Stomach cancer, also known as gastric cancer, is the abnormal growth of cells that start in the stomach. The stomach is a muscular sac located in the upper middle part of your abdomen, just below your ribs. It receives and holds the food you eat and then helps to break it down and aid in digestion. Stomach cancer can affect any part of the stomach.

Where the cancer originates in the stomach is a factor that doctors consider when determining your treatment options. Treatment generally involves surgery to remove the stomach cancer. Other treatments may be recommended before and after surgery.

What are the Symptoms of Stomach Cancer?

Symptoms of stomach cancer may include:

• Difficulty swallowing
• Feeling bloated after eating
• Feeling full after eating small amounts of food
• Painful burning sensation in the chest
• Indigestion
• Nausea
• Abdominal pain
• Unintentional weight loss
• Vomiting

What Causes Stomach Cancer?

It’s not clear what causes stomach cancer, but research has identified several factors that can increase the risk.

Doctors know that stomach cancer begins when a cell in the stomach develops changes in its DNA. The DNA of a cell contains instructions that tell the cell what to do. The changes tell the cell to grow rapidly and continue to survive while healthy cells die. The accumulating cells form a tumor that can invade and destroy healthy tissue. Over time, the cells may break away and spread to other areas of the body (metastasize).

What are the Risk Factors for Stomach Cancer?

Factors that increase the risk of stomach cancer include:

• Gastroesophageal reflux disease
• Obesity
• A diet high in salty and smoked foods
• A diet low in fruits and vegetables
• Family history of stomach cancer
• Infection with Helicobacter pylori
• Long-term stomach inflammation (gastritis)
• Smoking
• Stomach polyps

What Can Be Done to Prevent Stomach Cancer?

To reduce the risk of stomach cancer, you can:

• Maintain a healthy weight. If you are overweight or obese, talk to your doctor about strategies to help you lose weight. Aim for slow and steady weight loss of 1 to 2 pounds per week.
  Choose a diet filled with fruits and vegetables. Try to add more fruits and vegetables to your diet every day. Select a variety of colorful fruits and vegetables.
• Decrease the amount of salty and smoked foods you consume. Protect your stomach by limiting these foods.
• Quit smoking. If you smoke, quit. If you don’t smoke, don’t start. Smoking increases your risk of stomach cancer and many other types of cancer. Quitting smoking can be very challenging, so seek help from your doctor.
• Discuss your risk of stomach cancer with your doctor. If you have a high risk of stomach cancer, talk to your doctor. Individuals with a strong family history of stomach cancer may consider tests such as endoscopy to look for stomach cancer symptoms.

How is Stomach Cancer Diagnosed?

The tests and procedures used to diagnose stomach cancer include:

• A small camera to view the inside of your stomach (upper endoscopy). A thin tube with a small camera is passed through your throat into your stomach to allow your doctor to examine for signs of cancer.
• Removal of a tissue sample for testing (biopsy). If any suspicious areas are found during the upper endoscopy, special tools can be used to remove a tissue sample for analysis. The sample is sent to a laboratory for examination.
• Imaging tests. Imaging tests such as CT scans can be used to look for stomach cancer.

Determining the Stage of Stomach Cancer

The stage of your stomach cancer helps your doctor determine the best treatments for you. The tests and procedures used to determine the stage of cancer include:

• Blood tests. Blood tests performed to measure organ function can indicate if other organs in your body, such as your liver, are affected by cancer.
• Endoscopic ultrasound. During an endoscopic ultrasound, a thin tube with a camera is passed through your throat into your stomach. A special ultrasound device is used to create images of your stomach. Endoscopic ultrasound helps doctors determine how deeply a cancer has penetrated the stomach wall.
• Imaging tests. These may include CT scans and positron emission tomography (PET). Your doctor uses the information obtained from these procedures to assign a stage to your cancer.

Treatment Methods for Stomach Cancer

The treatment options for stomach cancer depend on the location, stage, and aggressiveness of the cancer. Your doctor will also consider your overall health and preferences when creating a treatment plan.

Surgery

The goal of surgery is to remove the entirety of the cancer and a portion of the surrounding healthy tissues.
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 that involve cutting out the cancer from the inner lining of the stomach include endoscopic mucosal resection and endoscopic submucosal resection.
• Removal of a portion of the stomach (subtotal gastrectomy). During a subtotal gastrectomy, the surgeon removes the part of the stomach affected by cancer and a portion of the surrounding healthy tissues. This surgery may be an option if your stomach cancer is located near the part of the stomach closest to the small intestine.
• Total gastrectomy: Total gastrectomy involves the removal of the entire stomach and some surrounding tissues. The esophagus is then directly connected to the small intestine to allow food to pass through the digestive system. Total gastrectomy is most commonly used for stomach cancers that affect the body of the stomach and occur at the gastroesophageal junction.
• Lymph node removal for cancer staging: The surgeon can remove lymph nodes in your abdomen to test for cancer and determine the stage of the disease.
• Surgical removal to alleviate symptoms: Surgical removal of part of the stomach can help alleviate symptoms of advanced stomach cancer by reducing the size of the growing tumor.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs circulate in your body and kill cancer cells that may have spread beyond the stomach.

Chemotherapy can be given before surgery to help shrink the cancer and make it easier to remove. It is also used after surgery to kill any remaining cancer cells in the body. Chemotherapy is often combined with radiation therapy.

Chemotherapy can be used alone or in combination with targeted drug therapy in people with advanced stomach cancer.

Radiation Therapy

Radiation therapy uses high-powered 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 can be used before surgery to shrink the tumor and make it easier to remove. It can also be used after surgery to kill any remaining cancer cells. Radiation therapy is often combined with chemotherapy.

For advanced stomach cancer that cannot be treated with surgery, radiation therapy can be used to alleviate side effects such as pain or bleeding caused by a growing tumor.

Targeted Drug Therapy

Targeted drug therapies focus on specific vulnerabilities found in cancer cells. By targeting these vulnerabilities, targeted drug therapies can cause cancer cells to die. For stomach cancer, targeted drugs are typically combined with chemotherapy for advanced or recurrent cancers.

Your doctor may test your cancer cells to determine which targeted drugs would be most effective for you.

Immunotherapy

Immunotherapy is a drug treatment that helps your immune system fight against cancer. Your body’s immune system, which fights against diseases, may not attack cancer because cancer cells produce proteins that make it difficult for immune cells to recognize cancer cells as dangerous. Immunotherapy intervenes in this process and works by helping the immune system recognize and attack cancer cells.
For stomach cancer, immunotherapy can be used when the cancer progresses, comes back, or spreads to other parts of the body.

Supportive (Palliative) Care

Palliative care is specialized medical care focused on relieving the pain and other symptoms of a serious illness. Palliative care specialists work with you, your family, and other doctors to provide an additional layer of support to complement your ongoing care. Palliative care can be used alongside aggressive treatments like surgery, chemotherapy, or radiation therapy.

When used in conjunction with all other appropriate treatments, palliative care can help cancer patients 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 in addition to any curative or other treatments you may receive.

Coping and Support for Stomach Cancer

A cancer diagnosis can be overwhelming and frightening. As you begin to adapt after the initial shock of your diagnosis, you may find it helpful to focus on tasks that can help you cope. For example, try:

• Educating yourself about your care. Ask your doctor to write down the details of your cancer, including the type, stage, and treatment options. Use these details to learn more about stomach cancer and the benefits and risks of each treatment option.
• Connecting with other cancer survivors. Reach out to individuals who have beaten cancer or join support groups in your community.
• Staying active. Being diagnosed with cancer doesn’t mean you have to stop doing the things you enjoy or normally do. If you feel well enough to do something, go ahead and do it.

When to See a Doctor?

If you have symptoms that concern you, consult with a specialized doctor. If your doctor suspects a problem with your stomach, you may be referred to a doctor specializing in conditions affecting the digestive system (gastroenterologist). After a diagnosis of stomach cancer, you may be referred to a cancer specialist (oncologist) or a surgeon specializing in the digestive system.

Before the Appointment

Appointments can be short and there may be a lot of information to discuss, so it’s a good idea to be prepared. Here are some tips to help you prepare:

• Write down all the symptoms you have experienced, including those that may seem unrelated to the reason for your appointment.
• Include important personal information, such as major stresses or recent life changes.
• Make a list of all the medications, vitamins, or supplements you are currently taking.
• Take note of what improves or worsens your symptoms. Keep track of which foods, medications, or other factors affect your symptoms.
• Consider bringing a family member or friend with you. Sometimes it can be difficult to absorb all the information provided during an appointment. Having someone accompany you can help you remember anything you may have missed or forgotten.
• Write down the questions you want to ask your doctor. Your time with the doctor is limited, so preparing a list of questions can help address all your concerns.