Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

See all office information »

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Overview

Your stomach is the muscular hollow organ located in the upper part of your abdomen, below your ribs, that stores and digests food. Cancer that begins in this J-shaped organ is called stomach cancer, or sometimes gastric cancer.

Stomach cancer can form anywhere in the stomach and may spread to nearby lymph nodes, the bean-shaped organs that help your body fight infections. It can also spread to other organs, such as the lungs or liver. Cancer that spreads from where it started to a new part of the body is called metastatic cancer.

If cancer develops, the normal cells in your stomach start to change and grow uncontrollably. Over time, a mass called a tumor may form in the lining of the stomach. The cancer may then grow outward through additional layers of the stomach. The stomach has a total of 5 layers, but most cancers start in the innermost layer, where stomach acid and the enzymes that help digest food are made.

Almost all stomach cancers are a type called adenocarcinoma, which begins in the glandular cells lining the inside of your stomach. Glandular cells secrete mucus that protects the stomach lining from damage by the acid needed for digestion. Rarely, cancer starts in other types of cells in the stomach. These rare stomach cancers include lymphoma (develops from immune system cells), carcinoid tumor (develops from hormone-producing cells), and gastrointestinal stromal tumor (develops from nervous system cells).

It can take years for stomach cancer to develop. Often precancerous changes occur first, but these changes can go undetected because they may not cause symptoms. Stomach cancer is much less common in the United States than in other parts of the world, likely due to differences in diet and a higher rate of infection with a bacterium called Helicobacter pylori in certain other countries.

Understanding stomach cancer and what to expect can help you make informed decisions about your care and give you the tools you need to cope with the disease.

Risk Factors

A risk factor is something that increases your chances of developing a condition or disease such as cancer. For stomach cancer, we have identified several factors that may increase your risk:

  • Helicobacter pylori (H. pylori) infection. Infection with a common bacterium called Helicobacter pylori can cause stomach cancer because it affects the innermost lining of your stomach. In addition to increasing the risk of cancer, the germ can cause stomach ulcers and other digestive problems. Most people infected with H. pylori, however, never develop cancer or other conditions. If you are diagnosed with H. pylori, antibiotics can kill the bacteria.
  • Diet. The risk of stomach cancer is higher in people whose diets include large amounts of smoked, salted, or pickled foods. However, eating a diet high in fresh fruits and vegetables and whole-grain foods may lower the risk of stomach cancer.
  • Smoking. People who smoke are at higher risk for stomach cancer.
  • Age. The risk of developing stomach cancer increases as you get older. Most patients are in their 60s and 70s when diagnosed.
  • Gender. Stomach cancer affects more men than women.
  • Pernicious anemia. A blood disease called pernicious anemia increases the risk of stomach cancer. In this condition, the stomach cannot properly absorb vitamin B12, causing a severe drop in red blood cells.
  • Previous stomach surgery. Long-term stomach inflammation can occur after surgery to remove part of your stomach, a strategy that may be used to treat ulcers and other noncancerous conditions.
  • Inherited cancer syndromes. Certain inherited conditions increase the risk of stomach cancer. These conditions are rare and include hereditary diffuse gastric cancer, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis.

Having 1 or more risk factors does not mean you will develop stomach cancer. For example, H. pylori infection is common, but few people with the infection get stomach cancer. Sometimes, people develop stomach cancer even though they have no risk factors.

Nevertheless, knowing the risk factors for stomach cancer can help you take action to lower your risk. If you are a current smoker, talk to us about ways to help you quit. We can help you make lifestyle changes to improve your nutrition. If there is a family history of stomach cancer, we can talk with you about genetic counseling and testing.

Symptoms

It is important to know the possible indications of stomach cancer so we can evaluate your symptoms as soon as possible. You may not experience symptoms until the cancer grows larger. Symptoms of stomach cancer include:

  • Discomfort or pain in the abdomen, typically above the navel
  • Bloating
  • Feeling full after eating a small meal
  • Heartburn or indigestion
  • Loss of appetite
  • Unintentional weight loss
  • Nausea
  • Vomiting, sometimes with blood
  • Diarrhea or constipation
  • Blood in stool

These symptoms may be caused by health problems other than stomach cancer, such as an ulcer or stomach virus. It is important that we assess your symptoms to figure out what is causing them.

Diagnosis

There are a number of methods to diagnose stomach cancer. We review your medical history, including the presence of risk factors or any symptoms. A physical exam can check for bloating and other signs of stomach cancer. We may then use various tests to diagnose the disease, including:

  • Upper endoscopy. The primary test used to find stomach cancer is an upper endoscopy. During the test, we guide a thin, flexible tube (endoscope) with a light and video camera on the end down your throat. We examine the lining of your esophagus, stomach, and the first part of your small intestine. We remove (biopsy) samples of any abnormal areas to check them for cancer cells under a microscope.
  • Barium swallow. You drink a liquid that contains barium, a silver-white compound that coats your esophagus and stomach. The coating makes it easier to see tumors or other abnormalities on X-rays.
  • Endoscopic ultrasound. We use an endoscope with a probe at the end that gives off sound waves to create an image from inside your stomach. This test allows us to see how big the tumor is and whether it has grown into surrounding tissues or nearby lymph nodes. If we see swollen lymph nodes, we will remove a sample to determine whether cancer is present.
  • Imaging scans. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) take pictures of areas inside the body to determine whether and how far the cancer has spread.
  • Laparoscopy. After stomach cancer is diagnosed, we may perform a minimally invasive surgery to check whether and where the cancer has spread. During the procedure, we make 1 or more small cuts in your abdomen. We insert a thin tube with a light and video camera on the end to see the areas around your stomach, such as the lining of the abdominal cavity. We may remove lymph nodes and tissue samples to determine whether the cancer has spread.
  • Octereotide. For stomach tumors that begin in either endocrine or nerve tissue origin, nuclear medicine imaging with an agent known as octereotide can help determine the extent of the disease. Octereotide works by attaching itself to receptors, known as  somatostatin receptors, found on the surface of the tumors. As a group, these tumors are also called gastroenteropancreatic neuroendocrine tomors.

We may also check your stool for blood and perform other tests to learn more about your disease. For example, some stomach tumors produce high amounts of a protein called HER2, which helps the cancer grow. We may test your tissue samples for HER2 because a drug is available to treat cancers that test positive.

Staging

We use information gathered from the various diagnostic tests to pinpoint the size of your cancer and how much it has spread. Knowing the extent (stage) of your stomach cancer helps us determine what treatment plan is best for you. We consider a number of factors when staging your cancer. These include:

  • How far the tumor has grown into the wall of your stomach and other nearby areas
  • Whether cancer is found in lymph nodes near the stomach
  • Whether it has spread (metastasized) to other parts of your body

The stages range from 0 to 4, with stage 0 being confined to a very small area and stage 4 referring to widespread disease. The stages for stomach cancer are:

  • Stage 0. In this very early stage of stomach cancer, which is also known as carcinoma in situ, cancer cells are found only in the top layer of cells that line your stomach.
  • Stage 1. Cancer has grown beyond the top layer of cells into tissue below. It may have spread to 1 or 2 nearby lymph nodes.
  • Stage 2. The tumor has invaded deeper layers of the wall of your stomach, and cancer may have spread to more lymph nodes.
  • Stage 3. Cancer has grown through most or all layers of the stomach wall and to nearby lymph nodes. Or cancer may be found in lymph nodes as well as nearby organs, such as your liver or spleen.
  • Stage 4. Cancer has spread to distant parts of your body.

Treatment

We will discuss the treatment options and develop a plan that is right for you. Standard treatment options for stomach cancer include surgery, chemotherapy, radiation therapy, and targeted therapy.

Additional References:

Lifestyle Changes

Eating habits

Stomach cancer and its treatments can affect your nutrition. Eating may be difficult if you have had all or part of your stomach removed. You may get full more quickly and experience indigestion, cramps, and other problems. You may also experience diarrhea, nausea, vomiting, and mouth sores while receiving chemotherapy and radiation therapy.

There are ways to manage these symptoms so you get the nutrition you need during and after treatment for stomach cancer. Here are tips for how to establish and maintain good nutrition:

  • Instead of 3 large meals a day, eat small frequent meals throughout the day. Eating too much at once can cause undigested food to enter your small intestine too quickly. This results in dumping syndrome, which causes cramps, nausea, diarrhea, and other symptoms.
  • Limit drinks with meals. This helps prevent getting full quickly.
  • Eat slowly. Take your time and give your body the chance to digest foods.
  • Avoid foods that are sugary, spicy, and fatty. Also avoid carbonated beverages and alcohol. This can help prevent indigestion, nausea, and diarrhea.
  • If treatment caused you to lose weight, eat foods high in calories and protein. These include nuts, cheese, eggs, beans, and yogurt. You can also use whole milk when making oatmeal or other recipes that include milk.
  • If you have mouth sores, choose foods that are soft or moist. These include pudding, milkshakes, cream soups, mashed potatoes, yogurt, and eggs. You can also add broth or gravy to foods to make them easier to chew.
  • Take vitamin supplements. The stomach helps the body absorb vitamins, so you may need vitamin supplements if part or all of your stomach is removed.

Medications may also be used to control your symptoms. In addition, a nutrition expert can help you create an eating plan to deal with specific side effects you might experience.

Coping with fatigue

Stomach cancer and its treatments can cause a type of fatigue that is not relieved with sleep. Sometimes called cancer-related fatigue, it can affect your quality of life.

Regular physical activity for 30 minutes at least 3 times a week can increase your energy. Walking is an easy and effective option. Talk with us about your plans for physical activity so that we can develop an exercise plan that is right for you. Here are some additional tips to deal with cancer-related fatigue:

  • Conserve your energy by not rushing through tasks. Take your time and spread out tasks to allow time for rest.
  • Take a nap if you need one, but limit it to no more than 30 minutes.
  • Ask family members, friends, or neighbors for help with running errands or doing yard work or household chores.
  • At the grocery store, use a motorized cart instead of pushing a cart.
  • Have a sleep routine in which you get up and go to bed at roughly the same time every day.
  • Avoid caffeinated beverages and foods in the evening.

Follow-Up Care

When you finish treatment for stomach cancer, we will work with you to develop a plan for follow-up care. We will conduct regular checkups to monitor your recovery and to immediately catch any signs of the cancer coming back or getting worse.

Follow-up appointments are an important part of your cancer care. We will see you 2 to 3 times a year for the first few years after treatment. We will then see you at least once a year after that. During these regular visits, we do physical exams and check for side effects of treatment. X-rays or other tests may be done to look for any problems.

Stomach surgery can affect your body’s ability to absorb certain vitamins and minerals, so we may regularly test your blood to check vitamin levels. You may need to take vitamin supplements if levels are low.

Follow-up appointments are also an opportunity to tell us about any symptoms you are experiencing and any concerns you have so we can help you. We work closely with you to make sure you are getting the nutrition you need, so it is important to let us know if you start having trouble eating or experience other problems that affect your ability to eat.

Finding support, either from a trained professional or through a support group, can help you cope with life during and after cancer. We also encourage you to follow guidelines for good health, which can help your recovery. These include:

  • Eat a healthy diet.
  • Do not smoke.
  • Engage in exercise regularly.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Podcasts

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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