Stomach cancer, also known as gastric cancer, is a buildup of abnormal cells that form a mass in part of the stomach.
According to the World Health Organization (WHO),
723,000 cancer-related deaths are caused by stomach
cancer each year worldwide. It is the fifth most common cancer worldwide, but the third leading cause of cancer-related deaths.
In the United States, there are approximately
25,500 new cases of stomach cancer each year. It represents 2 percent of all new cancers diagnosed in the country.
The majority of people diagnosed with stomach cancer either already have metastasis or eventually develop it. Metastasis occurs when the cancer spreads from the area in which it first developed.
Around
90 to 95 percent of all stomach cancers are a type referred to as adenocarcinoma of the stomach. In this type, the cancer develops from the cells that form the mucosa, the most superficial lining of the stomach that produces mucus.
Fast facts on stomach cancer
Here are some key points about stomach cancer. More detail and supporting information is in the main article.
- Stomach cancer is the third leading cause of cancer-related deaths.
- The most common type of stomach cancer is adenocarcinoma of the stomach.
- Early symptoms include heartburn, persistent indigestion, and difficulty swallowing.
Symptoms
There are approximately 25,500 new cases of stomach cancer in the US every year
There are several symptoms associated with stomach cancer. However, as they also exist in many other less serious conditions, gastric cancer may be difficult to recognize at first.
It is for this reason that so many people with stomach cancer are not diagnosed until the disease is already advanced.
- a sensation of being very full during meals
- swallowing difficulties, known as dysphagia
- feeling bloated after meals
- frequent burping
- heartburn
- indigestion that does not go away
- stomachache, or pain in the breastbone
- trapped wind
- vomiting, which may contain blood
The following signs and symptoms should be seen as urgent in people at increased risk of developing stomach cancer:
- dysphagia
- indigestion, combined with unexpected weight loss, vomiting, or anemia, as well as fatigue and breathlessness
People aged
over 55 years who develop persistent indigestion should see their doctor.
Individuals who develop indigestion and have at least one of the following in their medical history should also see a doctor:
- a close relative who has/had stomach cancer
- Barret's esophagus
- dysplasia, or an abnormal collection of typically precancerous cells
- gastritis, or inflammation of the lining of the stomach
- pernicious anemia, where the stomach does not absorb vitamin B12 properly from food
- a history of stomach ulcers
When the stomach cancer becomes more advanced, the following signs and symptoms typically become more apparent:
- a buildup of fluid in the stomach, which may cause the stomach to feel "lumpy"
- anemia
- black stools that contain blood
- fatigue
- loss of appetite
- weight loss
Causes
Cancer starts when the structure of DNA changes. When this happens, it can disrupt the instructions that control cell growth.
Cells that should die may not do so, and cells that should be newly created may be produced too rapidly or in an uncontrollable way.
Experts are not sure why some stomach cells mutate and become cancerous. It is not known why only a few people develop stomach cancer.
Outlook
The outlook after receiving a stomach cancer diagnosis is generally poor.
The relative 5-year survival rate, or the likelihood that all people with stomach cancer will survive for 5 years or longer, compared to those without, is around
31 percent. It is low as this type of cancer is often not diagnosed until it reaches a later stage in the U.S.
A person with stage I stomach cancer has a 5-year survival rate of between 88 and 94 percent. At stage III, this decreases to 18 percent.
Early diagnosis is key to improving the outlook for stomach cancer.
Treatment
Treatment for stomach cancer depends on several factors, including the severity of the cancer and the individual's overall health and preferences.
Surgery
The surgeon's aim is to remove the stomach cancer from the body as well as a margin of healthy tissue. This is necessary to make sure no cancerous cells are left behind.
Examples include:
- Removing tumors from the stomach lining in early-stage cancer: The surgeon will use endoscopy to remove very small tumors that are confined to the inside lining of the stomach. This is called endoscopic mucosal resection.
- Subtotal gastrectomy: A part of the stomach is surgically removed.
- Total gastrectomy: The whole stomach is surgically removed.
Abdominal surgeries are significant procedures and may require prolonged recovery time. People may have to stay in hospital for 2 weeks after the procedure. This will be followed by several weeks of recovery at home.
Radiation therapy
In radiation therapy, energy rays are used to target and kill cancerous cells. This type of therapy is not commonly used to treat stomach cancer because of the risk of harming other nearby organs. However, if the cancer is advanced or causing serious symptoms, such as bleeding or severe pain, radiation therapy is an option.
Neoadjuvant radiation
Neoadjuvant radiation refers to the use of radiation therapy before surgery to make the tumors smaller, so that they can be removed more easily.
Adjuvant radiation
Adjuvant radiation is radiation therapy used after surgery. The aim is to kill off any remaining cancer cells around the stomach.
People may experience indigestion, nausea, vomiting, and
diarrhea as a result of undergoing radiation therapy.
Chemotherapy
Chemotherapy is a specialist treatment that uses drugs to stop rapidly-growing cancer cells from dividing and multiplying. These drugs are known as cytotoxic medicines. The medication travels throughout the patient's body and attacks cancer cells at the primary site of the cancer and any other regions it has metastasized to.
Neoadjuvant chemotherapy
Neoadjuvant chemotherapy is administered before surgery to shrink the
tumor so that it can be removed more easily.
Adjuvant chemotherapy
Adjuvant chemotherapy is administered after surgery to destroy any cancerous cells that may be left behind. Chemotherapy may be the preferred treatment modality for certain types of gastric cancer, including gastrointestinal stromal tumors and gastric
lymphoma.
Targeted medications
Examples of targeted medications include Sutent (sunitinib) and Gleevec (imatinib), which attack specific types of abnormalities in cancerous cells for people with gastrointestinal stromal tumors.
Clinical trials
These are experimental therapies which may be trying out new drugs or using existing therapies in novel ways. Patients may want to take part in some of the latest treatments. It is important to remember that clinical trials are experimental and in no way guarantee a cure for stomach cancer.
Patients should discuss this option carefully with their doctors and family and bear in mind that such therapies have many unknowns, for example, the investigators may not be sure what side effects the participants might experience.
Stages
There are several stages of stomach cancer. The higher the stage, the more advanced the cancer is, and the lower the chances of survival.
Unlike some other cancers, these are also given a letter depending on whether the stomach cancer has spread to any nearby lymph nodes.
- Stage 0: Highly abnormal precancerous cells are present in the mucosa but have not spread to other layers of the stomach or nearby lymph nodes.
- Stage IA: The cancer has moved into one of the next layers of the stomach, such as the submucosa, but not nearby lymph nodes.
- Stage IB: The cancer has moved into one of the next layers of the stomach and into one or two nearby lymph nodes.
- Stage IIA: The cancer has developed into an even deeper layer, and may have spread to one or two lymph nodes. If the tumor has grown deep enough, it may not need to have spread to qualify as a stage IIA cancer.
- Stage IIB: The tumor may not have necessarily spread as deep as a stage IIA stomach cancer but has spread to a greater number of lymph nodes, sometimes up to 15.
- Stage IIIA: This stage sees the cancer spread to a deeper layer and up to 15 lymph nodes or start to grow through the stomach wall and spread to fewer lymph nodes. It has also started to reach nearby organs and structures.
- Stage IIIB: The cancer has not grown as deep as a stage IIIA stomach cancer but has spread to over 16 lymph nodes. It has started to reach nearby organs and structures.
- Stage IIIC: The cancer has either grown through most layers of the stomach and spread to over 16 lymph nodes or spread to nearby organs and structures and up to 15 lymph nodes.
- Stage IV: The cancer has spread to distant sites. However, it may or may not have spread to nearby lymph nodes.
While this is not an exhaustive list of the criteria used to categorize stomach cancers, it does provide a picture of how an oncologist will grade the development of a tumor.
Diagnosis
Individuals with some of the signs and symptoms of stomach cancer should see their doctor as soon as possible.
The physician will ask the patient about their symptoms, family history, and medical history, as well as lifestyle choices, such as eating habits or smoking. They will also carry out a physical examination to check for stomach tenderness or lumpiness.
If the doctor suspects possible stomach cancer, the patient will be referred to a specialist for tests.
Gastroscopic exam
A specialist can look at the inside of the patient's stomach using a remotely-controlled endoscope.
The specialist looks at the inside of the patient's stomach with a fiber optic camera. Some tissue samples may be taken if the doctor suspects cancer. This is called a biopsy.
Ultrasound scan
If cancer is suspected in the top part of the stomach, the specialist may carry out this type of scan.
Barium meal X-ray
In a barium swallow study, the patient swallows a liquid which contains barium. This helps identify the stomach during an X-ray.
Laparoscopy
The specialist may want to look inside the abdomen in more detail to determine how much the cancer has spread. In a procedure called a laparoscopy, the patient is placed under a general anesthetic, and a laparoscope, a thin tube with a camera at the end, is inserted through a small incision in the lower part of the stomach.
CT scan or PET scan
These scans take a series of radiographic pictures of the inside of the body. The images help the specialist determine how advanced the cancer is, and where in the body it has spread to. These types of scans also help the doctor decide on the most appropriate treatment.
Can stomach cancer be prevented?
Experts do not know exactly what causes stomach cancer, and there are no vaccines against it. Therefore, there is no way to prevent it.
- Fruit and vegetables: People who eat plenty of fruit and vegetables are usually less likely to develop stomach cancer, when compared with those who do not.
- Salty and smoked foods: Reduce the quantity of these in the diet.
- Smoking: If you smoke, quit. If you don't smoke, avoid it.
- Check with a doctor: Individuals can ask whether they have any medical conditions that might increase the risk of developing stomach cancer. Those who do might consider having periodic screening.
Risk factors
- Certain medical conditions: These include esophagitis, gastroesophageal reflux disease (GERD), peptic stomach ulcers, Barrett's esophagus, chronic gastritis, and stomach polyps.
- Smoking: Regular, long-term smokers have twice the risk of developing stomach cancer compared to non-smokers.
- Helicobacter pylori infection: This bacterium is harmless for most people. However, it can cause infection and stomach ulcers in some individuals. Chronic ulcers pose some risk in the development of gastric cancer
- Family history: Having a close relative who has or has had stomach cancer can increase the risk.
- Consuming foods which contain aflatoxin fungus: These may be present in crude vegetable oils, cocoa beans, tree nuts, groundnuts, figs and other dried foods and spices.
- Diet: People who regularly eat salted fish, salty foods, smoked meats, and pickled vegetables have a higher risk of developing gastric cancer.
- Age: The risk of developing stomach cancer increases significantly after the age of 55 years.
- Sex: Men have twice the risk of developing stomach cancer compared with women.
- Previous or existing cancers: People who have or have had cancer of the esophagus or non-Hodgkin's lymphoma are more likely to develop stomach cancer. Men with previous or current prostate, bladder, or testicular cancer are at higher risk, as are females with a history of cervical, ovarian, or breast cancer.
- Some surgical procedures: Surgery to the stomach or a part of the body that affects the stomach, like the vagus nerve, can increase the risk of stomach cancer
Overview
Stomach cancer usually begins in the mucus-producing cells that line the stomach. This type of cancer is called adenocarcinoma.
For the past several decades, rates of cancer in the main part of the stomach (stomach body) have been falling worldwide. During the same period, cancer in the area where the top part of the stomach (cardia) meets the lower end of the swallowing tube (esophagus) has become much more common. This area of the stomach is called the gastroesophageal junction.
Symptoms
Signs and symptoms of gastroesophageal junction cancer and stomach cancer may include:
- Fatigue
- Feeling bloated after eating
- Feeling full after eating small amounts of food
- Severe, persistent heartburn
- Severe indigestion that is always present
- Unexplained, persistent nausea
- Stomach pain
- Persistent vomiting
- Unintentional weight loss
When to see a doctor
If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more common causes of these signs and symptoms first.
Diagnosis
Tests and procedures used to diagnose gastroesophageal junction cancer and stomach cancer include
- A tiny camera to see inside your stomach (upper endoscopy). A thin tube containing a tiny camera is passed down your throat and into your stomach. Your doctor can look for signs of cancer. If any suspicious areas are found, a piece of tissue can be collected for analysis (biopsy).
- Imaging tests. Imaging tests used to look for stomach cancer include computerized tomography (CT) scans and a special type of X-ray exam sometimes called a barium swallow.
Determining the extent (stage) of gastroesophageal or stomach cancer
The stage of your stomach cancer helps your doctor decide which treatments may be best for you. Tests and procedures used to determine the stage of cancer include:
- Imaging tests. Tests may include CT and positron emission tomography (PET).
- Exploratory surgery. Your doctor may recommend surgery to look for signs that your cancer has spread beyond your esophagus or stomach, within your chest or abdomen. Exploratory surgery is usually done laparoscopically. This means the surgeon makes several small incisions in your abdomen and inserts a special camera that transmits images to a monitor in the operating room.
Other staging tests may be used, depending on your situation.
Stages of stomach cancer
The stages of adenocarcinoma of the stomach or esophagus include:
- Stage I. At this stage, the tumor is limited to the top layer of tissue that lines the inside of the esophagus or stomach. Cancer cells also may have spread to a limited number of nearby lymph nodes.
- Stage II. The cancer at this stage has spread deeper, growing into a deeper muscle layer of the esophagus or stomach wall. Cancer may also have spread to more of the lymph nodes.
- Stage III. At this stage, the cancer may have grown through all the layers of the esophagus or stomach and spread to nearby structures. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.
- Stage IV. This stage indicates that the cancer has spread to distant areas of the body.
Treatment
SurgeryYour treatment options for gastroesophageal junction cancer or stomach cancer depend on the stage of your cancer, your overall health and your preferences.
Gastroesophageal junction cancer that has not spread requires surgery to remove the part of the esophagus or stomach where the tumor is located. The goal of surgery is to remove all of the cancer and a margin of healthy tissue, when possible. Nearby lymph nodes are typically removed as well.
The goal of surgery for cancer in the body of the stomach is also to remove all of the stomach cancer and a margin of healthy tissue, when possible. Options include:
- Removing early-stage tumors from the stomach lining. Very small cancers limited to the inside lining of the stomach may be removed using endoscopy in a procedure called endoscopic mucosal resection. The endoscope is a lighted tube with a camera that's passed down your throat into your stomach. The doctor uses special tools to remove the cancer and a margin of healthy tissue from the stomach lining.
- Removing a portion of the stomach (subtotal gastrectomy). During subtotal gastrectomy, the surgeon removes only the portion of the stomach affected by cancer.
- Removing the entire stomach (total gastrectomy). Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system.
- Removing lymph nodes to look for cancer. The surgeon examines and removes lymph nodes in your abdomen to look for cancer cells.
Surgery to relieve signs and symptoms. Removing part of the stomach may relieve signs and symptoms of a growing tumor in people with advanced stomach cancer. In this case, surgery can't cure advanced stomach cancer, but it can make you more comfortable.
Surgery carries a risk of bleeding and infection. If all or part of your stomach is removed, you may experience digestive problems.
Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. The energy beams come from a machine that moves around you as you lie on a table.
In gastroesophageal junction cancer, as well as in cancer of the stomach body, radiation therapy can be used before surgery (neoadjuvant radiation) to shrink a tumor so that it's more easily removed. Radiation therapy can also be used after surgery (adjuvant radiation) to kill any cancer cells that might remain in the area around your esophagus or stomach.
In gastroesophageal junction cancer, radiation and chemotherapy are typically administered at the same time (chemoradiotherapy), most often before surgery.
Radiation therapy to your stomach can cause diarrhea, indigestion, nausea and vomiting. Radiation therapy to your esophagus can cause pain on swallowing and difficulty swallowing. To avoid this side effect, you may be advised to have a feeding tube placed in your stomach through a small incision in your abdomen until your esophagus heals.
In cases of advanced cancer, radiation therapy may be used to relieve side effects caused by a large tumor.
Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs travel throughout your body, killing cancer cells that may have spread beyond the stomach.
Chemotherapy can be given before surgery (neoadjuvant chemotherapy) to help shrink a tumor so that it can be more easily removed. Chemotherapy is also used after surgery (adjuvant chemotherapy) to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy. Chemotherapy may be used alone in people with advanced stomach cancer to help relieve signs and symptoms.
Chemotherapy side effects depend on which drugs are used.
Targeted drugs
Targeted therapy uses drugs that attack specific abnormalities within cancer cells or that direct your immune system to kill cancer cells (immunotherapy). Targeted drugs used to treat stomach cancer include:
- Trastuzumab (Herceptin) for stomach cancer cells that produce too much HER2
- Ramucirumab (Cyramza) for advanced stomach cancer that hasn't responded to other treatments
- Imatinib (Gleevec) for a rare form of stomach cancer called gastrointestinal stromal tumor
- Sunitinib (Sutent) for gastrointestinal stromal tumors
- Regorafenib (Stivarga) for gastrointestinal stromal tumors
Several targeted drugs are being studied for treatment of gastroesophageal junction cancer, but only two of these drugs — ramucirumab and trastuzumab — have been approved for this use.
Targeted drugs are often used in combination with standard chemotherapy drugs. Tests of your cancer cells can tell your doctor whether these treatments are likely to work for you.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing aggressive treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
Potential future treatments
Researchers around the world are studying a number of new medications that harness the power of the immune system to eradicate cancer — an approach called immunotherapy. These medications work in complex ways to make the immune system respond to cancer cells as if they were foreign invaders, such as bacteria.
Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Coping and support
A cancer diagnosis can be overwhelming and frightening. Once you start to adjust after the initial shock of your diagnosis, you may find it helps to stay focused on tasks that help you cope. For example, try to:
- Learn enough to make decisions about your care. Ask your doctor to write down the details of your cancer — the type, stage and your treatment options. Use those details to find more information about stomach cancer and the benefits and risks of each treatment option.
- Connect with other cancer survivors. Ask your doctor about support groups in your area. Or go online and connect with cancer survivors on message boards, such as those run by the American Cancer Society.
- Stay active. Being diagnosed with cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it.
Preparing for your appointment
Start by seeing your family doctor if you have signs or symptoms that worry you. If your doctor suspects you may have a stomach problem, you may be referred to a doctor who specializes in gastrointestinal diseases (gastroenterologist). Once gastroesophageal junction cancer or stomach cancer is diagnosed, you may be referred to a cancer specialist (oncologist) or a surgeon who specializes in operating on the digestive tract.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Note what seems to improve or worsen your signs and symptoms. Keep track of which foods, medications or other factors influence your signs and symptoms.
- Consider taking a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you cover all your concerns. List your questions from most important to least important in case time runs out. For stomach cancer, some basic questions to ask your doctor include:
- What type of stomach cancer do I have?
- How advanced is my stomach cancer?
- What other kinds of tests do I need?
- What are my treatment options?
- How successful are the treatments?
- What are the benefits and risks of each option?
- Is there one option you feel is best for me?
- How will treatment affect my life? Can I continue to work?
- Should I seek a second opinion? What will that cost, and will my insurance cover it?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions as they occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
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