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Stomach Cancer

Stomach Cancer

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Overview

Stomach cancer, also known as gastric cancer, begins in the stomach. While its cases have dropped significantly in the last two decades, it remains one of the most common cancers worldwide. The most frequent type, adenocarcinoma, develops in the stomach’s inner lining. Other types can form in the middle or outer layers, but they are much less common.

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What is Stomach Cancer (Gastric Cancer)?

Stomach cancer, also known as gastric cancer, begins in the cells lining the stomach. The stomach, located on the left side of the upper abdomen, plays a key role in digesting food. It is part of the digestive tract, a system of connected hollow organs that process nutrients and remove waste from the body:

  • Food travels from the throat to the stomach through the esophagus.
  • Once in the stomach, muscles mix the food with digestive juices to break it down.
  • The partially digested food then moves into the small intestine, followed by the large intestine.
  • The rectum, the final section of the large intestine, stores waste until it is expelled through the anus during a bowel movement.
Types of Stomach Cancer

Adenocarcinoma of the stomach starts in the mucus-producing cells of the stomach’s inner lining and accounts for nearly all cases of stomach cancer.

Types of Stomach Adenocarcinoma

Stomach adenocarcinoma is classified based on its location:

  • Gastric cardia cancer: Develops in the top portion of the stomach, just below the esophagus.
  • Non-cardia gastric cancer: Occurs in any other part of the stomach.

It is also categorized based on how the cells appear under a microscope:

  • Intestinal adenocarcinoma: The cancer cells are well differentiated, resembling normal stomach cells.
  • Diffuse adenocarcinoma: The cells are poorly differentiated, appearing different from normal cells. This type tends to grow and spread more aggressively, making it harder to treat.
Other Stomach-Related Cancers
  • Gastric cardia cancer: Gastroesophageal junction adenocarcinoma (GEJ): Forms where the esophagus meets the stomach. Treatment may follow approaches for either stomach or esophageal cancer.
  • Gastrointestinal neuroendocrine tumors: Arise from neuroendocrine cells in the digestive tract, which regulate digestive juices and muscle movement in the stomach and intestines.
  • Gastrointestinal stromal tumors (GIST): Develop in nerve cells in the stomach wall and other digestive organs. GIST is classified as a soft tissue sarcoma.
  • Primary gastric lymphoma: A type of non-Hodgkin lymphoma affecting the stomach, most commonly mucosa-associated lymphoid tissue (MALT) lymphoma or diffuse large B-cell lymphoma.
  • Rare stomach cancers: These include squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma, though they are uncommon.

Symptoms

Stomach cancer usually doesn’t cause noticeable symptoms in its early stages. Even common warning signs, such as unexplained weight loss and stomach pain, often don’t appear until the disease has progressed.

Possible Symptoms of Stomach Cancer: 

  • Loss of appetite
  • Trouble swallowing
  • Fatigue or weakness
  • Nausea and vomiting
  • Unexplained weight loss
  • Heartburn or indigestion
  • Black stools or vomiting blood
  • Bloating or gas after eating
  • Stomach pain, often above the belly button
  • Feeling full after eating only a small amount
Causes

Scientists don’t know exactly what triggers cancer cells to grow in the stomach, but several factors can increase the risk. One major factor is infection with Helicobacter pylori (H. pylori), a common bacteria linked to stomach ulcers. Other conditions, such as chronic stomach inflammation (gastritis), pernicious anemia, and stomach polyps, may also raise the chances of developing stomach cancer.

Additional Risk Factors:

  • Smoking
  • Being overweight or obese
  • A diet high in smoked, pickled, or salty foods
  • Regular alcohol consumption
  • Previous stomach surgery for ulcers
  • Type A blood
  • Epstein-Barr virus infection
  • Certain inherited genes
  • Occupational exposure in coal, metal, timber, or rubber industries
  • Asbestos Exposure
  • Family history of stomach cancer
  • Genetic conditions like familial adenomatous polyposis, Lynch syndrome (hereditary non-polyposis colorectal cancer), and Peutz-Jeghers syndrome

Diagnosis

Doctors don’t usually screen for stomach cancer as part of routine checkups. Since the disease isn’t very common, widespread testing isn’t considered necessary. Stomach cancer cases have been declining for the past 60 years.

However, if you have a higher risk, it’s important to talk to your doctor about monitoring options. You may need some of the same tests used to diagnose stomach cancer in people with symptoms.

How Stomach Cancer is Diagnosed

Your doctor will start with a physical exam and review your medical history to check for risk factors or a family history of the disease. If needed, they may recommend tests such as:

01
Blood Tests
Check for markers that could indicate cancer.
02
Upper Endoscopy
A thin, flexible tube with a camera is inserted down your throat to examine your stomach.
03
Upper GI series (barium swallow test)
You’ll drink a chalky liquid containing barium, which helps outline the stomach on X-rays.
04
CT Scan
A detailed imaging test that provides cross-sectional views of your body.
05
Biopsy
A small tissue sample is taken from your stomach, usually during an endoscopy, to check for cancer cells under a microscope.

Treatments

There are several ways to treat stomach cancer, and the best approach depends on how advanced the disease is. The stage of cancer, how much it has spread, guides the treatment plan.

Stage 0
Early Abnormal Cells
At this stage, abnormal cells are found in the stomach lining but haven't turned into cancer yet. Surgery is often enough to remove the affected area. Doctors may take out part or all of the stomach along with nearby lymph nodes, which are part of the body's immune system.
Stage I
Small Tumor in the Stomach Lining
The tumor is still in the stomach lining and may have spread to nearby lymph nodes. Surgery is the main treatment, either removing part or all of the stomach along with affected lymph nodes. Chemotherapy or chemoradiation (a combination of chemo and radiation therapy) may be used before surgery to shrink the tumor or after surgery to destroy remaining cancer cells.
  • Chemotherapy uses drugs to kill cancer cells.
  • Radiation therapy uses high-energy beams to destroy cancer cells.
Stage II
Cancer Spreading Deeper into the Stomach
Cancer has moved deeper into the stomach wall and possibly into nearby lymph nodes. Surgery is still the primary treatment, usually combined with chemotherapy or chemoradiation before or after the operation to increase the chances of success. 
Stage III
Cancer in Multiple Layers or Nearby Organs
By this stage, cancer may have spread through all layers of the stomach and reached nearby organs like the spleen or colon. It might also have spread deeper into the lymph nodes.
  • The usual approach is complete stomach removal (gastrectomy), combined with chemotherapy or chemoradiation. 
  • If surgery isn’t possible, doctors may recommend chemo, radiation, or a combination based on what the patient can handle.
Stage IV
Cancer Spreading to Other Organs
At this stage, cancer has spread to distant organs such as the liver, lungs, or brain. While a cure is unlikely, treatment focuses on managing symptoms and improving quality of life. Options may include:
  • Laser therapy to remove part of the tumor using a small tube (endoscope).
  • Stents (small metal tubes) to keep food flowing between the stomach and other digestive organs.
  • Gastric bypass surgery to reroute food around the tumor.
  • Surgery to remove part of the stomach in some cases.
  • Chemotherapy, radiation, or targeted therapy, attacks cancer cells while sparing healthy ones to reduce side effects.
  • Even in advanced stages, treatments can help ease discomfort and improve daily life.

Prevention

f you have ulcers caused by H. pylori, get treatment. Antibiotics can eliminate bacteria, and other medications can help heal stomach lining damage, reducing cancer risk.

Add more fresh fruits and vegetables to your meals. These foods are rich in fiber and essential nutrients that may lower your risk. Cut back on salty, pickled, cured, and smoked foods like processed meats and smoked cheeses. Maintaining a healthy weight is also important since excess weight can increase the risk.

Using tobacco doubles the risk of stomach cancer, so quitting can make a big difference.

Studies suggest that drinking alcohol regularly may increase the likelihood of stomach cancer. Reducing intake can help lower the risk.

If you take aspirin daily for heart health or use NSAIDs for arthritis, talk to your doctor about potential effects on your stomach.
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Is Stomach Cancer Curable?

Stomach cancer is treatable, especially when caught early. However, it's often diagnosed at a later stage when symptoms appear. Talk to your doctor about the factors that can affect your treatment options and outcomes.

What is the Prognosis (Outlook) for People Who have Stomach Cancer?

The chances of recovery depend on how far the cancer has progressed. Early-stage stomach cancer has a much higher survival rate compared to advanced stages. The five-year survival rate can be around 70% if the cancer is still localized but drops to about 6% if it has spread extensively.

For a clearer understanding of your prognosis, talk to your doctor. Factors like the type of stomach cancer, how far it has spread, your overall health, and how well the cancer responds to treatment all play a role in the outlook.

When should I see my Healthcare Provider?

If you're at higher risk for stomach cancer, talk to your doctor about the benefits and drawbacks of regular screenings. Otherwise, pay attention to any changes in your health. Many symptoms linked to stomach cancer can also be caused by other conditions, and only a medical professional can confirm a diagnosis.

See your doctor if you experience stomach pain, unexplained weight loss, or other symptoms such as:

  • Difficulty eating
  • Nausea
  • Diarrhea
  • Bloody or black stool
What Questions should I ask my doctor?
  • Q1. Where is my cancer located?
  • Q2. What stage is my cancer, and how does it affect my outlook?
  • Q3. What treatment options do I have?
  • Q4. What are the benefits and possible risks of this treatment?
  • Q5. Are there alternative treatments I should consider?
  • Q6. How will my diagnosis and treatment affect my daily life?
  • Q7. Would getting a second opinion be helpful?