After Toby Keiths death, doctors warn that stomach cancer signs are easy to miss

Country singer Toby Keith died Monday night at age 62, more than two years after he was diagnosed with stomach cancer.

In June 2022, Keith announced on X that he had been diagnosed in fall 2021 and had already received chemotherapy, radiation and surgery. 

Then last June, he told The Oklahoman newspaper of Oklahoma City that his tumor had shrunk by a third and that he was continuing chemotherapy. He also received immunotherapy, he said — medicine that helps the immune system destroy cancer cells.

His death has sparked renewed calls from doctors to pay attention to signs of stomach cancer, which include heartburn, acid reflux, anemia, nausea, ulcers, pain after eating, sudden weight loss or feeling full after eating small amounts.

“A lot of these things are relatively innocuous. But of course with a cancer, that’s how it gets you,” said Dr. Fabian Johnston, the division chief of gastrointestinal oncology at Johns Hopkins Medicine.

Johnston said doctors and patients may be inclined to dismiss symptoms like acid reflux as harmless, which can delay diagnoses. By the time symptoms appear, many already have advanced disease, he said.

The average age of diagnosis is 68, and men have a slightly higher risk. 

The American Cancer Society estimates that nearly 27,000 new cases of stomach cancer will be diagnosed this year, though the disease is still relatively rare: It makes up around 1.5% of new cancers diagnosed in the U.S. each year.

Overall rates of stomach cancer diagnoses have also declined slightly over the last 10 years. But rates among adults younger than 50 are rising, for reasons that aren’t clear.

“There’s something that’s going on — something we’re eating, something we’re ingesting, some combination of factors that’s modern and present — which is resulting in these increased cancers in young people,” said Dr. Ben Schlechter, a gastrointestinal medical oncologist at Dana-Farber Cancer Institute in Boston.

Schlechter said alcohol and tobacco — once common contributors to stomach cancer — are now associated with a minority of cases in the U.S., perhaps because people are smoking less.

Instead, many new cases are found in people with chronic acid reflux or infections with a bacterium called Helicobacter pylori, which can cause inflammation in the stomach. However, scientists haven’t pinpointed why certain people with those conditions get stomach cancer and most do not.  

For many patients right now, “it’s a disease of bad luck,” Schlechter said. “Maybe there’s an association with H. pylori infection. Maybe there’s a history of heartburn or reflux, but usually it’s not as clear.”

Schlechter said stomach cancer is generally aggressive compared to other cancers. 

“It doesn’t mean that people are imminently dying. It just means that the tools that we have to cure them are pretty limited,” he said. “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.”

Up to 95% of stomach cancers in the U.S. are adenocarcinomas, which start in the innermost lining of the stomach. From there, the cancer may spread to the stomach wall, the body of the stomach or the lymph nodes. 

Patients whose cancer hasn't spread often undergo or receive chemotherapy or immunotherapy or a combination of these options, said Dr. Rutika Mehta, a medical oncologist in the Gastrointestinal Oncology Program at Moffitt Cancer Center in Tampa, Florida.

"In more advanced cases, we are not yet at a point where we can offer patients a ‘cure,’” Mehta wrote by email. However, she added that chemotherapy or immunotherapy may help prolong lives. 

Doctors are also getting better at matching patients with treatments that target specific proteins associated with stomach cancers. For instance, some stomach cancers express a gene called HER2, which is also linked to breast cancer.

“The drugs that work in HER2 breast cancer to some degree work in HER2 gastric cancer. So we can now give those drugs to people with stomach cancer and substantially boost their benefit from treatment," Schlechter said.

Though outcomes of the disease are "generally poor," he said, they're "much better than they used to be."

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