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Stomach cancer
Last reviewed: 12.07.2025
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Stomach cancer has many causes, but Helicobacter pylori plays a significant role. Symptoms of stomach cancer include fullness, obstruction, and bleeding, but tend to occur in the late stages of the disease. Diagnosis is by endoscopy, followed by CT and endoscopic ultrasound for staging. Treatment of stomach cancer is primarily surgical; chemotherapy may provide only temporary relief. Long-term survival is poor, except in cases of localized disease.
Each year in the United States, there are approximately 21,000 cases of stomach cancer and 12,000 deaths. Gastric adenocarcinoma accounts for 95% of malignant gastric tumors; limited gastric lymphomas and leiomyosarcomas are less common. Stomach cancer is the second most common cancer worldwide, but its incidence varies greatly; incidence is extremely high in Japan, Chile, and Iceland. In the United States, incidence has decreased in recent decades and is the seventh leading cause of cancer death. In the United States, the disease is more common among blacks, Hispanics, and Indians. Cancer incidence increases with age, with more than 75% of patients over age 50.
Read also: Stomach cancer in the elderly
[ What causes stomach cancer?
H. pylori infection is the main cause of most stomach cancers. Autoimmune atrophic gastritis and various genetic disorders are risk factors.
Gastric polyps may be precursors to gastric cancer. Inflammation of the polyps may develop in patients taking NSAIDs, and pitted polyps of the fundus are common in patients taking proton pump inhibitors. Adenomatous polyps, especially multiple ones, are rarely but definitely subject to malignancy. Malignancy is especially likely if the adenomatous polyp is larger than 2 cm in diameter or has a villous structure. Since malignant transformation cannot be detected by examination, all polyps detected by endoscopy should be removed. The incidence of gastric cancer is generally reduced in patients with duodenal ulcer.
Gastric adenocarcinomas can be classified based on their macroscopic appearance.
- Protruding - the tumor is polypoid or mushroom-shaped (polypoid cancer).
- Invasive - a tumor in the form of an ulcer (saucer-shaped cancer).
- Superficial spread - the tumor spreads along the mucous membrane or superficially infiltrates the wall of the stomach (ulcer-infiltrative cancer).
- Linitis plasties (plastic linitis) - the tumor infiltrates the wall of the stomach with an associated fibrous reaction, which causes rigidity of the stomach in the form of a "vessel made of skin".
- Mixed - the tumor is a manifestation of two or more other types; this classification is the largest.
Polypoid tumors have a better prognosis than common types of tumors because symptoms of stomach cancer appear earlier.
Symptoms of stomach cancer
The initial symptoms of gastric cancer are usually vague, often consisting of dyspepsia suggestive of peptic ulcer. Patients and physicians often ignore the symptoms and treat the patient according to the ulcer. Symptoms of early satiety (feeling of fullness after eating a small amount of food) may develop later if the tumor involves the pyloric region or if the stomach becomes secondarily rigid due to linitis plastica. Dysphagia may develop if cancer of the cardiac region of the stomach obstructs the esophagus. Weight loss and weakness are characteristic, usually due to dietary restriction. Hematemesis or melena are uncommon, but secondary anemia is a consequence of occult bleeding. Sometimes the first signs of gastric cancer are metastases (e.g., jaundice, ascites, fractures).
Physical examination findings may be subtle or limited to heme-positive stool. In advanced cases, changes include an epigastric mass; umbilical, left supraclavicular, and left axillary lymph nodes; hepatomegaly; and ovarian or rectal masses. Pulmonary, CNS, and bone lesions may be present.
Where does it hurt?
What's bothering you?
Diagnosis of stomach cancer
Differential diagnosis of gastric cancer usually includes peptic ulcer and its complications.
Patients with suspected gastric cancer should undergo endoscopy with multiple biopsies and cytology of mucosal scrapings. Occasionally, biopsies limited to the mucosa miss tumor tissue in the submucosa. Fluoroscopy, especially with double-contrast, may visualize the lesion but does not eliminate the need for subsequent endoscopy.
Patients with identified cancer require chest CT and abdominal CT to verify the extent of tumor spread. If CT excludes metastasis, endoscopic ultrasound should be performed to determine the depth of tumor invasion and regional lymph node metastasis. The obtained data determine the treatment and prognosis.
Basic blood tests should be performed, including complete blood count, electrolytes, and liver function tests to assess anemia, hydration, homeostasis, and possible liver metastasis. Carcinoembryonic antigen (CEA) should be measured before and after surgery.
Screening endoscopic testing is used in high-risk populations (eg, Japan) but is not recommended in the United States. Follow-up screening in patients after treatment consists of endoscopy and CT of the chest, abdomen, and pelvis. If CEAg levels fall after surgery, follow-up should include monitoring of CEAg levels; an increase indicates recurrence.
What do need to examine?
What tests are needed?
Who to contact?
Treatment of stomach cancer
The choice of the extent of treatment depends on the stage of the tumor and the patient's wishes (some refrain from aggressive treatment).
Surgical treatment of gastric cancer involves removal of most or all of the stomach and regional lymph nodes and is indicated for patients with disease limited to the stomach and possibly regional lymph nodes (less than 50% of patients). Additional chemotherapy or combined chemotherapy and radiation therapy after surgery is of questionable effectiveness.
Local resection of advanced regional disease results in an average survival of 10 months (versus 3-4 months without resection).
Metastasis or extensive nodal involvement precludes surgical treatment, and at most palliative procedures should be prescribed.
However, the true extent of tumor spread is often not known until surgery is performed. If the patient's quality of life can be improved, palliative surgery should be performed, usually involving gastroenterostomy for pyloric obstruction. In patients not amenable to surgery, combination chemotherapy regimens (5-fluorouracil, doxorubicin, mitomycin, cisplatin, or leucovorin in various combinations) may provide temporary relief, with a modest survival benefit of up to 5 years. Radiation therapy has limited efficacy.
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What is the prognosis for stomach cancer?
Stomach cancer has a different prognosis. It depends on the stage, but it is not entirely favorable everywhere (5-year survival: less than 5-15%), since most patients come with an advanced form of the disease. If the tumor is limited to the mucous or submucosa, 5-year survival can reach 80%. With tumors with damage to regional lymph nodes, survival is 20-40%. With a wider spread of the disease, the prognosis is almost always fatal within 1 year. With gastric lymphomas, the prognosis is better.