Toby Keith's Openness and What Stomach Cancer Really Is

What Toby Keith said

Toby Keith made his diagnosis public in June 2022, six months after treatment began. "Last fall I was diagnosed with stomach cancer," he wrote. "I've spent the last 6 months receiving chemo, radiation and surgery. So far, so good. I need time to breathe, recover, and relax."

He had been diagnosed in the fall of 2021. He kept sharing updates, and played three sold-out shows in Las Vegas in December 2023.

Keith died on February 5, 2024, at 62, after more than two years living with stomach cancer. A message on his website said he "passed peacefully last night on February 5th, surrounded by his family," that he "fought his fight with grace and courage," and asked for privacy for his family.

That is what he and his family chose to share, and this article adds nothing to it. What it can add is an account of a cancer most Americans know little about, and that has one preventable cause.

What stomach cancer is

The National Cancer Institute states that gastric adenocarcinoma accounts for 90% to 95% of all gastric malignancies. Adenocarcinoma means the cancer starts in the gland cells of the stomach lining.

Location matters more than people expect. The gastric cardia is the part of the stomach where the esophagus joins it. Cancers there behave differently from noncardia cancers lower down. NCI notes that noncardia gastric cancer has been falling overall in the United States. Meanwhile cardia and gastroesophageal junction cancers rose sharply from the 1970s into the 1990s. NCI also flags a rise in noncardia gastric cancer among people aged 25 to 39, and says the reasons for these shifts are unclear.

The infection behind much of it

This is the part worth knowing. NCI's fact sheet on Helicobacter pylori states that the majority of cases of gastric adenocarcinoma and gastric MALT lymphoma are attributed to H. pylori infection.

H. pylori is a bacterium that lives in the stomach lining and can persist for decades, usually without symptoms. Researchers think the long-term inflammatory response it provokes predisposes stomach lining cells to become cancerous.

The consequence is unusual in cancer medicine. NCI reports that treatment to wipe out H. pylori lowers the risk of gastric cancer. That holds in people without symptoms, in people at higher risk from family history, and in people who have already had surgery for early gastric cancer. The treatment is a course of antibiotics plus a drug that suppresses stomach acid.

NCI's clinician guidance lists the other known risk factors. They include older age and male sex. They include a diet low in fruits and vegetables, and one high in salted, smoked, or preserved foods. They also include chronic atrophic gastritis, intestinal metaplasia, pernicious anemia, stomach polyps, a family history of the disease, and smoking.

Risk factors describe populations. They never explain one person's cancer.

When to get checked

NCI puts the problem in one sentence: early on, stomach cancer usually does not have symptoms, and symptoms usually begin after the cancer has spread.

When early symptoms do appear, NCI lists indigestion and stomach discomfort, a bloated feeling after eating, mild nausea, loss of appetite, and heartburn. Every one of those describes an ordinary bad week.

NCI lists these as symptoms of advanced stomach cancer, in addition to the earlier ones:

• Blood in the stool.
• Vomiting.
• Weight loss for no known reason.
• Stomach pain.
• Jaundice, meaning yellowing of the eyes and skin.
• Ascites, a buildup of fluid in the abdomen.
• Trouble swallowing.

Useful thresholds, given how bland the early list is:

• Indigestion or heartburn that is new, has lasted more than a few weeks, and is not settling with over-the-counter treatment. Persistence is the signal, not severity.
• Feeling full after only a few bites, repeatedly.
• Any weight loss you did not intend, especially paired with appetite loss.
• Black or tarry stools, or vomit that contains blood. Those need urgent care today.
• New difficulty swallowing at any age.

If indigestion is a regular part of your life, it is reasonable to ask whether you should be tested for H. pylori. A breath test, a stool test, or a biopsy taken during endoscopy can find it, and eradicating it is a treatment with a known effect on cancer risk. There is no general stomach cancer screening program in the United States.

What treatment involves

NCI describes surgery as the main treatment. A subtotal gastrectomy takes out the part of the stomach holding the cancer. It also takes nearby lymph nodes and some surrounding tissue. A total gastrectomy takes the whole stomach, nearby nodes, and parts of the esophagus and small intestine. The surgeon then joins the esophagus straight to the small intestine, so the person can eat and swallow.

Other procedures address blockage rather than the tumor. An endoluminal stent holds open a blocked passage. Endoluminal laser therapy opens an obstruction. A gastrojejunostomy connects the stomach to the jejunum so food and medicine can pass.

Drugs come next. NCI lists a long roster of chemotherapy agents for stomach cancer, among them fluorouracil, oxaliplatin, cisplatin, and paclitaxel. Radiation is used at times. Targeted drugs include trastuzumab and ramucirumab. Immunotherapy options include nivolumab and pembrolizumab. Biomarker testing decides which of these, if any, fit a given tumor.

What the numbers describe

These are group figures across a whole country, not a forecast for anyone.

SEER, the federal cancer statistics program, carries American Cancer Society projections of 31,510 new stomach cancers in the United States in 2026, about 1.5% of all new cancers, and 10,740 deaths. Five-year relative survival across all stages is 39.8% for people diagnosed between 2016 and 2022. Stomach cancer is most often diagnosed between ages 65 and 74.

Stage separates those outcomes sharply. In that same 2016 to 2022 group, SEER records five-year relative survival of 78.1% for localized disease, 39.0% for regional disease, and 8.1% once the cancer is distant. About 32% of cases are localized at diagnosis and 35% are already distant.

NCI's clinician guidance adds two details that matter. In localized distal gastric cancer, more than 50% of patients can be cured. But early-stage disease accounts for only 10% to 20% of cases diagnosed in the United States, and even with apparently localized disease, five-year survival for proximal gastric cancer is only 10% to 15%.

That gap between what treatment can achieve and how late the disease is usually caught is the whole problem with stomach cancer. It is also why an indigestion that will not go away is worth one appointment.

Sources

• NCI: Gastric Cancer Treatment (PDQ) — Health Professional Version
• NCI: Symptoms of Stomach Cancer
• NCI: Treatment for Stomach Cancer
• NCI: Helicobacter pylori and Cancer Fact Sheet
• SEER Cancer Stat Facts: Stomach Cancer
• TODAY: Toby Keith died at 62 due to stomach cancer diagnosis — a timeline of his health