What You Need To Know About Stomach Cancer

What is stomach cancer?

Stomach cancer, also known as gastric cancer, is an abnormal and fast-growing collection of cells in the inner lining of your stomach. Typically located in the upper middle of your abdomen, a tumor forms in your muscular sac (stomach), consisting of the extra cells formed after uncontrollable growth. This cancer is relatively rare, with only 26,560 cases appearing per year in the U.S.

Stages of stomach cancer are identified by the layer of your stomach where the cancer appears. The innermost layer, the mucosa, is where most stomach cancers begin. From there, cancer makes its way into four more layers before landing on the most outer layer: submucosa, muscularis propria, subserosa, and serosa.

Different types of stomach cancer include:

  • Adenocarcinomas

  • Lymphomas 

  • Gastrointestinal stromal tumors, or GISTs

  • Neuroendocrine neoplasms

  • Other rare subtypes

Adenocarcinomas

According to the American Cancer Society (ACS), Adenocarcinomas make up 90% to 95% of stomach cancer diagnoses. According to Lauren's classification, there are two main histological types of stomach adenocarcinomas: intestinal-type and diffuse-type. The intestinal type tends to grow slowly and is usually more treatable. The diffuse type is less common and usually much more aggressive (can spread to other parts of the body quickly).

Lymphomas

Making up about 4% of all stomach cancers, lymphomas are cancers that begin in your lymph tissues; in this case, the lymph tissue in your stomach. It is usually slow-growing, often easy to detect early, and treatable.

Gastrointestinal stromal tumors, or GISTs

GISTs form in the wall of your stomach, arising from cells known as the interstitial cells of Cajal (ICC). It can be found anywhere in your digestive tract but is more common in your stomach.

Neuroendocrine neoplasms

Neuroendocrine neoplasms start in the stomach and can grow and spread to other areas of the body. However, particularly for well-differentiated neuroendocrine neoplasms (also known as carcinoids),  it's more common for them to grow slowly and stay in the stomach.

Symptoms

The symptoms often vary depending on the type of stomach cancer you have. The best chance for survival is early detection. The survival rate is significantly higher if cancer does not spread outside your stomach.

Early signs to look out for include:

  • Nausea

  • Heartburn

  • Feeling bloated after eating

  • Poor appetite

  • Discomfort in your stomach

These symptoms are mild and often occur in the early stages. As the cancer advances in the later stages, the symptoms advance as well and may include:

  • Vomiting

  • Unintentional weight loss

  • Bloody stool

  • Yellowing in your skin and eyes (jaundice)

  • Stomach pains

  • Difficulty swallowing

  • Ascites

All of these symptoms are common for most stomach cancers. A more specific symptom to look out for is swelling in your stomach from gastrointestinal stromal tumors.

Learn more about stomach cancer symptoms, risk factors, and when to see a doctor.

Causes

There are several factors and risks that can play a role in the development of stomach cancer, the most important of which are infection with Helicobacter pylori and a family history of gastric cancer.

While some causes have yet to be identified, other known risk factors include:

  • A poor diet (high-salt, few vegetables, nitroso compounds)

  • Genetic factors

  • Infections (such as Helicobacter pylori, and Epstein-Barr virus) 

  • Obesity 

  • Smoking 

  • Previous gastric surgery

  • previous abdominal irradiation.

Sex

Incidence rates for stomach cancer are two to three times higher for men than women. According to a study by the Massachusetts Institute of Technology (MIT)¹, males are at a higher risk of getting stomach cancer than females because of basic biological differences. The study found that by injecting male mice with estrogen, their rates of stomach cancer decreased substantially.

Genetics

1-3%² of all gastric cancers is associated with inherited genetic predisposition disorders, such as familial adenomatous polyposis, hereditary diffuse gastric cancer and gastric adenocarcinoma, and proximal polyposis of the stomach.

In particular, with hereditary diffuse gastric cancer, the mutation of your CDH1 gene can cause stomach cancer. According to the Genetic and Rare Diseases Information Center (GARD)³, in at least one in ten cases of stomach cancer, other family members have had cancer or have an increased risk of having cancer.

Infections and diseases

Evidence supports an association between Helicobacter pylori infection (a bacterial infection) and gastric cancer, thought to be due to the mucosal inflammation followed by atrophy and intestinal metaplasia caused by this bacteria.

It is estimated that between 5-10% of gastric cancers worldwide are associated with the Epstein-Barr virus.

Likewise, pernicious anemia is a rare autoimmune disease that attacks the stomach, putting you at a higher risk of getting stomach cancer.

Overweight or obese

Obesity is considered one of the strongest factors associated with stomach cancer. One of the mechanisms proposed to explain this increased risk is the chronic low-grade inflammation associated with obesity. This appears to affect males more often than females.

Smoking

Smoking is most commonly associated with lung cancer and other respiratory damages, but it can also put you at risk for stomach cancer. When you smoke, the products you take in attack your stomach lining, typically in the upper part of your stomach.

Poor diet

Although it is known to be safe in moderation, a diet filled with cured meats (meats and fish that have been through the food preservation process) can put you at risk for stomach cancer. High salt content and low intake of fruit and vegetables can also be risk factors.

Keep learning about the causes of stomach cancer.

  1. Study explains why men are at higher risk for stomach cancer | Massachusetts Institute of Technology

  2. Carcinoma-general | PathologyOutlines.com

  3. Stomach cancer | NIH: National Center for Advancing Translational Sciences

Treatments

There are several types of standard treatments and therapies available to patients with stomach cancer. It's common to receive multiple treatments to battle your cancer, but in more mild cases, you may only receive one.

Surgery

Different surgeries can be performed to treat gastric cancer or reduce the symptoms. In very early-stage cancers, an endoscopic mucosal resection or endoscopic submucosal dissection could be performed. These procedures use an endoscope without the need for a cut in the skin. 

Otherwise, part or all of your stomach will be removed in a gastrectomy, known respectively as subtotal (partial) or total gastrectomy.

When cancer cannot be removed completely, palliative procedures may be necessary. One example is a gastrojejunostomy, in which the tumor is bypassed by attaching part of your small intestine to the upper part of your stomach to allow food to leave the stomach through this new connection.

Medications

Medication is a common treatment in most cancers, typically in the form of chemotherapy and chemotherapy protective drugs (leucovorin).

Chemotherapy drugs for stomach cancer include capecitabine, fluorouracil, oxaliplatin, irinotecan, carboplatin, cisplatin, docetaxel, epirubicin, and paclitaxel.

The drugs can be used in cycles as a stand-alone treatment, but many doctors use them prior to surgery.

Radiation therapy

Medical procedures like radiation therapy are another standard treatment. Radiation therapy uses a machine outside the body to try and kill cancer inside your body. Standard machines include an x-ray and other high-energy rays.

This method is often used before or after surgery, as it shrinks cancer before the procedure or destroys what remains after your surgery. 

Palliative treatments

Palliative treatments also include other types of supportive care. Palliative therapy is not used to extend your life but rather to improve the quality of your life.

While every other treatment is focused solely on destroying your stomach cancer, palliative care's sole focus is managing your symptoms, so you can live as normal of a life as you can.

See all stomach cancer treatment options explained here.

Prevention

While some risk factors cannot be controlled, like the passing down of a familial gene and your sex, there are some measures that you can take to prevent stomach cancer.

Lifestyle choices

A good example is the lifestyle choices you make. You can control your diet, exercise, and habits like smoking and drinking.

A diet with plenty of fruits and vegetables, and limited processed preservatives and salt, will not only lower your risk for stomach cancer but several other cancers.

Exercise is another factor that can reduce your risk. According to the National Cancer Institute¹, studies have found that more physically active people have a 19% lower risk of stomach cancer.

People who don't take up smoking and drinking also have a lower risk because they're not continuously damaging their stomach lining, which is a precursor to stomach cancer.

Smoking in any amount is harmful. However, studies have shown that drinking in moderation has not been associated with stomach cancer. It's drinking too much alcohol that could be a risk factor.

Screening

There aren't any standard or routine screening guidelines for stomach cancer yet. Screening test types like barium-meal gastric photofluorography, upper endoscopy, and serum pepsinogen levels have been studied, but there has not been an outcome that suggested a lower risk of dying. According to NIH², stomach cancer screening is still being studied in clinical trials.

Early diagnosis is still important, so it's essential to look out for early-stage symptoms and discuss them with your doctor. The sooner your cancer is detected and treated, the higher your chances are to beat it.

Find other ways to reduce your risk of stomach cancer here.

Awareness

Stomach cancer awareness month comes around every November, with the periwinkle blue ribbon reminding individuals to look out for the early-stage signs. Organizations like No Stomach For Cancer, Debbie's Dream Foundation, and Gastric Cancer Foundation saw this as a great time to also educate more people on the risks of overeating meats and salty foods, and under-eating fruits and veggies.

Each foundation has a sentimental story behind it, driving actions and change in stomach cancer funding and research. Similar to the goals of other foundations, No Stomach For Cancer states their goals as raising awareness and funds for research to contribute to the findings of early detection and treatment, encouraging people to support the cause, and empowering people to unite.

These foundations and awareness actions have successfully spread the word about stomach cancer and impacted research significantly with donations. According to NCI¹, stomach cancer funding increases every year, from just above $11 million in 2013 to $14.2 million in 2018. 

These donations and awareness campaigns have significantly impacted research funding over the last decade. Each year, the number of stomach cancer cases drops by 1.5%², with 2021 cases at the lowest in the last 10 years (estimated 26,560 new cases, 11,180 deaths).

Learn about how you can get involved and help spread stomach cancer awareness.

  1. Funding for Research Areas | National Cancer Institute

  2. Key Statistics About Stomach Cancer | American Cancer Society

Costs

While this is the last thing you want to think about when you find out that you or someone you know has stomach cancer, treatment in the United States will come with a substantial cost.

According to a cancer study in the U.S. National Library of Medicine¹, costs break down in the following ways.

  • The average annual cost of gastric cancer in the U.S. is $3.1 million.

  • The average overall cost per patient with stomach cancer, 18 months after diagnosis, is estimated to be around $96,571¹.

  • For patients over 65 years old, that number reduces to $44,203 for men and $41,899 for women.

Without health insurance

Without health insurance², patients could be looking at an average cost of $50,000 per surgery and up to $200,000 in average overall costs. This number does not include doctor fees and can add up quickly with the number of treatments you receive throughout the process. For instance, a patient can expect to see around $20,100 added to their rapidly growing medical bills for each chemo and radiation treatment.

With health insurance

Standard health coverage varies from person to person. However, a typical employer-sponsored health insurance plan would lead to 25% coinsurance³ costs that add up to about $2,500 for a cancer drug that costs $10,000 every month.

Indirect costs

Indirect costs are also a factor to consider. While no estimated cost average can be tracked, cancer can increase transportation, lodging, secondary effects of treatment (wigs, special food, etc.), and caregiving costs for themselves and their children.

At the same time, many patients also experience loss of income as they have to stop working temporarily.

Statistics

According to current research and studies, stomach cancer is the fifth most common¹ cancer worldwide. This is just under breast cancer, lung cancer, prostate cancer, and skin cancer (non-melanoma).

In 2021, stomach cancer diagnoses² are estimated at 16,160 cases for men and 10,400 cases for women. The estimated number of deaths² due to gastric cancer is around 6,740 for men and 4,440 for women.

Survival rates

Almost half the number of people diagnosed with this type of cancer will survive the first year, but that number continues to drop significantly after that.

According to NHS Inform³:

  • One year after diagnosis, 42 out of 100 people (42%) will live.

  • At least five years after being diagnosed, 19 out of 100 people (19%) will live.

  • Up to ten years after the diagnosis, 15 out of every 100 people (15%) will live.

Demographics

The demographics most commonly affected by a stomach cancer diagnosis are:

  • Age: people 65 years olds and older are most at risk, with about six of every ten⁴ people diagnosed with stomach cancer each year being 65 or older. The average age of diagnosis is 68.

  • Sex: 1 in 96 men risk developing gastric cancer⁴ compared to 1 in 152 women. 

  • Race: An NIH⁵ study found that Asians had the highest incidence of stomach cancer (double that of whites) and had the highest survival of all race groups.

Find more statistics for stomach cancer survival rates and prevalence here.

Doctors & specialists

If you have any concerns that you or someone you know has stomach cancer, it is important to consult your doctor right away. The survival rates significantly increase when the cancer is detected early before it can spread throughout your stomach, layers, or other parts of your body. Learn how to recognize the early warning signs.

The doctors and specialists involved with the entire process vary by the type of stomach cancer you have, the treatments you receive, and the stages you're in.

The health professionals you may see include:

  • General practitioner: when you have initial concerns about stomach cancer, you'll first consult your primary doctor. They will discuss the symptoms with you, go over educational information, and direct you through the following steps.

  • Gastroenterologist: involved in performing endoscopes and inserting feeding tubes for certain types of gastric cancer.

  • Upper gastrointestinal surgeon: the surgeon that will diagnose, treat, and perform the upper gastrointestinal surgery on the patient. 

  • Medical oncologist: involved with drug therapies like chemotherapy options, targeted therapy, and immunotherapy treatments to treat cancer.  

  • Radiation oncologist: the doctor that will oversee and treat with radiation therapy.

  • Radiation therapist: lays out the plans for radiation therapy and schedules them. 

  • Nurses: offer general care and support, as well as supplying helpful information.  

  • Dietitian: since patients with stomach cancer need special foods at the time of their treatment and recovery, a dietitian recommends an eating plan to follow during this time. 

  • Physiotherapist: rehabilitates patients while preventing any further injury. 

  • Psychologist: helps patients confront and manage emotional issues that may come with having and treating cancer. 

  • Palliative care team: work together to help patients manage their cancer symptoms and sustain a higher quality of life.



Clinical trials for stomach cancer

Actively recruiting
A Study of Regorafenib in Refractory Advanced Gastro-Oesophageal Cancer
AustraliaNew ZealandUnited States
Actively recruiting
Trial of Preoperative Therapy for Gastric and Esophagogastric Junction Adenocarcinoma (TOPGEAR)
AustraliaNew Zealand
Actively recruiting
Study comparing the Efficacy and Safety of FOLFIRINOX ( Fluoropyrimidine, Oxaliplatin and Irinotecan) as Chemotherapy regimen For Resectable Gastric Or Gastroesophageal Junction Cancer to ECF (Cisplatin, Epirubicin and Fluoropyrimidine) as chemotherapy regimen which is the standard treatment
SA (AU)

Medications for stomach cancer