Most stomach cancers are adenocarcinomas, which develop in the cells of the stomach’s inner lining. However, stomach cancer can develop anywhere in the organ.
Stomach anatomy
Many times, people refer to the abdomen, the area between the hips and chest, as the stomach. But in medical terms, the word stomach refers only to the organ.
The stomach, sits in the upper abdomen. After you chew and swallow food, it moves through a hollow tube called the esophagus into the stomach. The stomach mixes the food with gastric juices and begins digestion of the food.
The lining of the stomach has three main layers:
- Mucosal (inner)
- Muscularis (middle)
- Serosal (outer)
Generally, adenocarcinoma stomach cancer starts when cells in the mucosal layer change. Sometimes these changes develop into cancer, but most times they do not.
The other types of cancer found in the stomach are considered rare. They include:
- Lymphoma, which affects a body’s immune system
- Gastrointestinal stromal tumors, often called GIST or gastric sarcomas
- Carcinoid tumors, which affect the hormone-producing cells of the stomach
Stomach cancer statistics, survival rates
According to the National Cancer Institute, about 26,200 new cases of stomach cancer will be diagnosed in 2018. More than 60% of these will are for people age 65 or over, with the median age of diagnoses at 68. The five year survival rate for the disease is 31%.
Stomach cancer, also called gastric cancer, has become much less common in the United States and Europe over the past 60 years. While the rates of stomach cancer in general are declining, cancers in the area of the stomach near where it joins the esophagus are increasing.
While stomach cancer is becoming less common in this country, it is the second leading cause of cancer death in much of the rest of the world, especially Japan, Eastern Europe, South America and parts of the Middle East. This may be due to differences in diet, the rate of infection with Helicobacter pylori (a type of bacteria) and the environment.
Stomach cancer risk factors
Although the exact cause of stomach cancer is not known, certain factors seem to increase your risk of developing the disease. These include:
- Eating foods preserved through pickling, salting and drying or that contain nitrates
- Eating foods that have not been stored or prepared correctly
- Obesity: Men who are obese have a higher risk of cancer in the part of the stomach nearest the esophagus.
- Infection with Helicobacter pylori: This type of bacteria, or germ, is a common cause of ulcers and may cause chronic inflammation in the stomach lining. This sometimes develops into pre-cancerous changes and cancer.
- Tobacco and alcohol abuse: Smoking and drinking excessive amounts of alcohol appear to increase the likelihood of cancer in the upper part of the stomach. Some studies have shown that smoking doubles the risk of stomach cancer.
Family history. If close relatives have any of the following conditions, you may be at a higher risk of stomach cancer:
- Stomach cancer
- Hereditary non-polyposis colon cancer (HNPCC)
- Li-Fraumeni syndrome
Having any of the following medical conditions:
- Pernicious anemia
- Chronic stomach inflammation and intestinal polyps
- Menetrier disease
- Epstein-Barr virus
- Acid reflux or chronic indigestion
- Stomach lymphoma
- Type A blood
- Prior stomach surgery
Other factors include:
- Gender: The majority of stomach cancer patients are male.
- Age: Most individuals who develop stomach cancer are older than 55.
- Ethnicity: In the United States, stomach cancer occurs more often in Hispanic Americans and African Americans than in non-Hispanic whites. It is found most in Asian/Pacific Islanders.
- Working in the rubber, metal, coal and timber industries, as well as those who have been exposed to asbestos fibers, have a higher risk for stomach cancer
- Geography: More people in Japan, China, Southern and Eastern Europe, and Central and South America develop stomach cancer than those in Northern and Western Africa, South Central Asia and North America.
Not everyone with risk factors gets stomach cancer. However, if you have risk factors, you should discuss them with your doctor.
Behavioral and lifestyle changes can help prevent stomach cancer. Visit our prevention and screening section to learn how to manage your risk.
In rare cases, stomach cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
What are the symptoms of stomach cancer?
Stomach cancer often does not have symptoms in the early stages. When signs do appear, they may be mistaken for less serious problems such as indigestion or heartburn. This means stomach cancer often is not found until it spreads.
Stomach cancer symptoms may include:
- Abdominal pain or discomfort
- Loss of appetite
- Heartburn, indigestion or ulcer-type symptoms
- Nausea and vomiting
- Bloating or swelling in the abdomen
- Diarrhea or constipation
- Feeling of fullness after eating small amounts of food
- Bloody or black stools
- Fatigue
- Unintentional weight loss
These symptoms do not always mean you have stomach cancer. However, if you notice any of them for more than two weeks, talk to your doctor. Even if they are not signs of cancer, they may signal other health problems.
Behavioral and lifestyle changes can help prevent stomach cancer. Visit our prevention and screening section to learn how to manage your risk.
In rare cases, stomach cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Did You Know?
Endometrial, uterine, stomach, ovarian, prostate and liver cancer can be clues to a family history of colon cancer. Ask about your family history of cancer.
How is stomach cancer diagnosed?
Because stomach cancer often does not have symptoms until it has spread to other parts of the body or has symptoms that are mistaken for other conditions, it can be challenging to diagnose.
However, it is important for stomach cancer to be diagnosed as soon and as accurately as possible. This helps increase your odds for successful treatment and lowers the chance of side effects.
The experts at MD Anderson are among the most skilled and experienced in diagnosing and staging stomach cancer. They use specialized advanced technology with pinpoint focus and reliable outcomes.
Precise diagnostic tools
In addition to standard diagnostic procedures, MD Anderson offers endoscopic ultrasound, which gives specially trained doctors the ability to look inside the stomach and examine its walls for stomach cancer or pre-cancerous changes. This test, which is not available at many cancer centers, also allows physicians to view and biopsy the lymph nodes around the stomach.
Because stomach cancer can spread inside the abdomen and often is not detectable by any other means, specialists at MD Anderson often perform staging laparoscopies, which are minimally invasive procedures to see if tumors have spread in abdomen.
Researchers at MD Anderson were involved in recent studies to differentiate between gastrointestinal stromal tumor (GIST) and leiomyosarcoma (LMS) with near perfect accuracy. This will have wider application in more individualized diagnosis and treatment of stomach cancer and other types of cancer.
Stomach cancer diagnostic tests
If you have symptoms that may signal stomach cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family medical history.
If stomach cancer is suspected, early tests may include:
- X-rays of the gastrointestinal tract
- Testing a stool sample for traces of blood
In addition, one or more of the following tests may be used to find out if you have stomach cancer, if it has spread or if treatment is working.
Biopsy: A biopsy is the removal of tissue to examine under a microscope. Different methods are available to obtain the tissue, depending on where it is located. In stomach cancer, biopsies usually are performed by endoscopy. An endoscope is inserted through the mouth, nose or an incision into the esophagus and stomach. The endoscope has a tool to remove tissue samples for examination.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (Magnetic resonance imaging)
- Chest and dental X-rays
Endoscopic ultrasound: Using specialized equipment, doctors insert an endoscope equipped with a small ultrasound device into the stomach. It produces sound waves that produce an image on a video screen.
Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for stomach cancer.
Blood tests, which may include:
- Complete blood count (CBC) to look for anemia (low level of red blood cells) that may be caused by internal bleeding
- β-hCG (beta-human chorionic gonadotropin), CA-125 and CEA(carcinoembryonic antigen) assays that measure certain chemicals in the blood
Behavioral and lifestyle changes can help prevent stomach cancer. Visit our prevention and screening section to learn how to manage your risk.
In rare cases, stomach cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
What are the stages of stomach cancer?
If you are diagnosed with stomach cancer, your doctor will determine the stage of the disease.
Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.
Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
Stomach cancer stages
(source: National Cancer Institute)
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the mucosa (innermost layer) of the stomach wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
Stage I is divided into stages IA and IB.
- Stage IA: Cancer has formed in the mucosa (innermost layer) of the stomach wall and may have spread to the submucosa (layer of tissue next to the mucosa).
- Stage IB: Cancer:
- has formed in the mucosa (innermost layer) of the stomach wall and may have spread to the submucosa (layer of tissue next to the mucosa). Cancer has spread to 1 or 2 nearby lymph nodes; or
- has formed in the mucosa of the stomach wall and has spread to the muscle layer.
Stage II
Stage II gastric cancer is divided into stages IIA and IIB.
- Stage IIA: Cancer:
- may have spread to the submucosa (layer of tissue next to the mucosa) of the stomach wall. Cancer has spread to 3 to 6 nearby lymph nodes; or
- has spread to the muscle layer of the stomach wall. Cancer has spread to 1 or 2 nearby lymph nodes; or
- has spread to the subserosa (layer of connective tissue next to the muscle layer) of the stomach wall.
- Stage IIB: Cancer:
- may have spread to the submucosa (layer of tissue next to the mucosa) of the stomach wall. Cancer has spread to 7 to 15 nearby lymph nodes; or
- has spread to the muscle layer of the stomach wall. Cancer has spread to 3 to 6 nearby lymph nodes; or
- has spread to the subserosa (layer of connective tissue next to the muscle layer) of the stomach wall. Cancer has spread to 1 or 2 nearby lymph nodes; or
- has spread to the serosa (outermost layer) of the stomach wall.
Stage III
Stage III gastric cancer is divided into stages IIIA, IIIB, and IIIC.
- Stage IIIA: Cancer has spread:
- to the muscle layer of the stomach wall. Cancer has spread to 7 to 15 nearby lymph nodes; or
- to the subserosa (layer of connective tissue next to the muscle layer) of the stomach wall. Cancer has spread to 3 to 6 nearby lymph nodes; or
- to the serosa (outermost layer) of the stomach wall. Cancer has spread to 1 to 6 nearby lymph nodes; or
- to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen.
- Stage IIIB: Cancer:
- may have spread to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the stomach wall. Cancer has spread to 16 or more nearby lymph nodes; or
- has spread to the subserosa (layer of connective tissue next to the muscle layer) or to the serosa(outermost layer) of the stomach wall. Cancer has spread to 7 to 15 nearby lymph nodes; or
- has spread from the stomach to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen. Cancer has spread to 1 to 6 nearby lymph nodes.
- Stage IIIC: Cancer has spread:
- to the subserosa (layer of connective tissue next to the muscle layer) or to the serosa (outermost layer) of the stomach wall. Cancer has spread to 16 or more nearby lymph nodes; or
- from the stomach into nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen. Cancer has spread to 7 or more nearby lymph nodes.
Stage IV
In stage IV, cancer has spread to other parts of the body, such as the lungs, liver, distant lymph nodes, and the tissue that lines the abdomen wall.
What are the treatment options for stomach cancer?
At MD Anderson, we customize your stomach cancer treatment to ensure the highest chances for successful treatment while focusing on your quality of life. Our treatments include targeted and gene therapies, laser therapy and minimally invasive surgery.
Since stomach cancer treatment often involves more than one type of therapy, your personalized course of treatment is planned by a group of experts that may include oncologists, radiation oncologists and surgeons. This team approach – coupled with extraordinary skill and the latest technology – means you receive the best possible care with the least impact on your body.
MD Anderson's skilled surgeons and specialized procedures to treat stomach cancer are focused on helping you retain as much of the stomach as possible. However, if surgical removal of part or all of the stomach is unavoidable, we have the skill and staff to help you cope.
If you are diagnosed with stomach cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer, the location of the tumor and your general health.
One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Stomach Cancer Surgery
Surgery is the most common treatment for stomach cancer, many times with chemotherapy and radiation. If all three therapies are needed, MD Anderson’s standard approach is to give chemotherapy and radiation before surgery. This method usually is more successful and better tolerated.
Stomach cancer surgery is delicate and challenging, and it requires special expertise. Studies have shown that patients do better when their surgeons have a high level of experience, and MD Anderson surgeons are among the most experienced in the country.
Surgical techniques for stomach cancer may include:
Endoscopic mucosal resection: An endoscope is inserted down the throat and into the stomach, allowing doctors to remove certain types of early, non-invasive stomach cancers.
Subtotal (partial) gastrectomy: The cancerous part of the stomach, nearby lymph nodes (tissues that filter infection and disease) and parts of other organs near the tumor are surgically removed.
Total gastrectomy: The entire stomach, nearby lymph nodes and sometimes the spleen, parts of the esophagus, intestines, pancreas and other organs where the cancer has spread, are removed. The esophagus is reconnected to the small intestine you can continue to eat and swallow.
During the surgery, the surgeon forms a new “stomach” from part of the intestine. After surgery, you may:
- Have a feeding tube that goes directly into your small intestine to be sure you receive needed nutrients
- Need to eat smaller, more frequent meals and avoid sugar
- Have abdominal discomfort and diarrhea
- Need to take vitamin supplements as pills or shots (injections)
If a stomach cancer tumor is blocking the stomach but cannot be removed completely, surgery may be done to help you eat normally. Procedures include:
- Endoluminal stent placement: A thin, expandable tube is placed between the stomach and esophagus or small intestine to keep the passageway open.
- Endoluminal laser therapy: An endoscope with a laser is inserted into the body. The laser cuts the tumor.
Stomach cancer chemotherapy
At MD Anderson, chemotherapy for stomach cancer often is given before surgery to shrink the tumor. MD Anderson offers the most advanced chemotherapy regimens with the fewest side effects.
Stomach cancer radiation therapy
We use the most precise methods of radiation therapy, targeting the stomach cancer while limiting damage to surrounding areas.
Somach cancer targeted therapies
Targeted therapies are specially designed to treat stomach cancer’s specific genetic and molecular profile to help your body fight the disease.
Stomach cancer gene therapy
We have the expertise to examine each tumor carefully to determine gene-expression profiles, which then guide us toward the most effective, gentlest treatment targeted to your specific cancer. Gene therapy is a personalized medicine approach that sets us above and beyond most cancer centers and allows us to attack the specific causes of each stomach cancer.
Our Stomach Cancer Clinical Trials
Since MD Anderson is one of the nation’s leading research centers, we’re able to offer clinical trials (research studies) of new treatments for every type and stage of stomach cancer.
Why choose MD Anderson for stomach cancer care?
When you receive treatment for stomach cancer at MD Anderson's Gastrointestinal Center, you are the focus of some of the world's leading experts. They discuss your case at every juncture, planning together to ensure you receive personalized care that ensures the most advanced treatments with the least impact on your body.
Your personal team of experts may include oncologists, surgeons and radiation oncologists, as well as specially trained nutritionists, nurses and others. They provide complete yet specialized stomach cancer treatment that is designed to provide optimum results and recovery. Stomach cancer can have a marked impact on your life, and our experts guide you every step of the way to help you cope and adjust.
World-class Surgeons
Stomach cancer surgery often is challenging, and your highest chances for a successful outcome are with a surgeon who has a high degree of experience and skill in these highly specialized procedures. Because MD Anderson is one of the nation's most active cancer centers, our surgeons use the latest techniques to perform a large number of delicate stomach cancer surgeries each year, with outcomes higher than many other cancer centers.
With groundbreaking research, MD Anderson's physicians have pioneered many improvements in treating stomach cancer. We have led some of the largest international studies on chemotherapy for stomach cancer, and we continue to explore new, more-advanced treatments.
And at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
MD Anderson is a big organization, but it’s welcoming and it makes you feel safe. Help was always available.
Marne Shafer thought her running days were behind her after she received a total gastrectomy, a surgical removal of the stomach and nearby lymph nodes. She braced herself for the worst.
At age 33, the mother of two and experienced marathoner, learned she has a CDH1 gene mutation, which is associated with high-risk of a rare type of stomach cancer called hereditary diffuse gastric cancer, as well as lobular breast cancer.
Marne came to MD Anderson for genetic testing after several family members passed away from stomach cancer, including her father, grandmother and aunt. Since screening isn’t successful in identifying the disease in its early stages, the recommended treatment plan was for Marne to undergo the prophylactic total gastrectomy. But the surgery revealed she already had stage I cancer, which was removed during the procedure.
“It seems counterintuitive to feel in full health and then go out and get your stomach removed,” she says. “People ask, ‘how are you still alive?’”
Life without a stomach
While she had a feeding tube for nearly two months and worked hard to get enough nutrients post-surgery, Marne credits her quick recovery to the expert care provided by her surgeon, Paul Mansfield, M.D., in addition to her history of running.
“I thought I was supposed to still feel horrible two weeks after my surgery. I didn’t have a lot of strength, but I didn’t think I would feel that much better,” she says. “At the end of the day, Dr. Mansfield is just awesome. He is very personable in addition to being one of the best doctors in the world. He is extremely knowledgeable, and he put me at ease about the surgery.”
After her stomach removal, Marne resolved to help others facing similar situations. She started a blog, Life Without a Stomach, to share her experiences, including challenges with eating.
Because Marne’s esophagus is connected to her small intestine as a result of the gastrectomy, she can eat and swallow, but it’s a slower process. She focuses on eating several small meals packed with protein and nutrients. “It’s like a forced, healthy diet,” she says.
In addition to blogging, Shafer raises awareness and funds for stomach cancer research.
“I think I was meant to have this so I can help other people,” she says.
The stomachless runner
Marne’s return to running is another way that she’s inspiring others, including Dr. Mansfield. Just months after her gastrectomy, she began training for a half marathon in Houston. Three years later, on Jan. 15, 2017, she completed the full Chevron Houston Marathon, coming in just one minute shy of her 3:21 personal record.
“It felt doubly important to run a marathon without a stomach,” Marne says. “Look what you can do!”
Running the marathon wasn’t without its unique challenges. Marne experimented during training to see if her body could process sugar gels used by long-distance runners to boost energy. Throughout the race, she couldn’t gulp water or sports drinks to remain hydrated. Instead, she had to pinch the top of the cups and slowly sip while she ran.
She had never been so excited to cross a finish line.
“I had so many people supporting me because they knew what a milestone it was. Everyone has a meaning for the marathon. For me, not having a stomach is something that I deal with. Only through your trials do you understand your strength.”
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