Stomach Cancer: 7 Treatment Options, Causes, Stages, Diagnosis & Symptoms

Stomach cancer facts*

Stomach cancer
The most common form of cancer that affects the stomach is adenocarcinoma, which arises in the glands of the innermost layer of the stomach.

*Stomach cancer facts medical author: Charles P. Davis, MD, PhD

The stomach is a hollow organ that liquefies food and is part of the digestive system.
Cancer is the growth of abnormal (malignant) body cells: stomach cancer cells spread by breaking away from other cancer cells and going into the bloodstream or lymphatics while others penetrate into organs near the stomach.
The most common form of cancer that affects the stomach is adenocarcinoma, which arises in the glands of the innermost layer of the stomach.
Although the cause of stomach cancer development is not known, risk factors include
- inflammation of the stomach,
- Helicobacter pylori infection,
- smoking,
- poor diet,
- obesity,
- lack of physical activity, and
- a history of stomach cancer in the family.
The symptoms of stomach cancer may include discomfort and/or pain in the stomach, nausea, and vomiting, weight loss, difficulty swallowing, vomiting blood, blood in the stool, and feeling full or bloated after a small meal.
Stomach cancer is diagnosed by a physical exam, medical history, endoscopy, and biopsy of the tissue.
Stomach cancer is staged according to where cancer is found and how far it has invaded the stomach tissue, or if it has spread beyond the stomach and into other organs (stages 0 to IV).
The treatment of stomach cancer depends on the size and location of the tumor, the stage of the disease, and the patient's general health.
Surgery is done to remove cancer tissue; in general, two procedures are common: partial (subtotal) gastrectomy and total gastrectomy.
Chemotherapy is the use of drugs to kill cancer cells: it may be used before or after surgery.
Radiation therapy uses high-energy rays to kill cancer cells: it is used frequently along with chemotherapy.
Many doctors recommend getting a second opinion before starting treatment: this article provides contact phone numbers to several institutions that can help find a doctor to give a second opinion.
Good nutrition after stomach surgery may require supplements like vitamins and minerals, plus changing your eating habits.
Surgery, a stent placement, radiation therapy, and laser therapy are treatment options for cancers that block the gastrointestinal (GI) tract.
Tests to rule out recurrence of cancer; complementary and alternative medicine should be discussed with your doctor.
There are support groups for cancer patients; contact information is listed.
Contact information for joining clinical trials is also included in this article.

Stomach Cancer Treatment

Radiation Therapy

In radiation therapy (also called radiotherapy), invisible high-energy rays or beams of subatomic particles are used to damage cancer cells and can stop them from growing and dividing. This ultimately can kill the cancer cells treated with radiation. A specialist in radiation therapy is called a radiation oncologist.

What is stomach (gastic) cancer?

The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and help pass waste material out of the body. Food moves from the throat to the stomach through a hollow, muscular tube called the esophagus. After leaving the stomach, partly-digested food passes into the small intestine and then into the large intestine.

The wall of the stomach is made up of 3 layers of tissue: the mucosal (innermost) layer, the muscularis (middle) layer, and the serosal (outermost) layer. Gastric cancer begins in the cells lining the mucosal layer and spreads through the outer layers as it grows.

Stromal tumors of the stomach begin in supporting connective tissue and are treated differently from stomach (gastric) cancer.

What are risk factors for stomach cancer?

Age, diet, and stomach disease can affect the risk of developing gastric cancer. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for gastric cancer include the following:

Having any of the following medical conditions:
- Helicobacter pylori (H. pylori) infection of the stomach.
- Chronic gastritis (inflammation of the stomach).
- Pernicious anemia.
- Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines).
- Familial adenomatous polyposis (FAP) or gastric polyps.
Eating a diet high in salted, smoked foods and low in fruits and vegetables.
Eating foods that have not been prepared or stored properly.
Being older or male.
Smoking cigarettes.
Having a mother, father, sister, or brother who has had stomach cancer.

What are signs and symptoms of stomach cancer?

Symptoms of stomach (gastric) cancer include indigestion and stomach discomfort or pain. These and other signs and symptoms may be caused by gastric cancer or by other conditions.

In the early stages of gastric cancer, the following symptoms may occur:

Indigestion and stomach discomfort.
A bloated feeling after eating.
Mild nausea.
Loss of appetite.
Heartburn.

In more advanced stages of gastric cancer, the following signs and symptoms may occur:

Blood in the stool.
Vomiting.
Weight loss for no known reason.
Stomach pain.
Jaundice (yellowing of eyes and skin).
Ascites (build-up of fluid in the abdomen).
Trouble swallowing.

Check with your doctor if you have any of these problems.

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How does smamach cancer spread?

There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood:

Tissue. Cancer spreads from where it began by growing into nearby areas.
Lymph system. Cancer spreads from where it began by getting into the lymph system. Cancer travels through the lymph vessels to other parts of the body.
Blood. Cancer spreads from where it began by getting into the blood. Cancer travels through the blood vessels to other parts of the body.

What is metastasis?

Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

Lymph system. Cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. Cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if gastric cancer spreads to the liver, the cancer cells in the liver are actually gastric cancer cells. The disease is metastatic gastric cancer, not liver cancer.

What are the four stages of stomach cancer?

The following stages are used for gastric cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the inside lining of 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

In stage I, cancer has formed in the inside lining of the mucosa (innermost layer) of the stomach wall. Stage I is divided into stage IA and stage 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 stage IIA and stage IIB, depending on where the cancer has spread.

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 stage IIIA, stage IIIB, and stage IIIC, depending on where the cancer has spread.

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.

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What is recurrent stomach cancer?

Recurrent gastric cancer is cancer that has recurred (come back) after it has been treated. Cancer may come back in the stomach or in other parts of the body such as the liver or lymph nodes.

What are treatments for stomach cancer?

Different types of treatments are available for patients with gastric cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Seven types of standard treatment are used:

Surgery

Surgery is a common treatment for all stages of gastric cancer. The following types of surgery may be used:

Subtotal gastrectomy: Removal of the part of the stomach that contains cancer, nearby lymph nodes, and parts of other tissues and organs near the tumor. The spleen may be removed. The spleen is an organ that makes lymphocytes, stores red blood cells and lymphocytes, filters the blood, and destroys old blood cells. The spleen is on the left side of the abdomen near the stomach.
Total gastrectomy: Removal of the entire stomach, nearby lymph nodes, and parts of the esophagus, small intestine, and other tissues near the tumor. The spleen may be removed. The esophagus is connected to the small intestine so the patient can continue to eat and swallow.

If the tumor is blocking the stomach but cancer cannot be completely removed by standard surgery, the following procedures may be used:

Endoluminal stent placement: A procedure to insert a stent (a thin, expandable tube) to keep a passage (such as arteries or the esophagus) open. For tumors blocking the passage into or out of the stomach, surgery may be done to place a stent from the esophagus to the stomach or from the stomach to the small intestine to allow the patient to eat normally.
Endoluminal laser therapy: A procedure in which an endoscope (a thin, lighted tube) with a laser attached is inserted into the body. A laser is an intense beam of light that can be used as a knife.
Gastrojejunostomy: Surgery to remove the part of the stomach with cancer that is blocking the opening into the small intestine. The stomach is connected to the jejunum (a part of the small intestine) to allow food and medicine to pass from the stomach into the small intestine.

Endoscopic mucosal resection
Endoscopic mucosal resection is a procedure that uses an endoscope to remove early-stage cancer and precancerous growths from the lining of the digestive tract without surgery. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also include tools to remove growths from the lining of the digestive tract.

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

A type of regional chemotherapy being studied to treat gastric cancer is intraperitoneal (IP) chemotherapy. In IP chemotherapy, the anticancer drugs are carried directly into the peritoneal cavity (the space that contains the abdominal organs) through a thin tube.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment used during surgery that is being studied for gastric cancer. After the surgeon has removed as much tumor tissue as possible, warmed chemotherapy is sent directly into the peritoneal cavity.

See Drugs Approved for Stomach (Gastric) Cancer for more information.

Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Chemoradiation
Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both. Chemoradiation given after surgery, to lower the risk that cancer will come back, is called adjuvant therapy. Chemoradiation given before surgery, to shrink the tumor (neoadjuvant therapy), is being studied.

Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy does. Monoclonal antibodies and multikinase inhibitors are types of targeted therapy used in the treatment of gastric cancer.

Monoclonal antibodies: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies can then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

There are different types of monoclonal antibody drugs:

Trastuzumab blocks the effect of the growth factor protein HER2, which sends growth signals to gastric cancer cells.
Ramucirumab blocks the effect of certain proteins, including vascular endothelial growth factors. This may help keep cancer cells from growing and may kill them. It may also prevent the growth of new blood vessels that tumors need to grow.

Trastuzumab and ramucirumab are used in the treatment of stage IV gastric cancer and gastric cancer that cannot be removed by surgery or has recurred.

Multikinase inhibitors: These are small-molecule drugs that go through the cell membrane and work inside cancer cells to block multiple protein signals that cancer cells need to grow and divide. Some multikinase inhibitors also have angiogenesis inhibitor effects. Angiogenesis inhibitors stop the growth of new blood vessels that tumors need to grow.

There are different types of multikinase inhibitor drugs:

Regorafenib is a multikinase inhibitor and angiogenesis inhibitor that blocks the effects of the multiple proteins inside tumor cells. Regorafenib is being studied in the treatment of stage IV gastric cancer and gastric cancer that cannot be removed by surgery or has recurred.

See Drugs Approved for Stomach (Gastric) Cancer for more information.

Immunotherapy
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.

Immune checkpoint inhibitor therapy is a type of immunotherapy.

Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching. This allows the T cells to kill cancer cells. Pembrolizumab and nivolumab are types of PD-1 inhibitors.

See Drugs Approved for Stomach (Gastric) Cancer for more information.

New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI website.

Treatment for gastric cancer may cause side effects.
For information about side effects caused by treatment for cancer, see our Side Effects page.

Treatment Options by Stage

Treatment of Stage 0 (Carcinoma in Situ)

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage 0 may include the following:

Surgery (total or subtotal gastrectomy).
Endoscopic mucosal resection.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Stage I Gastric Cancer
For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage I gastric cancer may include the following:

Surgery (total or subtotal gastrectomy).
Endoscopic mucosal resection for certain patients with stage IA gastric cancer.
Surgery (total or subtotal gastrectomy) followed by chemoradiation therapy.
Surgery and chemotherapy.
A clinical trial of chemoradiation therapy given before surgery.

Treatment of Stages II and III Gastric Cancer
For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage II gastric cancer and stage III gastric cancer may include the following:

Surgery (total or subtotal gastrectomy).
Surgery and chemotherapy.
Surgery (total or subtotal gastrectomy) followed by chemoradiation therapy or chemotherapy.
A clinical trial of chemoradiation therapy given before surgery.
A clinical trial of chemotherapy given before surgery.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Stage IV Gastric Cancer, Gastric Cancer That Cannot Be Removed By Surgery, and Recurrent Gastric Cancer
For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage IV gastric cancer, gastric cancer that cannot be removed by surgery, or recurrent gastric cancer may include the following:

Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
Targeted therapy (trastuzumab, ramucirumab) with or without chemotherapy.
Immunotherapy (pembrolizumab) with or without chemotherapy.
Immunotherapy (nivolumab) with chemotherapy.
Endoluminal laser therapy or endoluminal stent placement to relieve a blockage in the stomach, or gastrojejunostomy to bypass the blockage.
Radiation therapy as palliative therapy to stop bleeding, relieve pain, or shrink a tumor that is blocking the stomach.
Surgery as palliative therapy to stop bleeding or shrink a tumor that is blocking the stomach.
Clinical trials of combinations of immunotherapy and chemotherapy.
A clinical trial of targeted therapy with regorafenib and nivolumab.
A clinical trial of surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Who should consider taking part in a clinical trial?

Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

When can patients enter clinical trials for stomach cancer?

Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

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