Stomach Cancer

There are several types of stomach cancer. Most begin in the cells that line the stomach walls. Less than 10% are other types of stomach cancers, including cancers related to the immune system and to cells that produce hormones. Very rarely, other types of cancer can start in the stomach, including squamous cell carcinoma, small cell carcinoma and leiomyosarcoma.

Adenocarcinoma

Adenocarcinoma is cancer that starts in the glandular (secretory) cells of the innermost tissue that lines certain internal organs, including the stomach. Adenocarcinoma represents about 90% to 95% of stomach cancers.

Lymphoma

Lymphoma is sometimes found in the stomach wall as a cancer that begins in the cells of the immune system tissue. The two basic types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.

Gastrointestinal stromal tumor (GIST)

Also called GIST, gastrointestinal stromal tumors are tumors that form very early in the cells of the stomach wall. These tumors also are found in other types of digestive cancers, usually starting in the cells of the wall of gastrointestinal tract.

Carcinoid tumors

Carcinoid tumors begin in the stomach cells that produce hormones. In most cases, these tumors do not spread to other organs. For more on this, see our page on gastrointestinal carcinoid tumors.

What causes stomach cancer? Researchers don’t know exactly why cancer cells develop in the stomach, and research into possible culprits is ongoing. But a number of risk factors may raise the risk of developing stomach cancer.

In the United States, the most common stomach cancer risk factors include:

Gender

More men develop stomach cancer than women.

Age

Stomach cancer rates increase significantly after age 50. Most people who have stomach cancer are diagnosed after age 65.

Ethnicity

Stomach cancer affects more Hispanic-Americans, African-Americans and Asian-Pacific Islanders than non-Hispanic whites.

Helicobacter pylori (H. pylori)

This bacterial infection is more often found in people who have stomach cancer than in those who do not. But most people who have H. pylori don’t develop stomach cancer.

Diet

Diets high in smoked foods, salted fish and meat, and pickled vegetables may increase stomach cancer risk. On the other hand, diets high in fresh fruits and vegetables seem to lower the risk.

Tobacco use

Smokers have about twice the risk of developing stomach cancer, especially in the upper portion of the stomach, as nonsmokers.

Family history

People with first-degree relatives (parents, siblings or children) who have had stomach cancer have a higher risk of developing it themselves.

Inherited gene mutations

A small percentage of stomach cancers may be linked to genetic mutations passed down in families.

Talk to your doctor about your risk and whether you should consider genetic counseling.

As with most cancers, the earlier stomach cancer is diagnosed, the greater the likelihood of successful treatment. Because stomach cancer isn’t common in the United States, routine stomach cancer screening isn’t recommended for people with an average risk. But if you have risk factors for stomach cancer, especially H. pylori infection, talk to your physician about being tested.

Stomach cancer cannot be completely prevented, but taking steps to reduce the risk factors within your control may help reduce your risk. 

• Minimize smoked foods, pickled foods, and salted meats and fish in your diet, and eat more fresh vegetables and fruits, especially citrus fruits.
• Maintain a healthy weight.
• Be physically active on a regular basis.
• Avoid tobacco use.
• If you’re diagnosed with H. pylori infection, follow through with treatment. 

As the disease develops, symptoms of stomach cancer may include:

• Poor appetite
• Unintended weight loss
• Abdominal pain or discomfort
• Feeling full even after eating a small meal
• Heartburn or indigestion
• Nausea
• Vomiting, with or without blood
• Swelling or fluid buildup in the abdomen
• Low red blood cell count (anemia)

Having any of these symptoms doesn’t mean you have stomach cancer; stomach viruses, infections and the flu often cause similar symptoms. If your symptoms persist or become worse, let your doctor know so that you can find the cause and any potential health problems.

Scripps cancer specialists are experts in diagnosing and staging stomach cancer to determine the best course of treatment. Treatment depends on the stage, as well as whether a patient has other gastrointestinal problems and their general health.

In addition to a physical exam and family medical history, Scripps physicians use the most advanced stomach cancer diagnostic testing methods.

Upper endoscopy

Upper endoscopy is a procedure in which a physician uses an endoscope to examine the lining of the esophagus, stomach and first section of the small intestine. The procedure is also known as an esophagogastroduodenoscopy (EGD).

Endoscopic ultrasound (EUS)

Endoscopic ultrasound combines an endoscopy with ultrasound to obtain images of the area in question.

Upper gastrointestinal (GI) series

An upper gastrointestinal (GI) series is an X-ray imaging test to allow physicians to look at the inner lining of the esophagus, stomach and first part of the small intestine.

Biopsy

Biopsy is the collection of a small part of the suspicious tissue for testing and further examination in the lab by a pathologist.

Computed tomography (CT) scan

A CT scan is a form of X-ray imaging that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.

Positron emission tomography (PET) scan

A PET scan uses a glucose that contains a radioactive substance (called a tracer) to look for cancer. A PET scan is combined with a CT scan.

Magnetic resonance imaging (MRI)

An MRI relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.

The stomach has five layers, as well as numerous lymph vessels and nodes. Stomach cancer stages indicate how far the cancer may have spread within these layers and beyond the stomach to help doctors determine the best course of treatment. Unfortunately, many stomach cancers are not diagnosed until they have reached advanced stages.

Stage 0

Stage 0 is the earliest stage of stomach cancer. Cancer has not grown beyond the inner layer of the stomach. Stage 0 is also known as carcinoma in situ.

Stage IA

Stage IA stomach cancer is cancer that has grown into the layer of the stomach below the inner layer, but has not spread.

Stage IB

Stage IB stomach cancer is cancer that has grown into the connective tissue and spread to one or two lymph nodes, or into the main muscle layer.

Stage IIA

Stage IIA stomach cancer is cancer that has spread into other layers and fewer than six nearby lymph nodes, but not outside the stomach.

Stage IIB

Stage IIB includes cancer that has grown:

• Beneath the top layer of cells of the mucosa and has spread to seven or more nearby lymph nodes, but not to distant sites
• Into the main muscle layer and has spread to three to six nearby lymph nodes, but not to distant sites
• Into other layers of the stomach but not to the outside, and has spread to one or two nearby lymph nodes but not to distant sites
• Through all the layers of stomach wall into the outer covering of the stomach but not into nearby organs or tissues, and has not spread to any nearby lymph nodes or distant sites

Stage IIIA

Stage IIIA includes cancer that has grown:

• Into the main muscle layer and spread to seven or more nearby lymph nodes, but has not spread to distant sites
• Into other layers of the stomach but not to the outside, and has spread to three to six nearby lymph nodes but not to distant sites
• Completely through all the layers of the stomach wall into the outer covering of the stomach but not into nearby organs or tissues, and has spread to one or two nearby lymph nodes but not to distant sites

Stage IIIB

Stage IIIB includes cancer that has grown:

• Into other layers of the stomach but not to the outside, and has spread to seven or more nearby lymph nodes but not to distant sites
• Completely through all the layers of the stomach wall into the outer covering of the stomach but not into nearby organs or tissues, and has spread to three to six nearby lymph nodes but not to distant sites
• Through the stomach wall and into nearby organs, and may also have spread to up to two nearby lymph nodes but not to distant sites

Stage IIIC

Stage IIIC includes cancer that has grown:

• Completely through all stomach layers but not into nearby organs or tissues, and has spread to seven or more nearby lymph nodes, but not to distant sites
• Through the stomach wall and into nearby organs, and may also have spread to three or more nearby lymph nodes but not to distant sites

Stage IV

Stage IV stomach cancer is cancer that has spread to distant organs.

Resectable and unresectable stomach cancer

While staging provides information about the severity of stomach cancer, it does not indicate how the cancer should be treated. Doctors generally need to know whether the tumor can be removed with surgery (resectable) and may describe stomach cancer as resectable or unresectable.

• Resectable stomach cancer is when surgery may be a possibility for removing all of the cancer when tumors are detected early and the rest of the stomach is in good health. 
• Unresectable stomach cancer is when surgery cannot be performed to completely remove the tumor because the cancer has spread too far, the location of the tumor is hard to reach or the patient’s health prevents surgery.

No one wants to hear that they have stomach cancer. You may feel frightened, overwhelmed, anxious or sad. All of these feelings are perfectly normal. The more you learn about your diagnosis and next steps, the sooner you can begin to make informed decisions about your treatment.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your stomach cancer diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of stomach cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer care team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones at Scripps.

At Scripps, you’ll have a multidisciplinary team of professionals caring for you, including physicians, surgeons, medical oncologists, radiation oncologists and nurses who specialize in cancer care. In addition, you’ll be partnered with a nurse navigator, who will help coordinate your care and ensure you get the support you need throughout your treatment and recovery. Learn more about how Scripps puts you at the center of stomach cancer care. 

The most appropriate stomach cancer treatment options depend on several factors, including the type and stage of the cancer and any other medical conditions, as well as the patient's age and overall health.

Our goal is to completely eliminate your cancer using the most advanced therapies and technologies, including several surgical options, precise radiation and targeted chemotherapy. In most cases, treatment for stomach cancer requires radiation therapy before or after surgery, often given at the same time as chemotherapy.

Stomach cancer surgery

Surgery is the most common treatment for stomach cancer. Scripps surgeons are experts in all types of stomach cancer surgical procedures.

Endoscopic resection

Scripps surgeons perform endoscopic resection to remove stomach tumors that are found very early and have not spread to lymph nodes. No incision is needed to access the tumor(s).

Subtotal (partial) gastrectomy

Depending on the location of the cancer, Scripps surgeons may perform a subtotal (partial) gastrectomy to remove part of the esophagus and/or small intestine, fatty lining in the lower abdomen, nearby lymph nodes and parts of other nearby organs. The remaining stomach and esophagus are then reconnected.

Total gastrectomy

For more advanced stomach cancer, Scripps surgeons may perform a total gastrectomy to remove the entire stomach, nearby lymph nodes and fatty lining in the lower abdomen. If necessary, surgery may include parts of nearby organs or tissues. The esophagus is reattached to the small intestine.

A subtotal gastrectomy or total gastrectomy may be performed as an open surgery, laparoscopic surgery or robot-assisted surgery, depending on the size of tumor(s) and treatment plan.

Palliative surgery for late-stage gastric cancer

If stomach cancer reaches the stage where it’s too advanced to treat (late-stage cancer), Scripps surgeons may perform palliative surgery to help prevent or relieve symptoms or complications and improve the patient’s quality of life.

Radiation therapy

Scripps has the most comprehensive radiation therapy offerings in San Diego for gastric cancer, including highly targeted radiation therapy technologies that treat cancerous cells while protecting surrounding tissues and organs from excess radiation damage.

Chemotherapy and chemoradiotherapy for stomach cancer

Chemotherapy for stomach cancer may be provided before a surgery with the goal of shrinking the tumor, or after a surgery to help prevent cancer from recurring. Chemotherapy may also be combined with radiation therapy — an approach known as chemoradiation.

Chemotherapy also may be the primary treatment for gastric cancer when a patient cannot tolerate surgery or has late-stage disease that cannot be surgically removed.

Some stomach cancer treatment plans may include clinical trials. Talk with your physician about whether a clinical trial is right for you. For a list of clinical trial that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your stomach cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your stomach cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. 

Your team may include:

• Gastroenterologists
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

For specific details on Scripps' multidisciplinary approach to treatment, visit your cancer care team.

In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics such as:

• Nutrition
• Expressive writing
• Yoga
• Meditation

Check the current list of support offerings or contact your oncology social worker or cancer care coordinator.

For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.

We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your stomach cancer journey is about much more than your medical treatment. Specifically, Scripps offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:

• Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
• Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
• Home health care services when you require skilled intermittent care in the comfort of your home.
• Nutrition and weight-maintenance services via registered dietitians of Scripps Center for Weight Management and Scripps Center for Integrative Medicine.
• Psychological and emotional care for patients and family members seeking mental health counseling from experts in psychology and psychiatry.
• Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
• Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
• Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
• Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.

For the full lineup of offerings, please visit our cancer patient resources section.