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Stomach

This information should not be used for self-diagnosis or in place of a qualified physician’s care.

Reviewed March 2016

The basics
  • Guidelines for treating this cancer have been developed by the Gastrointestinal (GI)Tumour Group.
  • For health 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.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors. 

  • 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 

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

No effective screening program exists for this cancer yet. 

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 & staging

Diagnosis

These are tests that may be 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. This 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. This is used to make a definite diagnosis. 
  • CT scan will give a cross section view of the stomach. It pinpoints the size and location of the tumour. 
  • MRI - a cross section view of the stomach. It 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 tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages 

Types

  • 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.

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).
  • 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.

Treatment

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.

RadiationTherapy

  • 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 are covered on our website.
  • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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