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Stomach cancer


Expert reviewer, Mr Stephen Pollard, Consultant Surgeont
Next review due August 2021

Stomach cancer happens when cells in your stomach grow in an abnormal and uncontrolled way. It’s also known as gastric cancer.

Treatment for stomach cancer can be successful if it’s found at an early stage. Early symptoms of stomach cancer may be quite vague and similar to indigestion. This means that many people with stomach cancer don’t find out until the cancer is quite advanced. Your treatment then will help control the cancer, ease your symptoms and improve the quality of your life.

older man smiling

About stomach cancer

Your stomach is a muscular bag in your upper abdomen (tummy). Its job is to receive and break down the food you eat before passing it on to your intestine. It does this by mixing the food with stomach ‘juices’ – strong acid and special proteins (enzymes) – produced by the stomach lining. If stomach cancer develops, it’s usually in the cells of this lining (see types of stomach cancer).

If you don't get treatment for stomach cancer, it can spread to other parts of your body or organs such as your liver. The spread of cancer through the body is called metastasis.

In the UK, nearly 7000 people get stomach cancer each year. This makes it one of the less common cancers, and fewer and fewer people are getting it as the years go by. Stomach cancer mostly affects people over about 55 and is more common in men than women.


Image showing the digestive system

Types of stomach cancer

More than nine out of 10 stomach cancers are a type called adenocarcinoma. This starts in the lining of your stomach, in cells that produce the stomach juices.

Other, rarer, types of stomach cancer include:

  • gastrointestinal stromal tumours (GIST), where the cancer starts in your stomach wall
  • lymphomas, where the cancer starts in your lymphatic system
  • neuroendocrine (also called carcinoid) tumours, where the cancer starts in hormone-producing cells

Our information here is about adenocarcinomas, the commonest type of stomach cancer. If you have one of the other types of stomach cancer, your doctor will talk to you about what that involves. The tests and treatments will be different from the ones described here for adenocarcinomas.

Symptoms of stomach cancer

In the early stages of stomach cancer, you may have no symptoms at all. Or you may just have symptoms of indigestion. See our information on indigestion for a description of these.

Other symptoms of stomach cancer may begin to happen as the cancer advances. These can include:

  • pain in your abdomen
  • losing weight unexpectedly
  • losing your appetite
  • feeling unusually full after eating
  • difficulty swallowing
  • feeling sick or vomiting – you may vomit blood (it will look like coffee grounds if it’s been in your stomach for a while)
  • blood in your faeces (stools), which can look black

Because symptoms of indigestion are very common it can be hard to decide when to seek medical help. Contact your GP if your indigestion goes on for longer than is usual for you, or if you have any of the other symptoms as well. You should also contact your GP if you regularly take indigestion medicines but they seem to have stopped working. You should always seek medical help if you have bleeding or difficulty swallowing.

Diagnosis of stomach cancer

Your GP will ask about your symptoms and examine you. They’ll also ask you about your medical history. Your GP may give you a blood test, which will assess your general health.

Doctors can’t usually tell if you have stomach cancer without doing tests. These may include the following.

  • Gastroscopy and biopsy. Your GP may arrange for you to have this test or may refer you to a hospital specialist who’ll arrange it. A narrow, flexible, tube-like telescopic camera called an endoscope is used to look inside your stomach. A small sample of tissue may be removed from your stomach at the same time. This is called a biopsy. This sample is sent to a laboratory to look for cancer cells. To find out more, see our information on gastroscopy.
  • Barium swallow and meal. If you aren’t able to have a gastroscopy, you might have this test. You’ll be asked to swallow a liquid that contains a substance called barium.. This coats the lining of your stomach so it shows up on X-ray images. This helps your doctor check for anything abnormal, like a cancer. You can find out more about having this test from our information on barium swallow and meal.

If you're found to have stomach cancer, your doctor will recommend further tests to find out how advanced it is. This process is known as staging. Tests may include:

  • a chest X-ray to look for spread of the cancer to your chest
  • a CT scan or MRI scan to look for spread throughout your chest, abdomen and pelvis
  • a PET-CT scan (this is a CT scan where you take a small amount of a radioactive medicine) to look for cells that are more active than normal, as in a cancer
  • endoscopic ultrasound, a test which combines endoscopy of your stomach and an ultrasound scan to show how deep the cancer goes
  • laparoscopy, a procedure to look inside your abdomen with an endoscope through cuts in your abdominal wall (keyhole surgery)

If your doctor recommends any tests, they’ll explain what each involves and why they’re helpful. You should feel free to ask your doctor questions or share any concerns you have about your tests.

Treatment of stomach cancer

The treatments for stomach cancer include surgery, radiotherapy and chemotherapy. You may have a combination of these. What treatment you have will depend on where your cancer is, how far it has spread, and how good your general health is. See our FAQ below, ‘How will my cancer treatment be decided?’

Surgery

Surgery is the main treatment for stomach cancer as it may offer you the chance of cure. You may have an operation to remove part of your stomach (called a partial or subtotal gastrectomy). Or your surgeon may remove all of your stomach (a total gastrectomy). Sometimes, part of the lower oesophagus (food pipe) needs to be removed too (oesophagogastrectomy).

Your surgeon may also remove the lymph nodes around your stomach to check whether the cancer has spread to them.

You might be able to have keyhole (laparoscopic) surgery rather than open surgery. This means your surgeon will make several smaller cuts in your abdomen instead of one larger one. Ask your surgeon if this is an option for you.

If your surgeon recommends surgery, they’ll explain what will happen before, during and after your operation.

Non-surgical treatment

Your doctor may offer you one of the following treatments as well as surgery or on its own.

  • Chemotherapy. This uses medicines to kill cancer cells. You may have chemotherapy both before and after surgery. You may also have it to improve your quality of life if your cancer has spread.
  • Biological (targeted) therapy. If your stomach cancer has spread, you may be offered a medicine called trastuzumab (Herceptin®) alongside chemotherapy. It works by targeting cancer cells that have a particular protein on their surface. Trastuzumab isn’t suitable for everyone – ask your doctor if it's an option for you.
  • Radiotherapy. This uses radiation to destroy cancer cells and may be used alongside chemotherapy.

You might be asked to be part of a clinical trial of a new treatment that may show promise for treating stomach cancer. If so, your doctor will give you information about the trial and what it involves.

Causes of stomach cancer

Doctors don’t yet know the exact reasons why some people develop stomach cancer. But you're more likely to develop it if you:

  • are over 55
  • are a man (men are around twice as likely to develop stomach cancer as women)
  • get infected with the bacterium Helicobacter pylori
  • have acid reflux, also known as gastro-oesophageal reflux disease (GORD)
  • have pernicious anaemia – where your body doesn't absorb enough vitamin B12 from your diet
  • have someone in your close family with stomach cancer
  • smoke
  • drink a lot of alcohol
  • eat too much salt or preserved foods, such as smoked or pickled foods
  • don't eat many fruit and vegetables
  • are overweight
  • have blood group A

Prevention of stomach cancer

If you make some changes to your lifestyle, it may reduce your risk of getting stomach cancer. These changes will all bring many other health benefits too.


Help and support

Being diagnosed with stomach cancer and facing treatment can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need. Talk to your doctor or nurse if you’re finding your feelings hard to cope with.

Everyone has their own way of coping. But for further support and advice you may find it helpful to contact one of the well-known cancer organisations or to visit their websites. They have information about most types of cancer – often in more detail than we can go into here. Some have a telephone helpline you can ring or an online forum you can join for a chat with others in your position. There may also be local groups where you can meet other people with similar medical issues, or other carers. Your cancer team may know of some.

See our section ‘Other helpful websites’ for contact details of relevant organisations. You may also find our general cancer articles helpful.

Frequently asked questions

  • This will depend on your individual circumstances. A multidisciplinary team (MDT) of health professionals will discuss which treatment is best for you. This team is made up of a range of health professionals including a surgeon, an oncologist (a doctor who specialises in cancer) and cancer nurses.

    Your team will take into account the size and position of your stomach cancer and how far it has spread, as well as your general health. Your own wishes about your treatment will also be considered.

    If you’re diagnosed with stomach cancer early, it can be easier to treat. Surgery will be your main option to remove all of the cancer and reduce the risk of it spreading. Your doctor might offer you chemotherapy before and after surgery, to increase the chance of your treatment being successful.

    If your stomach cancer is diagnosed at a late stage, it may not be possible to cure it. Your treatment will focus on treating your symptoms and improving the amount and quality of your life.

    Making a decision about treatment can be very difficult. It’s important that you talk to the doctors and nurses and ask any questions that you have. You can find out a lot more information about the various treatments for stomach cancer from Cancer Research UK and Macmillan. See our section ‘Other helpful websites’ for contact details.

  • Gastric dumping syndrome is a side-effect of some forms of stomach surgery. It's caused by the sudden movement of food into your small bowel. This can cause unpleasant symptoms straight after you eat a meal or a few hours later.

    Symptoms of gastric dumping syndrome may include:

    • feeling dizzy
    • a fast heart rate (palpitations)
    • feeling faint
    • pain in your abdomen (tummy) or feeling bloated
    • feeling sick and having diarrhoea

    Early gastric dumping syndrome happens because food moves into your small bowel more quickly than before your surgery. This can give you symptoms 15 minutes to an hour after eating. Late gastric dumping syndrome happens one to three hours after you eat.

    When sugary and starchy food passes into your small bowel, it causes a sudden rise in your blood sugar level. Your body responds by releasing lots of a hormone called insulin. The high insulin levels then cause your blood sugars to fall too far (called hypoglycaemia). This is what causes the symptoms.

    Your doctor, nurse or dietitian can give you advice about how to manage your symptoms.

    You can ease the symptoms of gastric dumping syndrome by:

    • eating smaller meals more often (have about six small meals a day)
    • resting for 30 minutes after meals by sitting or lying down
    • eating a low-carbohydrate, high-protein diet
    • cutting out sugary foods and milk altogether as they can make your symptoms worse
    • having drinks between meals rather than during them

    Early dumping syndrome often gets better on its own. If your symptoms of late dumping syndrome persist, there are some medicines that may help.

  • Treatment for stomach cancer often means having an operation to remove part or all of your stomach. So it’s natural to feel concerned about eating and drinking after your surgery. You’ll have advice and support from a dietitian as your body adjusts.

    In the first day or so after your operation, you won’t be able to eat or drink. You’ll be given the fluid you need through a drip directly into a vein. To help you get the nutrients your body needs, you may be fed through a tube that’s put straight into your bowel.

    You’ll usually be able to start drinking within a day or two of your operation. Most people can eat small amounts within a week or so.

    As you recover, you may feel full after small amounts of food. It’s also not unusual to lose weight. Some foods may make you feel sick or give you diarrhoea. But this should settle down as you become more familiar with which foods cause problems. It can take a couple of months before you’re eating a full range of food again.

    After stomach cancer surgery, you may not be able to absorb certain vitamins and minerals as well as before. Your doctor will keep an eye on whether you’re getting enough of these when they see you for regular follow-up appointments. You may need advice on your diet from a dietitian, and you may need to take supplements. For instance, if you’ve had all or part of your stomach removed, you may need regular injections of vitamin B12 (usually every three months).

    If you have concerns about what to eat or you’re having problems with eating, talk to your doctor, nurse or dietitian.


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Related information

Tools and calculators

    • Upper gastrointestinal cancer. Oxford handbook of oncology (online). Oxford Medicine Online. oxfordmedicine.com, published September 2015
    • Stomach cancer. BMJ Best practice. bestpractice.bmj.com, last updated July 2018
    • Gastric cancer. Medscape. emedicine.medscape.com, updated April 2018
    • Gastric cancer. PatientPlus. patient.info/patientplus, last checked November 2014
    • Stomach cancer. The MSD Manuals. www.msdmanuals.com, last full review/revision October 2017
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), 2015 (updated 2017). www.nice.org.uk
    • Stomach cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed June 2016
    • Stomach cancer statistics. Cancer Research UK. www.cancerresearchuk.org, accessed 1 August 2018
    • Gastrointestinal stromal tumour (GIST). Cancer Research UK. www.cancerresearchuk.org, last reviewed June 2018
    • About carcinoid. Cancer Research UK. www.cancerresearchuk.org, last reviewed May 2016
    • Stomach cancer. Macmillan. www.macmillan.org.uk, reviewed October 2016
    • Barium meal: patient information leaflet. British Society of Gastrointestinal and Abdominal Radiology (BSGAR), 2011. www.bsgar.org
    • Dumping syndrome. Medscape. emedicine.medscape.com, updated October 2017
    • Personal communication, Mr Stephen Pollard, Consultant Surgeon, August 2018
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, August 2018
    Expert reviewer, Mr Stephen Pollard, Consultant Surgeon
    Next review due August 2021



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