• Patients with stomach cancer are treated by members of the BC Cancer Agency’s Gastrointestinal (GI)Tumour Group.
• For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines.
• Other names/types of stomach cancer are gastric cancer, gastric lymphoma, gastrointestinal carcinoid tumour, and gastrointestinal stromal tumour (GIST).
• The stomach is a curved muscular sac-like organ in the upper abdomen between the esophagus and the small intestine.
• The stomach releases gastric juices to help with digestion and the breakdown of food.

• People over 50 have a higher risk of getting stomach cancer.
• Stomach cancer is twice as common in men as it is in women.
• The use of tobacco may increase the risk of stomach cancer.
• Stomach cancer is more common in Japan, China, Southern and Eastern Europe, and South and Central America.
• Eating a diet high in pickled, salted and smoked foods increases the risk of stomach cancer.
• The risk of stomach cancer is reduced by eating a diet high in fruits and vegetables.
• Lack of refrigeration and the eating of tainted or decaying food may lead to the development of stomach cancer.
• People with pernicious anemia (unable to absorb vitamin B12) are more likely to develop stomach cancer.
• Previous stomach surgery for benign ulcers or other disorders seems to increase the risk of cancer 15 or 20 years later.
• People with atrophic gastritis are at higher risk for stomach cancer.
• The presence of Helicobacter pylori (H. pylori) infection increases the risk of stomach cancer.
• Chronic reflux of bile into the stomach is linked to a higher incidence of stomach cancer.
• People with type A blood have a higher risk of getting stomach cancer. The reasons for this are unknown.
• People who have a family history of stomach cancer are at an increased risk. Genetic disorders such as hereditary diffuse gastric cancer, hereditary non-polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP) may increase the risk of stomach cancer.
• Statistics 
• BC
• Canada

Can I help to prevent it?

• Eat a lot of vegetables and fruit.
• Don’t eat a diet high in salted, smoked or pickled foods.
• Don’t smoke.
• Patients with H. pylori infection should be on “triple therapy” which is a combination of antibiotics and antacid.

Screening for this cancer

• Screening for stomach cancer is not recommended in Canada because the incidence of the disease is low.
• If you have a family history of stomach cancer, you should talk about it with your doctor.
• People with a strong family history of stomach cancer should be tested. There is more information on genetic testing from our Hereditary Cancer Program.

Signs and Symptoms

• Mild abdominal pain or discomfort made worse by food.
• Nausea or vomiting.
• Heartburn or indigestion.
• Loss of appetite.
• Difficulty swallowing.
• Tarry-looking or black stools.
• Fatigue or weakness.
• Unexplained weight loss.

Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer.

	Stool examination	To look for hidden (occult) blood.
	Blood tests	For iron deficiency anemia.
	Barium swallow	A liquid containing barium is swallowed and x-rays are taken.
	Endoscopy	A thin instrument is inserted through the mouth, down the esophagus and into the stomach; allows the doctor to view inside the stomach and to remove a tissue sample for biopsy.
	Biopsy	A small amount of tissue is removed for examination under a microscope; used to make a definite diagnosis.
	CT scan	Cross section view of the organ; pinpoints the size and location of the tumour.
	MRI	Cross section view of the organ; pinpoints the size and location of the tumour.
	Laparoscopy	A thin instrument is inserted into the abdomen to view the stomach; used to biopsy and stage the cancer.

• For more information on all cancer diagnostic tests, see our Recommended Websites, Diagnosis section.

Types and Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

• T describes the site and size of the main tumour (primary);
• N describes involvement of lymph nodes;
• M relates to whether the cancer has spread (presence or absence of distant metastases).

Stages

• Stomach cancers develop most often in the lower portion of the stomach closest to the small intestine.
• Stomach cancer has often spread at the time of first diagnosis.
• Stomach cancer commonly spreads to the gastrointestinal organs, lungs, bones, uterus, ovaries, kidneys, brain and skin.
• Staging depends on how deeply the tumour has invaded through the stomach wall.

Stage IA	Cancer is limited to the inner layer of the stomach wall.
Stage IB	Cancer is limited to the inner layer of the stomach wall and has spread to 1-6 lymph nodes; or cancer has spread to the outer muscle layer of the stomach wall, but has not spread to the lymph nodes or other organs.
Stage II	Cancer is limited to the inner layer of the stomach and has spread to 7-15 lymph nodes or other organs; or cancer has spread to the outer muscle layer of the stomach wall and has spread to 1-6 lymph nodes; or cancer has grown through the stomach wall, but has not spread to any lymph nodes or other organs.
Stage IIIA	Cancer has spread to the outer muscle layer of the stomach and has spread to 7-15 lymph nodes, but not to other organs; or cancer has grown through the stomach wall and has spread to 1-6 lymph nodes, but not to other organs; or cancer has spread to nearby organs, but has not spread to any lymph nodes or distant organs.
Stage IIIB	Cancer has grown through the stomach wall and has spread to 7-15 lymph nodes.
Stage IV	Cancer has spread to distant organs; or cancer has spread to more than 15 lymph nodes; or cancer has spread to nearby organs and to at least 1 lymph node.

• Adenocarcinoma
• About 90-95% of stomach cancers are adenocarcinomas.
• Lymphoma
• About 4% of stomach cancers are gastric lymphomas.
• Carcinoid Tumour
• About 3% of stomach cancers are gastrointestinal carcinoid tumours which start in the hormone-making cells of the stomach.
• Gastrointestinal Stromal Tumour (GIST)
• A rare kind of stomach cancer which starts in the cells in the wall of the stomach is known as a Gastrointestinal Stromal Tumour.

Treatment
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Surgery

• Surgery offers the best chance of cure.
• A subtotal gastrectomy involves the removal of part of the stomach, nearby lymph nodes, and parts of other tissues or organs near the tumour.
• A total gastrectomy involves the removal of the entire stomach, nearby lymph nodes, and the lower part of the esophagus or upper part of the small intestine, depending on the site of the tumour.
• If the cancer has spread, the affected parts of other organs, including the liver, spleen, pancreas or colon, may also be removed, if the cancer has not spread to distant organs.
• Over 50% of early-stage cases of stomach cancer are curable.

Radiation Therapy

• Radiation therapy may be given to help with bleeding or pain.
• Chemotherapy with 5-fluorouracil in combination with radiation therapy has recently been shown to improve survival in people who have had their tumour completely removed by surgery.

 Chemotherapy

• Chemotherapy is sometimes helpful, but it will not cure stomach cancer.
• At the BC Cancer Agency, the chemotherapy usually given is 5-fluorouracil combined with cisplatin.
• Chemotherapy with 5-fluorouracil in combination with radiation therapy has recently been shown to improve survival in people who have had their tumour completely removed by surgery.

Laser Treatment

• Laser treatment may be used for bleeding or obstruction in some cases.

Follow-up after Treatment

• Guidelines for follow-up after treatment has ended have been developed by the BC Cancer Agency and are listed on our website.
• You will be returned to the care of your family doctor or specialist for regular follow-up.
• Follow-up testing is based on your type of cancer and your individual circumstances.
• The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

Coping with Cancer

The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.

The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc. Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Stomach cancer
Websites for cancer survivors, and how to stay healthy after treatment.

Videos
View videos on cancer-related topics that the BC Cancer Agency produces.

How can I help with research at BCCA?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help:

• The BCCA is deeply involved in cancer research.  We operate various Research Programs, the BC Cancer Research Centre and Canada's Michael Smith Genome Sciences Centre.
• Clinical Trials – join our treatment-based research. Ask your oncologist if you qualify for a clinical trial. What are the pros and cons of joining a clinical trial?
• Tumour Tissue Bank – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money.

This information has been reviewed and approved by a member of the Gastrointestinal (GI) Tumour Group.