Toby Keith, 62, died on Monday night after being diagnosed with stomach cancer more than two years earlier.
Keith disclosed on X in June 2022 that he had been diagnosed in the fall of 2021 and had already undergone chemotherapy, radiation therapy, and surgery.
Then, in June, he informed The Oklahoman newspaper in Oklahoma City that his tumor had decreased by a third and that he was still undergoing chemotherapy. He also said he received immunotherapy, which is a type of drug that helps the immune system eliminate cancer cells.
His death has prompted doctors to emphasize the need to look for indicators of stomach cancer, such as heartburn, acid reflux, anemia, nausea, ulcers, pain after eating, abrupt weight loss, or feeling full after eating tiny amounts.
“Many of these are relatively benign. But, of course, that’s how cancer takes you,” said Dr. Fabian Johnston, division chief of gastrointestinal oncology at Johns Hopkins Medicine.
According to Johnston, clinicians and patients may dismiss symptoms such as acid reflux as innocuous, delaying diagnoses. Many people have severe disease by the time they have symptoms, he said.
The typical age at diagnosis is 68, with men having a slightly higher risk.
The American Cancer Society predicts that over 27,000 new cases of stomach cancer will be diagnosed this year, despite the fact that the disease remains relatively rare, accounting for only about 1.5% of new malignancies diagnosed in the United States each year.
Overall, stomach cancer diagnoses have decreased modestly over the last decade. However, rates among persons under the age of 50 are increasing, for unknown reasons.
“There’s something going on — something we’re eating, something we’re ingesting, some combination of modern and current factors — that is resulting in these increased cancers in young people,” said Dr. Ben Schlechter, a gastrointestinal medical oncologist at Dana-Farber Cancer Institute in Boston.
According to Schlechter, alcohol and tobacco, which were historically prominent causes of stomach cancer, are now associated with a minority of instances in the United States, possibly due to reduced smoking rates.
Instead, many new cases have been discovered in persons suffering from persistent acid reflux or infections with Helicobacter pylori, a bacteria that causes stomach inflammation. However, experts have not determined why some persons with those factors get stomach cancer and others do not.
For many people right now, “it’s a disease of bad luck,” Schlechter said. “Maybe there’s a link with H. pylori infections. Maybe there’s a history of heartburn or reflux, but it’s not always evident.”
Schlechter stated that stomach cancer is often more aggressive than other malignancies.
“It does not indicate that people are about to die. It simply implies that the tools we have to treat them are limited,” he explained. “People do pretty well compared to 15 years ago, but we are hardly at the level of, say, breast cancer, where the commanding majority of people are cured with surgery and chemotherapy and things like that.”
Adenocarcinomas begin in the stomach’s innermost lining and account for up to 95% of stomach malignancies in the United States. The malignancy may then spread to the stomach’s wall, body, or lymph nodes.
Dr. Rutika Mehta, a medical oncologist in the Gastrointestinal Oncology Program at Moffitt Cancer Center in Tampa, Florida, said that patients whose cancer has not spread frequently undergo or receive chemotherapy, immunotherapy, or a combination of these treatments.
“In more advanced cases, we are not yet at a point where we can offer patients a ‘cure,'” Mehta said in an e-mail. She did, however, say that chemotherapy or immunotherapy could help people live longer lives.
Doctors are also becoming more adept at matching patients with medicines that target specific proteins associated with stomach cancer. For example, certain stomach cancers express the HER2 gene, which has also been related to breast cancer.
“Some of the medications that function in HER2 breast cancer also work in HER2 gastric cancer. “So we can now give those drugs to people with stomach cancer and significantly increase their benefit from treatment,” Schlechter explained.
Though the disease’s outcomes are “generally poor,” he stated that they are “much better than they used to be.”