Episode Transcript
Frankye Myers: From Riverside Health System. This is the Healthy YOU podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
All right. I'm really excited to have in the healthy you studio with me today, Dr. Paul Thomas Kröner, Dr. Kröner, is a board certified, fellowship trained, advanced endoscopic and gastroenterologist. That's a mouthful. This episode we're going to be talking about gastric cancer signs, risk and prevention. Welcome to the Healthy YOU, the podcast where we explore everyday health topics and talk to the people who help keep our communities well.
I'm your host, Frankye Myers. Today we're turning our attention to a serious, often silent disease, gastric cancer. While it's less talked about than other cancers, its impact can be profound, especially when not caught early. So early detection is key. The good news is there's growing awareness and advancing tools for both prevention and detection. So, Dr. Kröner, tell us a little bit about how you ended up in this field of medicine.
Dr. Paul Kröner: Well, thank you for the introduction. It's great to be here as well. And I have been at Riverside for the past three years and as an advanced endoscopist, I really get to see very much firsthand how devastating gastric cancer or stomach cancer is in our patients, in their families, in our communities as a whole. So the more I have dwelled into looking at stomach cancer and studying it, the more I realize that it's not really about treatment all that much as much as it is about what you said, prevention for it. Yes, you're absolutely right. It's a silent disease in the sense that it only comes along and we realize that we have it once. It's a little bit too late to realize it, but it's also silent in another very interesting way that you mentioned that we don't really talk about it enough. So thank you for being this platform for us to start talking about it as well.
Frankye Myers: My pleasure. Pleasure. Thank you for taking time out of your busy schedule to talk to talk with us today. Before we dive into the conversation, let's take a look at what the numbers tell us because understanding the scope of gastric cancer can help us better recognize its risk and urgency. According to the American cancer society, in 2025, there will be an estimated 30,300 new cases of stomach cancer in the United States. 17,720 in men and 12,580 in women. Additionally, approximately 10,780 people are expected to die from this disease, including 6,400 men and 4,380 women.
Dr. Paul Kröner: Wow.
Frankye Myers: Stomach cancer accounts for approximately 1.5% of all new cancers diagnosed in the United States each year. It predominantly affects the older individuals, with the average age diagnosis being 68 and about 60% of cases coming in people age 65 or older. The lifetime risk of developing stomach cancer is approximately 1 in 101 for men and 1 in 155 for women. This is where more common again for men. While the overall incident of stomach cancer in the United States has been declining, which is a good thing, by approximately 1.5% annually over the past decade, it remains a significant health concern, especially among certain high risk groups. Dr. Kröner, what should we take away from these numbers?
Dr. Paul Kröner: Great points and many great points to be made out of out of these numbers. As ominous as these numbers sound, it's worthy of mentioning that these numbers tell us one thing and one resounding thing only, which is that stomach cancer happens in the United States. It's here. It involves our lives. We, we all know, either directly or indirectly, someone that may be battling through this, or a family member or friend of a friend as well. One very important thing to make mention about these numbers is that these numbers are a snapshot. They give us a very punctate thing in time where we know that it's 30,000 individuals for the year 2025. We need to look at this also in the perspective of the trend that, that it has been. While the incidence seems to have come down, as you mentioned, the total number of cases, the prevalence of it seems to be going up and it is expected to continue increasing over time. Now this in and out of itself we need to take with a grain of salt because is it really that the total number of cases are increasing or that we're becoming more aware about this disease and actually getting to know more of the cases that we were not diagnosing beforehand? So it's very important to make that distinction. Another very important point that you raise is how lethal this cancer is. And the sad statistic here is that only one in three Americans that are diagnosed with stomach cancer will be alive five years from the time of their diagnosis. That is dismal. That is a call to action. And, and that is also a reflection. We need to look at the root cause of all this. This is A reflection, really, of how late we are making the diagnosis here in the United States. To put a couple added, sprinkle a couple of more numbers onto these statistics. We know that in the United States, only 25% or less of cases of stomach cancer are being diagnosed on an early fashion, meaning on a easily curable, easily treatable stage, Whereas the rest, 3 out of 4, 75% of the rest, are diagnosed at the later stages, requiring very aggressive treatments. And sometimes it is not curable. So what this really tells us is let's go back and ask ourselves, why aren't we diagnosing this early enough? There's virtually no systematic, statewide, national protocols to work up patients for screenings like other things, right?
Frankye Myers: Like colonoscopies for colon, you know, some of those things. And breast cancer.
Dr. Paul Kröner: Exactly. So in its current state, really stomach cancer, we do not indiscriminately screen everyone like we do for breast cancer, or like we do for colonoscopies or whatnot. There is not a current consensus of exactly who needs screening for it. So we're not doing it just yet. But we know that in the places that is being done, like Korea or Japan, the findings of early gastric cancer in the population are within the 60 to 70% range. That is enormous. And it's very important to know that a diagnosis of early gastric cancer, that the survival of this is in an excess of 95 to 99% at five years. So this is how important it is for us to catch it early, because the vast majority of the majority of her patients will benefit from this and be alive in five years.
Frankye Myers: That's great information.
Dr. Paul Kröner: Wow.
Frankye Myers: So let's start with the basic, what exactly is gastric cancer and how does it develop?
Dr. Paul Kröner: Very good question. Gastric cancer is a very, very broad term. There are very different types of gastric cancers out there, divided by pathological state by the location within the stomach itself. But for all practical purposes of this discuss, let's talk about by far the most common type of gastric cancer, which is that of adenocarcinoma. Okay. The gastric Adenocarcinoma represents about 95% of all stomach cancers that are diagnosed. And the interesting thing about this gastric adenocarcinoma is that we've known for quite a while that it has developmental stages ever since it starts as a precancerous lesion up until it becomes the very ominous cancer that it is invading the wall of the stomach. And this sequence of events, we call in the medical world a cascade that was discovered by Dr. Pelayo Correa, which was a Colombian pathologist, he hammered down the details of how it evolved from a normal stomach lining into the full blown cancer. And the key to understand about this cascade, as we call it, is that it starts with inflammation, which may be caused by an infection of the stomach, like Helicobacter Pylori, or H. Pylori for short, that we're going to talk about too. Moving on to damaging the surface lining of the stomach. Then the inception of, or the occurrence, should I say, of anomalous tissue on the inside of the stomach, which we call gastric intestinal metaplasia, progressing to dysplasia, which is by excellence another word to say pre cancer, onto cancer. Now, let's not get carried away in the all these fancy terms that we use. The one thing that we need to understand about this cascade and the positive spin that we can give to this is that every single one of these steps in this cascade is identifiable during an upper endoscopy, a thorough upper endoscopy. When we do that upper endoscopy, we can take some biopsies and we can know which stage of development, whichever lesion we find this, that is absolutely huge and a game changer in the realm of early diagnosis of gastric cancer.
Frankye Myers: Okay, with the colonoscopies typically at the screenings, are they doing upper and lower? Has that become common or. Because I'm in that age group where I'm doing those pre screenings.
Dr. Paul Kröner: Great question. And the answer is, unfortunately, this is not a common practice, an instituted practice. There are many, many ongoing trials that have looked at cost effectiveness analyses, looking into whether it's worth it to do an upper endoscopy at the time of the screening colonoscopy. But these are yet to pour out the data that we need to actually make an official recommendation and very importantly in our world today, for insurance companies to accept this and cover that for our patients.
Frankye Myers: And thank you for clarifying that because, you know, even for myself or even our viewers, you may think because you're doing those things, you're covered, but they may not be a part of that standard screening. So that's great information. So what are some of the early symptoms which I think would be so pivotal for people to look for?
Dr. Paul Kröner: Great question. So when it comes, when it comes to gastric cancer, like we said in the beginning, by the time the symptoms kind of get, get a foothold on our bodies, it's this already means that the cancer is already settled in and more than likely quite advanced. Of course, and this is by Far the most unfortunate thing about this, like other kinds of very ominous cancers, like pancreatic cancer and sometimes colon cancer as well, and other cancers that are silent. By the time that the people who have stomach or gastric cancer develop these symptoms, it means that the cancer is likely already there and we need to act and we need to act fast. To answer your question, the symptoms that people who have stomach cancer develop are very non specific. That means that these symptoms, it can be a lot of other things other than stomach cancer. There's nothing that specifically tells us I have this symptom, so I have stomach cancer. These symptoms include involuntary weight loss, meaning we're losing weight without trying to lose weight. Early satiety, which means we get fat full very quickly with a couple of bites of food. Depending on the location of the cancer, we might have the sensation that food is getting stuck in the lower end of the food pipe as well. We can see blood in the stool or blood in the vomitus as well. And of course abdominal pain, pain in the belly. As you can see, these symptoms are very non specific. But the main point to make about these symptoms is that if you have them speak up, your doctor can work those up. Keep hammering on those issues. We're going to make a lot of emphasis as well that we are our own best advocates for this. Do not dismiss these symptoms. And it's very important to keep working them up until we find out what the cause of this is. While it may be nothing, it may be a lot of things. So do not dismiss the symptoms.
Frankye Myers: This is going to sound like a crazy question, but a lot of screenings have shifted to some, not a lot. There are some screenings now where they're over the counter type things that you can purchase and if all of other risk factors are not there to potentially early identify. Is there something related to gastric cancer? Unfortunately, that it could be some sort of home test or that you could identify potentially early cells.
Dr. Paul Kröner: Frankye, that will be the holy grail of diagnosis for any kind of cancer. Not just stomach cancer, pancreas cancer, any kind of cancer. If we would have a reliable way of telling us, easy, cheap, reliable way of telling us that someone has the risk of having cancer, then that will be the best case scenario for this, for early detection. So to answer your question, unfortunately we do not have that, but we can aspire to get to do that and continue researching on the matter.
Frankye Myers: Thank you. Are there similarities between colon cancer and gastric cancer that our listeners and viewers should be aware of?
Dr. Paul Kröner: Well, indeed, there are some similarities in terms of the symptoms. But as we spoke about, the symptoms are so nonspecific that they can't really point in which direction we're heading, Whether it's gastric cancer or colon cancer. Of course the stomach cancer will give us more upper gastrointestinal symptoms like the sensations in the upper abdomen of the symptoms that we're experiencing. Whereas colon cancer would typically manifest as more lower like symptoms. However, as frustrating as that may sound, one message that we can send our viewers and everyone watching this interview is they do have one very important thing in common, which is they are to some extent preventable. Work them up. Okay. There are differences as well with them in the realm of who gets screening and surveillance. Of course, with colon cancer we have a lot more noise going on on it. There's a lot of colon cancer awareness month and blue ribbon month and the colon cancer walk for this. But really, when was the last time that we are any one of us heard about any doing the stomach cancer walk or the stomach cancer month or not Shave your beard for a month for stomach cancer awareness. There's no such thing. So awareness, awareness, awareness is the main message that we need to start with. And it all starts by talking about, talking about absolutely.
Frankye Myers: So great, great information. Who is most at risk for gastric cancer?
Dr. Paul Kröner: Absolutely. Well, while in theory everyone would be at risk of stomach cancer, there are populations that have heightened risk of stomach cancer. And this is a very important point that we should know because the higher risk individuals, the higher risk people to have stomach cancer are the ones that we really need to put the magnifying glass on and really require this workup diagnostic and follow up workup on. Primarily the people who are most at risk are people who already have any pre cancerous condition of the stomach. These conditions that we briefly alluded to in the cascade of events.
Frankye Myers: Is that because they can metastasize to that area potentially?
Dr. Paul Kröner: No, that's a good question. That's because there has been inflammation of the stomach for any given reason for a chronic period of time that has caused that domino effect of set of events to happen within the stomach. Primarily what we're talking about here is the damage of the inner lining of the stomach, which we called atrophic gastritis, and the anomalous tissue that develops in the stomach that resembles small bowel, which we call gastric intestinal metaplasia. These are by excellence gastric precancerous conditions that significantly elevate the risk of developing gastric cancer. People who have these precancerous conditions which are by the way, very common in the general population. We don't have dedicated population studies, but we estimate that in excess of 10 to 15% of all Americans may already have these pre cancerous conditions.
Frankye Myers: Right.
Dr. Paul Kröner: And people who have these pre malignant conditions and have a strong family history of gastric cancer or belong to an ethnic group that is known to have a heightened risk of developing gastric cancer are populations that we need to really take a look at and really motivate workup and screening and surveillance.
Frankye Myers: Are there modifiable risk factors we can act on to lower our risk?
Dr. Paul Kröner: Well, in theory, yes. They are not as strong of an influence on the development of gastric cancer as the things that we already talked about the precancerous conditions and the family history and the ethnicity of. But there are things that are known to promote the development of gastric cancer, such as alcohol consumption, heavy alcohol consumption, smoking tobacco products, diets which are very high in red meats or smoked meats, pickled foods, heavily pickled foods, diets which are low on fruits and vegetables, among others. So this not only we can tie into the lowering our risk of gastric cancer, but also tie into the many different benefits throughout all our healthcare and cardiovascular risk and metabolic risk that doing these habits could have. So it would be a win, win situation from the perspective of stomach cancer and everything else. Our body will be grateful for it.
Frankye Myers: Okay, all right. We know that early detection saves lives. We talked about that. What screening tools are available and when should someone consider them?
Dr. Paul Kröner: Great. So in this day and age, June 2025, there is no indication to do screening per se for stomach cancer in the general population. So the real discussion needs to be had in risk stratification. Like we talked about plugging the risk factors and saying this person actually a surveillance test or a diagnostic test for it, because he or she has these elevated risk factors that put him at a higher risk of having stomach cancer. Now, again, the current guideline, which is very, very, very much in its infancy stages, and again, a reflection of how little we talked about it, even in the medical world here in the United States, this guideline is only three, three months old.
Frankye Myers: Okay?
Dr. Paul Kröner: Gastric cancer has been here for decades, years, centuries. And up until March, April 2025, is when we really develop more structured guidelines for it. Those guidelines from the American College of Gastroenterology state that only people who have the risk factors that we talked about, the premalignant conditions, plus the family history or the ethnicity, those are the people that we should be screening for. Of course, there are Exceptions to this, people who have very known genetic transmission of familial stomach cancers. Those folks really need screening themselves. But those are a very, very, very small minority of the patients that we're talking about.
Frankye Myers: Okay, so let's also talk a little bit about risk populations and what trends we're seeing.
Dr. Paul Kröner: Yes. So the populations that are at the highest risk are east Asians, East Asians, number one, Koreans, Korean ethnicity, Japanese ethnicity, and other east Asian ethnicities. By far the number one ethnicity associated with an increased risk of gastric cancer are Koreans and Japanese. Coincidentally, these are the countries that have the structured programs that we were talking about for stomach cancer prevention. There is a very, very heavy presence of a Korean population here in the peninsula. We get to see a lot of patients of Korean heritage. And that peninsula is very rich in all other ethnicities as well. Hispanics and African Americans are also at elevated risk of gastric cancer. And that in and out of itself, the ethnicity is a risk factor that we plug into a risk stratification to decide who gets that screening test. Okay.
Frankye Myers: All right. All right. If someone is diagnosed with gastric cancer, what are the next steps in terms of treatment?
Dr. Paul Kröner: Yes, once we get to that point where stomach cancer is diagnosed, it'll depend on how advanced the cancer is. It's not the same to treat the early gastric cancers, which can even be removed. Some of them can endoscopically with a minimally invasive procedure. We're going to talk about that further down the line as well. But we need to know at what stage the cancer is to know what to do. In any case, the most important thing is to connect our patients as swiftly as possible to a multidisciplinary care of doctors and teams, including gastroenterologists, surgeons, oncologists, radiation oncologists, radiologists, nutritionists, and all of us come together with a plan of action to immediately address this factor. Now, the one thing that we need our patients to know is that we're on their side, we're working with them. We want for them to get the care that they need as soon as possible. And thankfully, we have all those resources here at Riverside and all those specialized care teams that will need to be involved to appropriately treat them along those lines.
Frankye Myers: And just a side question. Does AI artificial intelligence, can it help us? Some with risk stratification, it eventually will.
Dr. Paul Kröner: In its present stages, it's all experimental data that's coming out from AI models that are being created. Of course, as little attention as, unfortunately, stomach cancer gets, the attention in the AI world is Also to that level. So the diseases that are actually getting all the attention for AI are things like breast cancer, colon cancer, cervical cancer, and whatnot. But we're getting there. There are people working on it. I am involved in several clinical trials to create AI risk stratification tools, number one, and AI identification models through an endoscopy as well. That will help us. So that's gonna be very big in the coming years.
Frankye Myers: Yeah. I would just think it at every point of entry that a patient may be coming in to access care for various symptoms that may not, to your point, realize that maybe gastric cancer or potential need to be ruled out. Maybe that could prompt some alert, right?
Dr. Paul Kröner: Absolutely.
Frankye Myers: To say, additional screening potentially for this 100%.
Dr. Paul Kröner: And that's exactly one of the things that we have in our program here at Riverside, that we're developing here at Riverside, from the gastric cancer prevention program that we're having, is an automated tool that will flag patients that are at high risk and really put them on all of our radars to get them onto us, to really take a look at them, to put the magnifying glass on and to work up any potential needs.
Frankye Myers: Absolutely.
Dr. Paul Kröner: Less missed opportunities, better care, better access.
Frankye Myers: Everyone wins because they may be going to our urgent care MD Express. And so, you know, and may not be coming routinely, but I think that technology could help so many. So it's great.
Dr. Paul Kröner: Most definitely, you're ahead of that and.
Frankye Myers: Already working very much.
Dr. Paul Kröner: Agreed.
Frankye Myers: What should patients and their families know about recovery and the long term? True north, Right?
Dr. Paul Kröner: Yes. Gastric cancer, as much as a lot of other cancers, is very much uncharted territory in a patient's lives. No one expects to be diagnosed with any kind of cancer. In this particular case, if anyone is diagnosed with stomach cancer again, the most important thing to know is the stage of the cancer, how advanced it is, because that will really give us the direction of what kind of treatments need to be done, what kind of timeframes are we talking about. But since all of that is up in the air, depending on what kind of cancers we're dealing with and what kind of stages of the cancers we're dealing with, then the one thing that we need our patients to know is that we are there for them, to walk with them every single step of the way, to connect them to the care that they need as soon as possible and not only follow up, but follow through with everything that they're fighting with, to give them that best fighting chance at this disease.
Frankye Myers: Absolutely. That's great. So let's Wrap up by talking about prevention and proactive steps. And then what would you say to someone listening or our viewers who might be nervous about their digestive health?
Dr. Paul Kröner: Well, a lot of this subject of stomach cancer is something that we can have some impact on by. From ourselves, by the healthy lifestyle that we live. By not dismissing the symptoms that we need to be reporting whenever that happens, by seeking attention whenever that is needed, Knowing that stomach cancer happens and knowing that we can somewhat do something about it to minimize the risks really gives us as patients some degree of responsibility over ourselves. So my message would be focusing on being proactive ourselves and living a healthy lifestyle and not dismissing any of the symptoms that we may have about this. Knowing our family history, reporting this to our doctors. I mean, we as patients, we know ourselves much better than any doctor that we meet for the first time or any other provider that we meet for for the first time. We need to educate our medical staff, which is on our side on what our body is telling us and help our healthcare teams translate that into our care.
Frankye Myers: Thank you so much for coming and spending time with us and sharing, you know, all of that key information as we wrap up. Anything else that you think would be important just to convey to our viewers and listeners before we wrap up?
Dr. Paul Kröner: Well, great. Knowledge is power. Read about these subjects from reputable sources. Know yourself and your family history. And really, it's all about how proactive we are from ourselves. And again, living our healthy lifestyles and knowing about ourselves that we can really get to do something about. A risk of stomach cancer itself.
Frankye Myers: Absolutely. I think the one thing that I take away is it's preventable and treatable. Right. And catching it early. I think you spent a lot of time reiterating that.
Dr. Paul Kröner: Oh, absolutely. That is, if anything, the main message of this talk is that it's here. We need to know about it, to know how to catch it early in time. Catching it early in time will translate into much better survival rates, into less anxiety, into less unfortunate outcomes that the lethality of stomach cancer, if we let it become in the late stages, would give us otherwise.
Frankye Myers: Yes. And gut health is central to our health. And so we have to start talking about it and making it a priority like we do some of the other screenings, right?
Dr. Paul Kröner: 100%.
Frankye Myers: Dr. Kroenr, thank you so much for sharing such vital information and empowering our listeners today through knowledge and information. Gastric cancer can be a silent threat. Right. But knowledge and awareness and early action can help make a difference in your outcome. All right, so early detection. Right. Early detection every symptom is worth investigating.
Dr. Paul Kröner: Yes.
Frankye Myers: Right. And preventative care is powerful.
Dr. Paul Kröner: 100%. 100%.
Frankye Myers: Thank you so much.
Dr. Paul Kröner: Again, thank you so much, Frankye, for giving us the platform as well and giving a voice to an otherwise silent disease. Again, the first step of getting to the bottom of making gastric cancer less lethal is to talk about it, to know that it's here. Let's give stomach cancer the same level of attention that other cancers get as well.
Frankye Myers: Yes. It's my pleasure. We're stronger together, so this is a part of the work that we're collectively doing. So thank you again and thank you to our listeners for joining us for this episode of Health YOU. If you or someone you know has concerns about their digestive health, we encourage you to visit Riverside's website to learn more about scheduling a screening. Thank you for listening to this episode of Healthy YOU. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
