Stomach Cancer (Gastric Cancer)

  • Medical Author: Robert J Fingerote, MD, MSc, BSc
  • Medical Editor: Scott H Plantz, MD, FAAEM
  • Medical Editor: Francisco Talavera, PharmD, PhD
  • Medical Editor: Jerry Balentine, DO
Reviewed on 10/20/2022

Things to Know About Stomach Cancer

Stomach cancer
The most common form of cancer that affects the stomach is adenocarcinoma, which arises in the glands of the innermost layer of the stomach.
  • The stomach is a muscular, sac-like organ with a capacity of about 1 liter or quart. It lies along the upper digestive tract between the esophagus and the small intestine.
    • It is normally found in the upper left portion of the abdominal cavity.
    • The stomach serves as a reservoir for food eaten during meals and begins the process of digestion.
    • Its inner lining contains glands that secrete acid and digestive enzymes.
  • Early symptoms of stomach cancer tend to be vague and nonspecific. Seek medical attention if you have any of the following symptoms: mild upper abdominal discomfort associated with nausea and loss of appetite, difficulty swallowing, and feeling of fullness.
  • The most common form of cancer that affects the stomach is adenocarcinoma, which arises in the glands of the innermost layer of the stomach.
    • Gastric cancer tends to spread through the wall of the stomach and from there into the adjoining organs (pancreas and spleen) and lymph nodes.
    • It can spread through the bloodstream and lymph system (metastasize) to distant organs such as the liver, bones, and lungs.
  • The incidence and death rates for stomach cancer have decreased markedly during the past 60 years in the USA.
    • In 1930, stomach cancer was the leading cause of cancer-related deaths among American men.
    • Since then, the death rate in men from stomach cancer in the United States has dropped markedly for reasons which are still being debated.

Stomach Cancer Risk Factors

Age, diet, and stomach disease can affect the risk of developing stomach cancer. Risk factors for stomach cancer include the following:

  • Stomach cancer remains the second most frequent cause of cancer-related death worldwide, with particularly high frequencies in Japan, China, Korea, parts of Eastern Europe, and Latin America. Established risk factors for stomach cancer include the following:
    • Low socioeconomic status
    • Male sex
    • Cigarette smoking
    • Advanced age
    • A prior diagnosis of pernicious anemia (a chronic progressive disease caused by the failure of the body to absorb vitamin B-12)
    • A diet deficient in fresh fruits and vegetables and rich in salted or smoked fish or meats and poorly preserved foods
  • Treating benign stomach or duodenal ulcer disease by removing part of your stomach is associated with an increased risk of cancer developing in the remaining stomach, especially at least 15 years after the surgery.
  • Recent studies have demonstrated a higher frequency of stomach cancer in people chronically infected with Helicobacter pylori, a common cause of chronic gastritis and peptic ulcer disease.
  • A family history of stomach cancer is a further risk factor for the disease.
  • People with blood type A also have an increased risk.

Stomach Cancer Symptoms and Signs

This photograph of adenocarcinoma of the lower part of the stomach was taken through a gastroscope and demonstrates the typical appearance of a gastric tumor with a central area of ulceration.
  • Early signs and symptoms of stomach cancer tend to be vague and nonspecific. Seek medical attention if you have any of the following symptoms:
    • Mild upper abdominal discomfort associated with nausea and loss of appetite
    • Difficulty swallowing because of a tumor involving the upper part of your stomach, near the esophagus
    • Feeling of fullness after taking only a small amount of food
  • The following symptoms may indicate advanced disease:

Stomach Cancer Diagnosis and Staging

Several procedures are used in the diagnosis and staging of stomach cancer. A diagnostic test establishes the presence of the disease, while staging determines its extent and helps to guide treatment decisions.

  • There are 5 stages of stomach cancer based on the extent of the spread of cancer within the stomach and other parts of the body.
    • Stage 0 and I: Tumor and cancer cells are found in the stomach wall and situ.
    • Stage II and III: Cancer spreads to deeper layers of the stomach and lymph nodes
    • Stage IV: Cancer metastasized to other parts of the body.
  • Physical exam and history: An exam of the body to check general signs of health.
  • Gastrointestinal (GI) endoscopy allows a direct view of the area of concern.
  • Complete blood count (CBC): A blood test procedure to check the number of red blood cells, hemoglobin, white blood cells, and platelets.
  • The doctor can also take a sample of tissue (biopsy) to confirm the diagnosis.
  • Once doctors establish the diagnosis, further tests are performed, including the following:
    • Upper gastrointestinal endoscopy with ultrasound imaging (EUS)
    • A PET scan and CT of the chest, abdomen, and pelvis in all but the earliest or lowest-stage cancers of the stomach.
    • Laboratory testing includes the analysis of cancer for specific mutations and genetic amplifications in advanced cases.
    • Barium swallow: A series of x-ray of the esophagus and stomach.

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Stomach Cancer Treatment

The treatment of stomach cancer depends on the results of tests and your overall health.

  • People with advanced heart and lung disease may not tolerate aggressive therapy.
  • Endoscopic mucosal resection is a procedure that uses an endoscope to remove early-stage cancer.
  • Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells such as monoclonal antibodies drugs.
  • Immunotherapy is a treatment that uses the patient's immune system to fight cancer.
  • In many cases, the stomach cancer may have advanced too far for any available treatment to be curative.
    • You will require surgery to be cured. Your stomach is removed entirely, and your esophagus is attached to your small intestine.
    • Surgery may relieve symptoms of obstruction. The upper end of your stomach is connected to your small bowel, bypassing the area of obstruction.
  • Companion treatment with either chemotherapy or radiation may improve your survival following surgery.
  • After your stomach has been removed, your doctor will monitor your disease with repeat CT scans of your abdomen and gastrointestinal endoscopy to make sure cancer does not return.

Stomach Cancer Prevention

It is felt today the number of stomach cancers has decreased because of the following:

  • Improved socioeconomic standards
  • Widespread use of refrigeration for food preservation
  • Adoption of diets rich in fruits and vegetables
  • In areas where the frequency of stomach cancer remains high, such as Japan, screening programs that include upper GI barium studies and, more recently, gastrointestinal endoscopy have improved survival rates. Evidence does not support mass screening of populations with lower rates of stomach cancer.
  • Eliminating Helicobacter pylori infection in people with peptic ulcer disease also may decrease rates of stomach cancer.
  • It has been suggested that people who had portions of their stomachs removed 20 years ago or longer should receive yearly endoscopies. This is because of the increased risk of stomach cancer following such surgery.

Is Stomach Cancer Curable? Survival Rate

Many factors affect prognosis and treatment options.  The chance of recovery and treatment options depend on the following:
  • Early stomach cancer may be amenable to even local removal through the endoscope in centers with experience with that technique.
  • The five-year survival rate is about 68 percent for a person who receives treatment before cancer spreads.
  • Patients with cancers found to have an operable or resectable stage of stomach cancer and who are well enough for major surgery should undergo an adequate removal of as much of the stomach as necessary to ensure adequate clear margins. In some people, this will involve the removal of a portion of the stomach, while in others the entire stomach must be removed. Lymph nodes next to the stomach as removed during these operations as well.
  • In stomach cancers found at an early stage, treatment can result in half of the patients living cancer-free for more than 5 years.
  • The more advanced or higher the cancer stage, the greater the likelihood of cancer recurring elsewhere after surgery, and the greater the likelihood that treatments involving chemotherapy and radiation will be recommended.
  • Stage 4, or metastatic stomach cancer patients are usually only offered surgery to relieve symptoms of obstruction- or blockage. Chemotherapy and radiation may prolong survival but are not curative in stage IV disease.
  • Targeted therapies include the use of monoclonal antibody therapy may be given alone or in combination with chemotherapy in cases of advanced stomach cancer.
  • After your stomach cancer has been removed, and if necessary other treatments given and completed, and you are felt to be free of disease, your doctor will monitor your disease with repeat scans, laboratory testing, and gastrointestinal endoscopy to make sure cancer does not return.
Reviewed on 10/20/2022
Medically reviewed by Jay B. Zatzkin, MD; American Board of Internal Medicine with subspecialty in Medical Oncology


"Clinical features, diagnosis, and staging of gastric cancer"

Stomach Cancer.

Stomach Cancer.