What is Stomach Cancer?
Stomach cancer is an abnormal growth of cells that begins in the stomach. The stomach is a muscular sac located in the upper middle part of the abdomen, just below your ribs. The stomach receives and holds the food you eat and then helps break it down and digest it.
Stomach cancer, also known as gastric cancer, can affect any part of the stomach. In most parts of the world, stomach cancers form in the main part of the stomach (body of the stomach).
Stomach cancer is also likely to affect the area where the long tube (esophagus) that carries the food you swallow meets the stomach. This area is called the gastroesophageal junction.
Where the cancer appears in the stomach is a factor that doctors consider when determining your treatment options. Treatment usually includes surgery to remove the stomach cancer. Other treatments may be recommended before and after the surgery.
Symptoms
The signs and symptoms of stomach cancer may include:
- Difficulty swallowing
- Feeling bloated after eating
- Feeling full after consuming small amounts of food
- Heartburn
- Indigestion
- Nausea
- Stomach pain
- Weight loss
- Vomiting
Causes of Stomach Cancer
The exact cause of stomach cancer is not clear, though research has identified several factors that may increase the risk.
Doctors know that stomach cancer begins when a cell in the stomach develops changes in its DNA. The DNA in a cell contains the instructions that tell the cell what to do. The changes tell the cell to grow rapidly and continue living when healthy cells would die. The cells accumulate and form a tumor that can invade and destroy healthy tissue. Over time, the cells can break apart and spread (metastasize) to other areas of the body.
Risk Factors
Factors that increase the risk of stomach cancer include:
- Gastroesophageal reflux disease (GERD)
- Obesity
- Diet high in salty and smoked foods
- Diet low in fruits and vegetables
- Family history of stomach cancer
- Helicobacter pylori infection
- Chronic stomach inflammation (gastritis)
- Smoking
- Stomach polyps
Prevention
To reduce the risk of stomach cancer:
- Maintain a healthy weight. If you’re overweight or obese, talk to your doctor about strategies to help you lose weight. Aim for a slow and steady weight loss of 1 or 2 pounds per week.
- Choose a diet rich in fruits and vegetables. Try to incorporate more fruits and vegetables into your diet every day.
- Reduce the amount of salty and smoked foods you eat. Protect your stomach by limiting these foods.
- Quit smoking. If you smoke, stop. If you don’t smoke, don’t start. Smoking increases the risk of stomach cancer, as well as many other types of cancer. Quitting smoking can be very difficult, so seek help from your doctor.
- Ask your doctor about your risk of stomach cancer. Talk to your doctor if you have an increased risk of stomach cancer. People with a family history of stomach cancer may need screenings, such as endoscopy, to check for signs of stomach cancer.
Diagnosis
Tests used to diagnose stomach cancer include:
- A microscopic camera to see inside your stomach (Gastroscopy). A thin tube with a microscopic camera passes through your throat into your stomach. Your doctor may use it to look for signs of cancer.
- Tissue sample for examination (biopsy). If suspicious areas are found during the gastroscopy, special tools can be used to remove a tissue sample for testing. The sample is sent to a lab for analysis.
- Imaging tests: Imaging tests used to look for stomach cancer include CT scans and a special type of X-ray called a barium swallow.
The stage of stomach cancer helps the doctor decide what treatments may be best for you. Tests used to determine the stage of cancer include:
- Blood tests: Blood tests to measure organ function may indicate whether other organs in your body, such as your liver, may be affected by cancer.
- Endoscopic ultrasound: During an endoscopic ultrasound, a thin tube with a camera on the end is passed into your throat and stomach. A special ultrasound tool is used to create images of your stomach. Endoscopic ultrasound helps doctors determine how deeply cancer has spread into the stomach wall.
- Imaging tests: These may include CT scans, MRIs, or Positron Emission Tomography (PET) scans.
Exploratory laparo - Exploratory laparotomy or laparoscopy: Your doctor may recommend surgery to look for possible signs that cancer has spread beyond your stomach or to assess the likelihood of curative or palliative surgery. The procedure is usually done laparoscopically, which means the surgeon makes several small incisions in your abdomen and inserts a special camera to transmit images to a screen in the operating room.
Other staging tests may be used depending on your condition.
Your doctor uses information from these procedures to define a stage for your cancer. The stages of stomach cancer are indicated by Roman numerals ranging from 0 to IV, with lower stages indicating that the cancer is small and affecting only the inner layers of your stomach. At stage IV, cancer is considered advanced and may have spread to other areas of the body.
Stomach Cancer: Treatment
Treatment options for stomach cancer depend on the location, stage, and aggressiveness of the cancer. Your doctor also takes into account your overall health and preferences when creating a treatment plan.
Surgery
The goal of surgery is to remove all the cancer and part of the healthy tissue surrounding it.
Surgical procedures used for stomach cancer include:
Removal of early-stage tumors from the stomach lining. Very small cancers confined to the inner lining of the stomach can be removed by passing special tools through an endoscope. Procedures for cutting out cancer from the stomach lining include endoscopic mucosal resection and endoscopic submucosal dissection.
Removal of part of the stomach (partial gastrectomy). During a partial gastrectomy, the surgeon removes the part of the stomach affected by cancer and part of the healthy tissue around it. This surgery may be an option if your stomach cancer is located near the small intestine.
Removal of the entire stomach (total gastrectomy). Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then directly connected to the small intestine to allow food to pass through the digestive system. Total gastrectomy is most often used for stomach cancers affecting the body of the stomach or those located at the gastroesophageal junction.
Removal of lymph nodes to check for cancer. The surgeon may remove lymph nodes in your abdomen to examine them for cancer.
Surgery to relieve signs and symptoms. Surgery to remove part of the stomach may help alleviate the signs and symptoms of an advancing cancer in people with advanced stomach cancer.
Chemotherapy
Chemotherapy is a treatment that uses chemicals to kill cancer cells. Chemotherapy medicines travel throughout your body, killing cancer cells that may have spread beyond the stomach.
Chemotherapy may be given before surgery to help shrink the cancer so it can be removed more easily. Chemotherapy is also used after surgery to kill any cancer cells that may remain in the body. Chemotherapy is often combined with radiation therapy.
Chemotherapy can be used alone or with targeted drug therapy in people with advanced stomach cancer.
Radiation Therapy
Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. The energy beams come from a machine that moves around you while you lie on a table.
For stomach cancer, radiation therapy may be used before surgery to shrink the cancer so it can be removed more easily. Radiation therapy can also be used after surgery to kill any cancer cells that may remain. Radiation therapy is often combined with chemotherapy.
For advanced stomach cancer that cannot be removed with surgery, radiation therapy may be used to relieve side effects, such as pain or bleeding, caused by growing cancer.
Targeted Drug Therapy
Targeted drug therapies focus on specific weaknesses in cancer cells. By blocking these weaknesses, targeted drug therapies can cause cancer cells to die. For stomach cancer, targeted medicines are usually combined with chemotherapy for advanced cancers or cancer that has returned after treatment.
Your doctor may test your cancer cells to see which targeted medicines are most likely to work for you.
Immunotherapy
Immunotherapy is a treatment that helps your immune system fight cancer. Your body’s immune system that fights disease may not attack the cancer because cancer cells produce proteins that make it difficult for immune system cells to recognize cancer cells as dangerous. Immunotherapy works by interfering with this process.
For stomach cancer, immunotherapy may be used when the cancer is advanced, has recurred, or has spread to other parts of the body.
Supportive (Palliative) Care
Palliative care is specialized medical care focused 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 you’re undergoing aggressive treatments, such as surgery.
When to See Your Doctor
If you have signs and symptoms that concern you, schedule an appointment with your doctor. Your doctor will likely first investigate the most common causes of your signs and symptoms.
