What is Stomach Cancer?

When cells in the stomach start to mutate or produce abnormal cells, they can transform into gastric cancer. Cancerous cells can metastasize to different areas or remain within the stomach area. The stomach is comprised of five parts, which are divided into two areas.

Those areas are the:

Proximal stomach, or the nearer area, which is comprised of the:

  • Cardia
  • Fundus
  • Body

Distal stomach, or the more distant area, which is comprised of the:

  • Antrum
  • Pylorus

The stomach wall is comprised of five layers:

  • Serosa, outermost layer.
  • Subserosa, second outermost layer.
  • Muscularis propria, the middle layer.
  • Submucosa, supporting layer to the mucosa.
  • Mucosa, innermost layer.

Digestive enzymes and stomach acid are made in the mucosa, and more than 90 percent of stomach cancers start in this area. Initially, cancer cells will develop in the cells in the mucosa. As cancer progresses, it will spread into other layers; the more layers containing cancerous cells, the more advanced the cancer stage.

By determining the extent to which cancer has penetrated the layers of the stomach, a doctor can determine the stage of cancer and thus the proper treatment protocol. Typically, stomach cancer metastasizes through the stomach wall into the esophagus, liver, and lymph nodes. Since the stomach area has an extensive network of blood vessels, it’s easy for cancer cells to enter the bloodstream and spread to other organs.

When stomach cancer spreads to the lymph nodes, the prognosis is usually poor. Since stomach cancer is often asymptomatic, individuals may be unaware of its presence until it has progressed to an advanced stage. Unfortunately, treatment outcomes at this stage are substantially less successful than when the cancer is diagnosed at an earlier stage.

Although many other organs, such as the colon, liver, and pancreas, are located close to the stomach, they are actually part of the abdomen and develop different types of cancer than does the stomach.

Types of Stomach Cancer

  • Adenocarcinoma

Stomach cancer can take many forms. The most common is adenocarcinoma, which begins in the mucosa or the inside lining of the stomach. Common terms for this type of cancer are gastric cancer and stomach cancer.

These two types of cancer comprise more than 90 percent of all incidences of stomach cancer.

  • Carcinoid tumor

Less than 5 percent of stomach cancers are carcinoid tumors. These tumors usually start in the cells responsible for manufacturing hormones and typically do not metastasize.

  • Gastrointestinal stromal tumor, or GIST

GISTs are rare, and some are not cancerous; they usually start in cells located in the stomach wall. GISTs can be found in other areas of the digestive tract but usually occur in the stomach.

  • Non-Hodgkin lymphoma

Less than 5 percent of lymphomas occur in the stomach. Usually, lymphomas are present in the lymphatic system. Optimal results for non-Hodgkin lymphomas are achieved when the disease is caught very early.

  • Other types of cancers

Rarely, other types of cancer can start in the stomach, such as small cell carcinoma, squamous cell carcinoma, and others. However, these are very rare; most stomach cancers present as adenocarcinoma. The location of cancer, as well as the stage of it, will determine the treatment protocol used and can significantly affect the prognosis. Additional factors that will determine the treatment protocol are the patient’s preferences, overall health, and age.


The first successful surgery to treat gastric cancer was in 1881. Treatment at that time consisted of removing all or parts of the affected section of the stomach and resectioning it. Unfortunately, only 20 percent of the resections were successful, and half of the patients died during surgery or from its complications.

During the 1970s, different combinations of chemotherapy drugs were tested to improve the survival rate for those with inoperable stomach cancer.

Most were ineffective, but eventually, a combination of three drugs showed promise, and this combination was used throughout the 1980s. At this time, total gastrectomies remained the surgical option for removing gastric cancer.

By the end of the decade, doctors added methotrexate to two other drugs, creating a treatment regimen called FAMTX, which increased the survival rate for some stomach cancer patients. Doctors also began using ultrasounds to diagnose the size and spread of stomach cancers more accurately.

Endoscopic ultrasound was developed, which further refined the doctor’s ability to diagnose the size and stage of gastric cancer.

Refinements continued, and by the late 1980s, doctors were able to endoscopically remove small tumors in the early stages and remove tumors and lesions that were questionable. By this time, the number of total gastrectomies performed had greatly diminished.

Research had proven that a partial gastrectomy could effectively remove tumors in the distal stomach, along with the surrounding lymph nodes, with a greater success rate than those who had a total gastrectomy and with fewer side effects.

In the 1990s, researchers found that patients with a genetic predisposition for Lynch syndrome were more likely to develop gastric cancer and colorectal cancer.

In 1993, a connection between the H. pylori bacteria and stomach cancer was established. The U.S. CDC, or Centers for Disease Control, estimated that this bacteria-infected two-thirds of the world population.

By 1997, endoscopic surgery led to laparoscopic surgery, which was considerably less invasive than either the endoscopic or the traditional surgery to remove gastric cancer. Also, in 1997, new chemotherapy drugs were developed that improved the longevity and quality of life for patients with stomach cancer.

In 2001, researchers linked a specific gene, the E-cadherin gene, to stomach cancer. They found that three-fourths of those with the E-cadherin gene had developed stomach cancer.

Around this time, researchers also found that removing more lymph nodes that had previously been removed would increase the survival rate and lower the risk of cancer recurring.

Advances in 2006 treatment regimens showed that those who had chemotherapy both before and after cancer surgery had a higher survival rate and a lower incidence of recurrence. This led to increased research on the necessity of radiation therapy after gastric cancer surgery.

In 2007, a large clinical trial indicated that adjuvant chemotherapy might be sufficient if gastric cancer is caught early, and radiation therapy may be unnecessary.

By 2008, chemotherapy with two drugs seemed to shrink the size of tumors for metastatic stomach cancers, and their growth was inhibited.

However, this treatment wasn’t popular because of the side effects, so it was replaced with two other drugs, Fluorouracil and Leucovorin.

The year 2010 saw an even greater survival rate for stomach cancer patients when doctors began using a drug that had been proven to be effective against breast cancer. Research and trials continue, and aggressive treatment regimens continue to provide the best outcome for patients with stomach cancer.

Risk Factors

Several factors can increase an individual’s risk for developing stomach cancer, including:

  • Genetic predisposition

A family history of stomach cancer, or those who have specific genetic markers, can increase an individual’s propensity to develop stomach cancer. The best course for anyone predisposed to stomach cancer is regular checkups with the family doctor.

Stomach cancer can present asymptomatically, or there may be frequent and severe heartburn, fatigue, stomach pain, bloating, nausea and/or vomiting, and/or unintentional weight loss.

Those who experience any or all of these symptoms should consult their family doctor without delay.

  • Persistent stomach inflammation can occur due to long-term use of medications such as ibuprofen and aspirin.

Excessive and frequent alcohol consumption can also cause inflammation of the stomach lining, as does smoking. In addition, certain bacteria can also cause stomach inflammation.

  • Pernicious anemia occurs when the body lacks the ability to absorb vitamin B12.

The term “pernicious anemia” is the term for a disease that doesn’t frequently occur anymore. In the past, a lack of vitamin B12 could be fatal; pernicious means deadly, so pernicious anemia was deadly anemia.

However, a lack of vitamin B12 can be easily remedied with an injection or dietary supplements.

  • Stomach cancer can occur from eating food that has been contaminated with aflatoxins, which are fungi that contaminate foods and grains.

Although more common in underdeveloped countries, low levels of aflatoxins can accumulate, and the most common sources of fungi are corn, cottonseed, and peanuts. Improved monitoring techniques have enabled better control of these aflatoxins, and the FDA, or the Food and Drug Administration, has imposed stringent regulations on the allowable limits.

  • Stomach polyps are groups of cells that accumulate and attach to the stomach lining.

Usually, they’re benign and don’t cause a problem.

However, certain types of stomach polyps can increase the risk of developing stomach cancer; the oncologist can ascertain the type of polyp and its propensity to become cancerous.

  • The H. pylori bacteria either burrow into the stomach’s mucus lining or attach themselves to the lining.

Usually, the body’s immune system will recognize the H. pylori bacteria as an invader and attack it.

However, resistant strains of H. pylori have developed that can interfere with the body’s immune response, which prohibits the destruction of the H. pylori bacteria.

H. pylori were classified as a carcinogen in 1994, and it spreads through mouth-to-mouth contact or ingestion of contaminated food and water.

  • Smoking and excessive alcohol consumption can interfere with the body’s destruction of the H. pylori bacteria and thus abet cancer development.

Excessive alcohol consumption causes the body to produce acetaldehyde, which is a known carcinogen.

  • Diets high in smoked, salty, or pickled foods and low in fresh vegetables and fruits can encourage the development of stomach cancer.

The fiber in vegetables and fruits can help cleanse the colon each day, discouraging the formation of polyps. In addition, the lower calorie content of vegetables and fruits can help maintain a healthy weight, which is beneficial in preventing stomach cancer.


Particularly in underdeveloped countries, stomach cancer is a leading cause of death. In the United States, though, it is less common than it is in other countries.

Researchers postulate that a better diet, increased awareness, and better methods for food storage may contribute to the decline in the rate of stomach cancer in the U.S. Different types of tests are used to screen for stomach cancer, depending on the symptoms and their severity, as well as the age of the patient.

Clinical trials are sometimes available to increase the understanding of the disease, the most effective treatment protocols and improve current screening methods. The screening method used is dependent on the type of stomach cancer suspected.

A barium meal photofluorography provides photographs of the stomach and the esophagus as the patient drinks a barium liquid. When the photos are processed, they are made into a film so the doctor can observe the function of the organs without exposing the patient to the radiation of an x-ray.

Upper endoscopy uses a thin tube inserted down the throat to check inside the esophagus, stomach, and duodenum. There may be a tool attached to the endoscope that will enable it to remove a tissue sample if the need should arise.

A serum pepsinogen test will indicate if there are low levels of pepsinogen in the stomach. Low pepsinogen levels could indicate gastric atrophy, which could indicate the presence of cancer or the potential for its development. Certain factors can increase the likelihood that a patient will need screening for stomach cancer.

Elderly individuals who have pernicious anemia or gastric atrophy, those with a family history of stomach cancer, those who are from countries with a high incidence of stomach cancer, those who have polyps, and those who have had a partial gastrectomy are all candidates for more aggressive screening for stomach cancer.

Since screening tests are not without risks, they should be performed judiciously and with careful consideration. Anyone who contemplates having a screening for stomach cancer should be fully informed of the risks and if the screening procedure will actually be of benefit. Unfortunately, not all screening techniques reduce the risk of contracting stomach cancer.


Stomach cancer can be asymptomatic for years, or it can precipitate a trip to the doctor.

Some signs of stomach cancer can include:

  • Bloating after eating
  • Fatigue
  • Inexplicable weight loss
  • Satiety from small amounts of food
  • Stomach pains
  • Severe indigestion or heartburn
  • Unusual and persistent nausea and/or vomiting

Although some of these symptoms may be normal, especially for older individuals, prudence would indicate a trip to the doctor if they are uncommon or become worrisome.

The presence of any or all of these does not indicate either the presence or the lack of stomach cancer, simply that it needs to be eliminated as a possibility. Stomach cancer has the best remission rate when caught early. Even if tests do not indicate that there is cancer present, the doctor may be able to provide solutions that will alleviate these digestive problems. Solutions could include medication, dietary changes, lifestyle changes, and so forth.

Diagnosis and Stages

Cancer is divided into seven stages for diagnostic purposes:

  • Stage 0

These cancers are small and can usually be treated endoscopically. A stage 0 cancer is restricted to the stomach’s inner lining and has not metastasized into the surrounding area or to other organs.

Since they are so small, endoscopic surgery is sufficient, and no radiation or chemotherapy is necessary.

  • Stage IA

Stage 1A cancers are usually treated with a total or partial gastrectomy, and the surrounding lymph nodes are removed. Endoscopy is not normally a surgical option for type 1A cancers, but there are exceptions, depending on the size of the cancer, and other factors.

Usually, no radiation or chemotherapy is needed after the surgery.

  • Stage 1B

Treatment for stage 1B cancers is the same as for stage 1A, except chemotherapy or chemoradiation may be used prior to the surgery to reduce the size of the cancer and facilitate its removal.

Depending on the patient, chemotherapy or chemoradiation will sometimes be recommended for these patients, especially if none were performed before the surgery.

If the patient is too ill for chemoradiation, they may receive either chemotherapy or radiation therapy.

  • Stage II

Patients with stage II stomach cancer will usually undergo either chemotherapy or chemoradiation to reduce the size of the tumor. Often, one of these will be necessary after the surgery as well.

Surgical removal of the stomach, the omentum, and surrounding lymph nodes is the procedure for treating stage II stomach cancer.

  • Stage III

Surgery is the primary treatment option for stomach cancer that has reached stage III. However, some cancer patients may not be cured by surgery alone, even if it includes chemotherapy or chemoradiation. At stage III, surgery can sometimes only alleviate the symptoms or help control cancer growth. Sometimes, receiving chemotherapy or chemoradiation therapy can reduce the size of the tumor and provide a more favorable outcome for the surgery.

  • Stage IV

Stage IV cancer is not usually curable through surgery because cancer has metastasized to other organs. However, surgery can help control the spread of the disease, and chemotherapy or chemoradiation therapy can help relieve symptoms and reduce the size of the tumor.

Doctors have experienced limited success with directing a laser beam through an endoscope to destroy a large part of cancerous tumors, which sometimes eliminated the need for surgery.

Targeted therapy has been shown to help treat stage IV cancers and can be administered alone or with chemotherapy. An advantage of targeted therapy is that it doesn’t damage the surrounding tissues. As a result, pain and symptoms can be alleviated even when cancer doesn’t shrink or isn’t destroyed. Dietary changes can also be beneficial as research has indicated that diet can play a substantial role in treating cancer.

Cancer patients should avoid sugar, except as it occurs naturally in fruit because cancer cells thrive in an environment full of refined sugars and carbohydrates.

  • Recurrent

When cancer returns after treatment, it’s classified as recurrent. Treatment protocols will depend on the location of the recurrence, treatments already administered, and the patient’s overall health.

Treatments and Drugs

Patient health and the stage of stomach cancer are the primary factors determining the treatment regimen for stomach cancer and the drugs used. Patient preference is also a determining factor.

When the treatment protocol includes surgery, the objective is to remove all the cancer and some of the surrounding healthy tissue to ensure the complete removal of all cancer cells. Depending on the type and the extent of cancer, surgery may be endoscopic or traditional. The best surgical outcome occurs when the cancer is caught at a very early stage.

Types of Surgery

  • Endoscopic Mucosal Resection

Surgery for small or early-stage cancers can use a lighted endoscope to remove the cancerous cells from the stomach lining.

  • Partial or Subtotal Gastrectomy

For cancers that are contained within a specific portion of the stomach, this procedure enables the surgeon to remove only the cancerous area(s). This procedure is also used for those with an advanced stage of stomach cancer.

Although it doesn’t cure or eliminate cancer, it can make the patient more comfortable and alleviate some or many of the symptoms of gastric cancer.

  • Total Gastrectomy

This procedure removes the stomach in its entirety and some of the surrounding tissue. Next, the surgeon will connect the esophagus to the small intestine so that food can pass through the digestive system.

This procedure will probably require a change in eating habits since some of the preliminary digestive processes will have been eliminated.

  • Lymphadenectomy

The purpose of lymphadenectomy is to remove some lymph nodes from the stomach and examine them microscopically to locate any cancerous cells that may be present.

Radiation Therapy

Radiation therapy is used at several stages of cancer. First, the patient lies on a table, and the machine(s) moves around the patient. Then, high-powered energy beams focus on the cancer cells to shrink the tumor before surgery; this procedure is called neoadjuvant radiation.

Adjuvant radiation is similar but is used after surgery to kill any cancer cells that may have remained after the surgery. Radiation may be used in combination with chemotherapy for those who have advanced cancer or a very large tumor. Side effects of radiation therapy can include diarrhea, nausea, vomiting, and/or indigestion.


Neoadjuvant chemotherapy is used before surgery to reduce the size of a tumor. This facilitates the removal of the tumor and enables more effective removal of cancer cells. Since chemotherapy uses powerful drugs that travel throughout the body, it is typically used for metastasized cancers. In addition, adjuvant chemotherapy is used to eliminate any cancer cells that might remain after surgery.

For those with an advanced stage of gastric cancer, chemotherapy can be used alone to alleviate the symptoms of the disease. Chemotherapy is frequently used in combination with radiation therapy in order to achieve maximum results.

Targeted Drug Therapy

Drugs have been developed that target specific areas of cancer cells but leave the surrounding cells intact. They also inhibit the growth of cancer cells. Targeted therapy is more popular because it destroys the cancer cells but not the surrounding cells, as is the case with radiation and chemotherapy.

Some of the targeted drugs available include:

  • Trastuzumab, or Herceptin, was initially developed for the HER2 cells in breast cancer; HER2 stands for human epidermal growth factor receptor 2 and is produced by approximately 20 percent of advanced stomach cancer cells. The HER2 cells stimulate the cancer cells, so they grow accelerated, making them a primary target for research.
  • Ramucirumab, or Cyramza, is used on patients with an advanced stage of stomach cancer that hasn’t responded to other treatment methodologies.
  • Imatinib, or Gleevec, treats the rare gastrointestinal stromal tumors, as does Sunitinib, Sutent, Regorafenib, or Stivarga.

Clinical Trials

New research into effective cancer treatments will require one or more clinical trials before approval by the FDA. Although clinical trials may carry some risk, they are a popular option for some cancer patients. There are eligibility requirements, and most doctors can determine if a patient meets the criteria for a specific clinical trial.

Palliative Care

Cancer patients who are undergoing aggressive cancer treatment(s) can avail themselves of a palliative care team.

Used in addition to the cancer treatment(s), the palliative care team is comprised of doctors, nurses, and other specialists whose purpose is to improve the quality of life for cancer patients and their families.

Coping and Support

A diagnosis of stomach cancer can be devastating to an individual and their family. Not only is there an overwhelming physical and emotional component to this diagnosis, but there’s a financial aspect as well.

Some insurance plans provide only limited coverage for cancer treatments, and copays can be very high, so the medical costs associated with this horrific disease can become astronomical.

Before beginning a treatment regimen, a cancer patient should discuss with their healthcare professional which side effects to expect, their duration, and steps that can be taken to alleviate or prevent them. Holistic remedies sometimes effectively prevent side effects, but all remedies pursued should be discussed with the physician beforehand. It’s essential that the cancer patient not pursue a treatment that will interfere with or negate any treatment protocol administered by the medical team. Many government programs can provide financial assistance for those who have been diagnosed with an advanced stage of cancer. It’s vitally important that cancer patients and their families and loved ones have a support network to help them transition through this very difficult period.

Friends and family can be available but may be experiencing their own emotional trauma from the diagnosis. Sometimes, friends and/or family members prefer not to talk about a devastating illness. The best source of support may be a professional counselor or therapist, who can sympathize with the cancer patient’s situation but remain objective.

Many organizations are available to help cancer patients with solutions to common concerns about health, diet, finances, end of life, and so forth. However, each cancer treatment regimen is unique to the individual, and the body’s response will also be unique.

Even when two individuals receive the same treatment for the same illness and symptoms, the side effects of the medication and their physiological responses to the treatment will be different.

Both online and local resources can help the cancer patient and their family locate resources for training and support. Talking to treating health care professionals will provide valuable information initially because they treat hundreds or thousands of cancer patients each year. They will usually be able to provide referrals to local agencies that can help the cancer patient with physical treatment, emotional support resources, financial assistance agencies, and so forth.

Hospice workers are available in most areas and can be incredibly beneficial for the family and friends of an individual with terminal cancer and the cancer patient.


Advances in the treatment of gastric cancers have significantly increased the efficacy of treatment regimens and reduced the negative health impacts on the patient. However, a diagnosis of gastric cancer doesn’t necessarily indicate that the end of life is near.

Instead, it can become a time of regrouping for the individual, and some cancer survivors state that overcoming the disease has made them stronger. Never give up in the fight against cancer and focus on the positive options that scientific advancements have provided.

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