By Kyle Melnick for Washington Post
Country music fans paid tribute this week to singer and guitarist Toby Keith after he died Monday at the age of 62. Keith was receiving treatment for stomach cancer, and his death raised awareness for the condition.
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The country music star was diagnosed with stomach cancer in the fall of 2021. Although it is less common than cancers of the breast, lung, prostate and colon, about 10,880 people die of stomach cancer annually in the United States, according to the American Cancer Society.
The Washington Post spoke with medical experts and doctors about its causes, symptoms and treatments.
Some lifestyle choices can increase people’s risk of developing stomach cancer. Smoking, eating unhealthy foods and drinking alcohol have been linked to stomach cancer, according to Meira Epplein, a professor for Duke University’s School of Medicine.
Another cause stems from bacteria called Helicobacter pylori, which is contagious and causes stomach infections, Epplein said. The bacteria is harmless to most people, Epplein said, but about 3 percent of people who have it develop stomach cancer.
Genetics can also play a role, experts said.
“Anybody who has a strong family history of stomach cancer … they’d be potentially at higher risk,” said Matthew Reilley, a professor for the University of Virginia School of Medicine.
The cancer is most common in those over the age of 60 and among men, according to David Bentrem, a surgery professor at Northwestern University’s Feinberg School of Medicine.
What are the symptoms of stomach cancer?
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Epplein said the symptoms of stomach cancer are similar to other digestive conditions, such as gastritis and peptic ulcers. She said symptoms include stomach pain, vomiting and bloating.
Reilley said heartburn, indigestion and unexpected weight loss are other symptoms. Acid reflux is another warning sign, Bentrem said.
The cancer is discovered late in some cases because some symptoms don’t appear until it has already progressed, according to Jennifer Eads, an oncologist at the University of Pennsylvania’s Abramson Cancer Center.
“Sometimes people don’t really have a symptom, necessarily, when it’s in the very early stage,” Eads said.
Many stomach cancer cases are diagnosed after an upper endoscopy, which requires doctors to insert a tube through the mouth — with a camera attached — to examine the stomach. Other cases are diagnosed with CT scans, medical experts said. After that, a biopsy is conducted to examine the stomach tissue.
“It’s not like some other cancers where we have a screening type of test,” Eads said. “Breast cancer patients get a mammogram, or colon cancer can be identified with a screening colonoscopy. So, unfortunately, we don’t have something like that that’s used broadly across all populations.”
There are two primary treatments for stomach cancer: surgery and chemotherapy.
If the cancer is in its early stages, doctors can remove the lesions from inside the stomach. But if the cancer has spread, doctors often remove parts of the stomach — or in some cases, the entire organ, experts said. Those patients store food and fluids in their esophagus and must eat smaller meals.
Chemotherapy is also used to try to attack cancer cells. Immunotherapy and radiation are other treatment options. Doctors can use all of those treatments or just one, experts said.
When patients are diagnosed with Stage 4 stomach cancer, experts said they try to control the cancer, but it often has spread too far to cure.
Keith did not specify the stage at which he was diagnosed, but he wrote on Instagram in June 2022 that he had undergone surgery and was receiving chemotherapy and radiation treatments.
What is the prognosis if you are diagnosed with stomach cancer?
Survival rates differ depending on the stage at which stomach cancer is caught. About 75 percent of patients whose cancer has not spread beyond their stomachs are still alive five years after their diagnoses, according to the National Cancer Institute. For patients whose cancer has spread beyond the stomach to other parts of the body, that five-year survival rate drops to lower than 36 percent.
If the cancer is in Stage 3 or Stage 4, patients often die within a year or two. “That’s pretty dismal,” Epplein said. As with most cancers, Eads said, early diagnosis can be the difference between life and death.
“It is one of the more aggressive cancers,” Eads said. “And we don’t have a really high success rate with curing people, even when they have had a surgery.”
Can stomach cancer be prevented?
The best ways to prevent stomach cancer are by making healthy lifestyle decisions, Reilley said. Those include eating more fruits and vegetables and reducing consumption of preserved and processed foods, and avoiding tobacco and alcohol. Epplein said doctors can test patients for H. pylori via a stool or breath test. If people have the bacteria, it can be treated with antibiotics, she said. It’s also important to check for symptoms and speak with a doctor soon after noticing them, Epplein said. “Paying attention to symptoms so you catch it before it’s late stage with such a high mortality rate … would really be a way to help prevent so many of the severe cancers,” she said.
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