Stomach Cancer

What Is Stomach Cancer?

Types of Stomach Cancer

There are several different types of stomach cancer, which vary depending on the types of cells they affect.

• Adenocarcinoma of the Stomach Adenocarcinomas account for 90 to 95 percent of stomach cancer cases. This type of cancer originates in the glandular, mucus-producing cells of the innermost lining of the stomach.

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   There are two main classes of adenocarcinoma of the stomach: If the cancer begins in the top inch of the stomach right below the esophagus, it is called gastric cardia cancer; otherwise, it is known as non-cardia gastric cancer.

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   Adenocarcinomas are also classified as either intestinal or diffuse, based on how the cancerous cells appear under a microscope.

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   Intestinal adenocarcinomas have cancer cells that look very similar to normal cells. Diffuse adenocarcinomas contain cells that don’t resemble normal cells, and these cancers tend to be more aggressive, meaning that they grow and spread more quickly and are harder to treat. 
• Gastrointestinal Stromal Tumors (GISTs) These originate in very early forms of cells in the stomach wall called the interstitial cells of Cajal. GISTs usually start in the stomach, but they can arise anywhere in the digestive tract.

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• Gastrointestinal Neuroendocrine Tumors This type of cancer begins in neuroendocrine cells — cells that act like a combination of nerve cells and hormone-producing cells — that line the digestive tract.

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• Primary Gastric Lymphomas This is a type of non-Hodgkin lymphoma. It’s a cancer of the immune system tissues and cells found in the stomach wall.

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Rarely, other types of cancer can also start in the stomach — squamous cell carcinomas, small cell carcinomas, and leiomyosarcomas, for example.

• Bloating, especially after eating
• Heartburn
• Indigestion
• Loss of appetite
• Mild nausea

• Persistent indigestion, heartburn, or stomach pain or discomfort
• Unexplained weight loss
• Jaundice, or yellowing of the skin or eyes

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• Bloating, swelling, or fluid buildup in the abdomen
• Feeling full after eating small amounts of food
• Loss of appetite
• Nausea
• Vomiting, sometimes with blood
• Bloody or black stools
• Fatigue
• Diarrhea or constipation

Generally speaking, stomach cancer develops when something damages the cells in the inner lining of the stomach, resulting in changes in their DNA. The cells multiply more quickly and live beyond their natural life cycle.

• Atrophic gastritis with intestinal metaplasia, which occurs when cells in the stomach lining are replaced with cells that line the intestines

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• Pernicious anemia, an autoimmune condition in which you can’t properly absorb vitamin B12, resulting in a low red blood cell count
• Epstein-Barr virus infection
• Acid reflux or chronic indigestion

• Being born male
• Older age, particularly 55 and above
• Overweight or obesity
• A diet high in salt-preserved foods (salted fish, meat, and pickled foods)
• A diet low in fruits and vegetables, and high in processed, grilled, or charcoaled meats
• Smoking, which doubles your risk of stomach cancer
• Alcoholic beverages
• History of stomach surgery to remove part of the stomach for a noncancerous condition, such as an ulcer
• Chronic stomach inflammation and intestinal polyps
• Blood type A
• Work in the rubber, metal, or coal industries
• Exposure to high levels of radiation
• A family history of stomach cancer
• A family history of certain genetic syndromes, such as hereditary diffuse gastric cancer, Lynch syndrome, juvenile polyposis syndrome, Li-Fraumeni syndrome, Peutz-Jeghers syndrome, and familial adenomatous polyposis

• Upper endoscopy with biopsy, which is a procedure to view and take tissue samples of the esophagus, stomach, and parts of the small intestine using a flexible tube with a camera (an endoscope)
• Imaging tests such as CT scans, PET scans, X-rays, and MRIs
• Blood tests to check for anemia, tumor markers (proteins) that may be produced by cancer, and the function of organs such as the liver and kidneys
• Fecal occult blood test to detect trace amounts of blood in the stool, which may be indicative of cancer bleeding in the stomach

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• Endoscopic ultrasound, which allows your provider to see how far your cancer might have spread into your stomach wall or nearby lymph nodes
• Biomarker testing to see if your cells carry certain gene or protein changes, including HER2, PD-L1, and NTRK

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Treatment options for stomach cancer depend on the cancer's type, stage, and location.

Surgery

• Endoscopic resection: A procedure that can be used for very early stage cancers to remove the tumor and parts of the normal stomach wall below and around it
• Gastrectomy: An invasive procedure to remove part or all of the stomach, and possibly nearby lymph nodes, other parts of the gastrointestinal tract, other tissues near the tumor, and the spleen

Chemotherapy

Many different chemotherapy drugs may be used alone or in combination with one another. The drugs used will differ depending on the stage of stomach cancer. Some of the chemotherapy drugs used for stomach cancer include:

• Capecitabine
• Carboplatin
• Cisplatin
• Docetaxel
• Epirubicin
• Irinotecan
• Oxaliplatin
• Paclitaxel

Chemotherapy may be delivered into the vein using a needle or catheter, or into the abdominal cavity through a port. These drugs may cause a range of side effects, including nausea and vomiting, hair loss, mouth sores, and fatigue.

Targeted Drug Therapy

• trastuzumab (Herceptin)
• fam-trastuzumab deruxtecan (Enhertu)
• ramucirumab (Cyramza)
• larotrectinib (Vitrakvi)
• entrectinib (Rozlytrek)
• zolbetuximab (Vyloy)

Immunotherapy

Sometimes considered a form of targeted therapy, immunotherapy works by helping the immune system better find and destroy cancer cells. Drugs like nivolumab (Opdivo) and pembrolizumab (Keytruda) target a protein called PD-1 that keeps the immune system’s T-cells from attacking other cells in the body. The drugs block PD-1, allowing T-cells to attack cancer cells.

Radiation Therapy

• A healthy diet rich in fresh fruits and vegetables
• Reduced consumption of smoked, charcoaled, pickled, or salted foods

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• Not smoking
• Limited alcohol consumption
• Treatment for H. pylori infections, which most people will have for years without knowing it because they don’t experience any symptoms
• Regular medical checkups, especially for those at higher risk
• Physical activity every day

The prognosis for stomach cancer depends on the stage at diagnosis, the person’s overall health, and response to treatment. Early-stage cancer has a better prognosis, while advanced-stage cancer often has a poorer outlook.

The five-year survival rate for stomach cancer also depends on the cancer stage at diagnosis:

• 75 percent if the cancer is in the stomach only
• 35 precent if the cancer has spread beyond the stomach to nearby lymph nodes or organs
• 7 percent if the cancer has spread to a distant part of the body

Stomach cancer disproportionately impacts certain minority groups.

• H. pylori infection
• Peptic ulcer, or open sores in the lining of the stomach and upper portion of the small intestine

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• Diabetes

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• Chronic gastritis, long-term inflammation of the stomach
• Pernicious anemia, an inability to absorb vitamin B12
• Obesity

Debbie’s Dream Foundation: Curing Stomach Cancer

With chapters located throughout the continental United States, Debbie’s Dream focuses on raising awareness, funding research, and supporting stomach cancer patients. It has extensive resources that span lectures about the disease, survivor stories, and newsletters.

Gastric Cancer Foundation

Dedicated to improving the lives of people affected by stomach cancer, this foundation hosts a wealth of information about gastric cancer, a Gastric Cancer Registry to assist researchers studying the disease, a clinical trial finder, and more.

Hope for Stomach Cancer

Part of the Stomach Cancer Awareness Network, Hope for Stomach Cancer is a nonprofit that provides resources and programs to help those living with stomach cancer, as well as their caregivers and loved ones. Their website offers links to various support groups and workshops.

No Stomach for Cancer

This nonprofit patient advocacy organization offers one-on-one support, consultations with certified genetic counselors, and help finding local cancer centers.

• Stomach cancer develops when cells in the lining of the stomach begin to grow out of control.
• Risk factors include Helicobacter pylori infection, smoking, and a diet high in salted or smoked foods, though practicing healthy lifestyle habits can reduce risks.
• Regular medical checkups, especially for those at high risk, can aid in earlier detection and improved treatment outcomes.