tumor extent and includes both nodal involvement and direct tumor extension beyond the gastric wall. Tumor grade may also provide some prognostic information.
“In localized distal gastric cancer, more than 50% of patients can be cured. However, early-stage disease accounts for only 10% to 20% of all cases diagnosed in the United States. The remaining patients present with metastatic disease in either regional or distant sites. The overall survival rate in these patients at 5 years ranges from almost no survival for patients with disseminated disease to almost 50% survival for patients with localized distal gastric cancers confined to resectable regional disease. Even with apparent localized disease, the 5-year survival rate of patients with proximal gastric cancer is only 10% to 15%. Although the treatment of patients with disseminated gastric cancer may result in palliation of symptoms and some prolongation of survival, long remissions are uncommon.”
Treatment of Gastric Cancer
For early-stage disease, surgical resection with regional lymphadenectomy is the treatment of choice. Resection for those with later-stage disease may be coupled with chemotherapy, radiation therapy, targeted therapy with monoclonal antibody or multikinase inhibitors, immunotherapy, or a combination thereof.
Drugs approved by the FDA for treatment of gastric cancer include:
- Ramucirumab (Cyramza)
- Doxorubicin hydrochloride
- Fam-trastuzumab deruxtecan-nxki (Enhertu)
- Trastuzumab (Herceptin)
- Pembrolizumab (Keytruda)
- Trifluridine and tipiracil hydrochloride (Lonsurf)
- Mitomycin (Jelmyto)
- Nivolumab (Opdivo)
FDA approved drug combinations:
A list of clinical trial for patients with gastric cancer can be found here.
Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.