About stomach cancer
Stomach cancer, or gastric cancer, is a fairly uncommon type of cancer.
The initial symptoms of stomach cancer are vague and easy to mistake for other less serious conditions. They include:
Symptoms of advanced stomach cancer can include:
- blood in your stools, or black stools
- loss of appetite
- weight loss
As the early symptoms of stomach cancer are similar to those of many other conditions, the cancer is often advanced by the time it’s diagnosed. It’s therefore important to get any possible symptoms of stomach cancer checked by your GP as soon as possible.
Read more about diagnosing stomach cancer
The exact cause of stomach cancer is still unclear, although you’re more likely to develop it if you:
- are male
- are 55 years of age or older
- have a diet low in fibre and high in processed food or red meat
- have a diet that contains a lot of salted and pickled foods
- have a stomach infection caused by Helicobacter pylori (H. pylori) bacteria
Read more about the causes of stomach cancer.
Types of stomach cancer
There are several different types of stomach cancer. More than 95% of stomach cancers develop in the cells of the stomach lining and are known as adenocarcinomas.
Less common types of stomach cancer include lymphoma of the stomach, which develops in the lymphatic tissue (tissue that drains away fluid and helps fight infection), and gastrointestinal stromal tumours (GISTs), which develop in the muscle or connective tissue of the stomach wall.
How stomach cancer is treated
Many cases of stomach cancer can’t be completely cured, but it’s still possible to relieve symptoms and improve quality of life using chemotherapy and in some cases radiotherapy and surgery.
If operable, surgery can cure stomach cancer as long as all of the cancerous tissue can be removed.
Surgery to remove some or all of the stomach is known as a gastrectomy. It will still be possible to eat normally after a gastrectomy, but you’ll probably have to adjust the size of your portions.
Chemotherapy can also be used before surgery to help shrink the tumour and sometimes after surgery to help prevent the cancer returning.
Read more about treating stomach cancer
Living with stomach cancer
Living with stomach cancer and the effects of surgery can be tough, but there are a range of services that can provide social, psychological and financial support.
Read more about living with stomach cancer
Symptoms of stomach cancer
Many symptoms of stomach cancer are similar to less serious conditions, so it can be difficult to recognise in the early stages.
Early stage symptoms include:
- persistent indigestion
- trapped wind and frequent burping
- feeling full very quickly when eating
- feeling bloated after eating
- feeling sick
- pain in your stomach or breastbone
- difficulty swallowing (dysphagia)
- vomiting (the vomit may be streaked with blood), although this is uncommon in the early stages
Advanced stomach cancer
Symptoms of more advanced stomach cancer include:
- blood in your stools, or black stools
- loss of appetite
- weight loss
- lumpiness and swelling in your stomach (caused by a build-up of fluid)
- anaemia (a reduced number of red blood cells that can cause you to feel tired and breathless)
- yellowing of the skin and whites of the eyes (jaundice)
When to seek medical help
Stomach cancer is usually easier to treat if it’s diagnosed early. It’s therefore important for your GP to refer you to a specialist as soon as possible if stomach cancer is suspected.
Stomach cancer is much more common in older people, with 90 out of 100 cases occurring in people who are over 55 years of age.
Indigestion is a very common symptom in the general population. However, it’s unlikely that someone with indigestion who’s under the age of 55 will have stomach cancer.
However, see your GP if you have indigestion and weight loss, anaemia or persistent vomiting. They should refer you to a specialist for further testing.
Also see your GP if you have difficulty swallowing. This isn’t a common symptom among the general population and the cause should always be investigated.
Read more about diagnosing stomach cancer
Causes of stomach cancer
Stomach cancer is caused by changes in the cells of the stomach, although it’s unclear exactly why these changes occur.
Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.
Left untreated, cancer can spread to other parts of the body, usually through the lymphatic system (a network of vessels and glands called lymph nodes located throughout the body).
Once the cancer reaches your lymphatic system, it’s capable of spreading to other parts of your body, including your blood, bones and organs.
It’s not known what triggers the changes in DNA that lead to stomach cancer and why only a small number of people develop the condition.
However, evidence suggests that a number of different factors can affect your chances of developing stomach cancer.
Age and gender
Your risk of developing stomach cancer increases with age. Most cases occur in people aged 55 or over.
For reasons that are unclear, men are twice as likely as women to develop stomach cancer.
People who smoke are about twice as likely to develop stomach cancer compared with non-smokers. This is because you swallow some cigarette smoke when you inhale and it ends up in your stomach. Cigarettes contain harmful chemicals which can damage the cells in your stomach.
The more you smoke and the longer you’ve been smoking, the bigger the risk. In the UK, around 1 in every 5 cases of stomach cancer (20%) is thought to be caused by smoking.
H. pylori infection
Helicobacter pylori (H. pylori) is a common type of bacteria. In most people, these bacteria are harmless, but in some people an H. pylori infection can cause problems such as stomach ulcers, recurring bouts of indigestion or long-term inflammation of the stomach lining (chronic atrophic gastritis).
Research has found people with severe chronic atrophic gastritis have an increased risk of developing stomach cancer, although this risk is still small.
A diet rich in pickled vegetables, such as pickled onions or piccalilli, salted fish, salt in general and smoked meats, such as pastrami or smoked beef, increases your risk of stomach cancer.
Countries where this type of diet is popular, such as Japan, tend to have much higher rates of stomach cancer than the UK.
A high fibre diet with 5 portions of fruit and vegetables a day will help protect against stomach cancer, and a diet high in fats and processed food and red meat will increase your risk of getting stomach cancer.
You’re more likely to develop stomach cancer if you have a close relative with the condition, such as one of your parents or a sibling (brother or sister). In such cases, it may be appropriate for your doctor to arrange genetic counselling.
It’s not fully understood why stomach cancer seems to run in families. It may be because of shared risk factors, such as having similar diets or having an H. pylori infection, or because of certain genes you inherit from your parents.
In around 1 in 50 cases of stomach cancer, testing has found that people share a mutation in a gene known as E-cadherin.
You may be more at risk of getting the condition if you have the blood type A. Your blood type is passed on from your parents, so this could be another way in which family history may increase your risk of developing stomach cancer.
There’s also a condition that runs in families called familial adenomatous polyposis (FAP), which may increase your risk of developing stomach cancer. FAP causes small growths, called polyps, to form in your digestive system, and is known to increase your risk of developing bowel cancer.
Having another type of cancer
Your risk of developing stomach cancer is increased if you’ve had another type of cancer, such as cancer of the oesophagus or non-Hodgkin lymphoma (cancer that develops in your white blood cells).
For men, the risk of getting stomach cancer is increased after having prostate cancer, bladder cancer, breast cancer or testicular cancer. For women, the risk of developing stomach cancer increases after having ovarian cancer, breast cancer or cervical cancer.
Certain medical conditions
Having certain medical conditions can also increase your risk of developing stomach cancer, such as pernicious anaemia (a vitamin B12 deficiency, which occurs when your body can’t absorb it properly), and peptic stomach ulcers (an ulcer in your stomach lining, often caused by H. pylori infection).
If you’ve had stomach surgery, or surgery to a part of your body that affects your stomach, you may be more likely to develop stomach cancer.
This can include surgery to remove part of your stomach (known as a partial gastrectomy), surgery to remove part of your vagus nerve (the nerve that carries information from your brain to organs such as your heart, lungs and digestive system), or surgery to repair a stomach ulcer.
How stomach cancer spreads
There are 3 ways stomach cancer can spread:
- directly – the cancer can spread from the stomach into nearby tissues and organs, such as the pancreas, colon, small intestine and peritoneum (the lining of the inside of the abdominal cavity)
- through the lymphatic system – the lymphatic system is a series of glands (nodes) located throughout your body, similar to the blood circulatory system; the glands produce specialised cells needed by your immune system to fight infection
- through the blood – which can cause the cancer to spread from the stomach to other parts of the body, most commonly the liver
Stomach cancer that spreads to another part of the body is known as metastatic stomach cancer.
Diagnosing stomach cancer
Speak to your GP as soon as possible if you have stomach cancer symptoms such as indigestion, unexpected weight loss, anaemia and persistent vomiting.
Your GP will ask about your symptoms and examine your stomach for any lumpiness or tenderness. If they think that stomach cancer may be a possibility they’ll refer you to a specialist for further investigation.
In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of stomach cancer and refer people for the right tests faster. Find out who should be referred for further tests for suspected stomach cancer.
If your GP thinks you may have stomach cancer, they’ll refer you to a specialist for tests.
These may include a blood test and chest X-ray, which will assess your overall health. A sample of your stools may also be tested for blood.
Because of the potentially serious nature of stomach cancer, you should be referred to the specialist within 2 weeks. Read more about waiting times.
Endoscopy and endoscopic ultrasound
An endoscopy is a procedure where the inside of your body is examined using a piece of equipment called an endoscope (a long, thin flexible tube with a light and a video camera at the end).
If you need to have an endoscopy, you won’t be able to eat or drink for four to eight hours before the procedure. This is to ensure your stomach and duodenum (top of the small intestine) are empty.
You’ll be awake during the endoscopy, but may be given a sedative by injection to make you feel drowsy and relaxed. A local anaesthetic may also be sprayed onto the back of your throat, so the area is numbed.
The endoscope will be passed down your gullet (food pipe) and into your stomach so the specialist can look for any stomach ulcers or signs of cancer. If tissue is found that may be cancerous, a sample will be taken for testing. This procedure is known as a biopsy. The sample will be examined under a microscope in a laboratory. The results will show whether the cells are cancerous (malignant) or non-cancerous (benign) and will usually take 7 to 10 days to come back.
The endoscopy itself usually takes about 15 minutes, although you should allow about 2 hours in total for your visit.
If your specialist thinks you may have cancer in the top part of your stomach, you may have an ultrasound scan at the same time as an endoscopy. This is known as an endoscopic ultrasound and uses high-frequency sound waves to produce an image of your stomach (this method is commonly used to view an unborn baby in the womb).
If you have an endoscopic ultrasound, an ultrasound probe will be attached to the end of the endoscope before it’s passed down your throat. The scan will help determine the stage of any cancer in the top part of your stomach.
After an endoscopy, or an endoscopic ultrasound, you won’t be able to drive for several hours because of the sedative. You may also have a sore throat, although this should pass within a few days.
Barium meal X-ray
A barium meal X-ray or barium swallow involves drinking a chalky liquid containing a substance called barium, which makes your stomach show up on an X-ray. Nowadays, however, it’s less commonly used to diagnose stomach cancers.
Organs such as your stomach don’t usually show up on an X-ray because they’re made of soft tissue that isn’t dense enough to stop the X-rays passing through. However, when these organs are filled with barium, it blocks the X-rays and shows up white on an X-ray screen.
You won’t able to eat or drink for at least 6 hours before the procedure because your stomach and duodenum need to be empty. You may be given an injection to relax the muscles in your digestive system.
A barium swallow usually takes about 15 minutes. Afterwards, you’ll be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. You may feel slightly sick, and the barium may cause constipation. Your stools may be white for a few days afterwards as the barium passes through your system.
If you’re diagnosed with stomach cancer, further tests may be needed to help determine how far it’s spread and how quickly it’s likely to spread (known as the stage and grade). Your cancer specialist (oncologist) will discuss this with you.
However, it may not always be possible to identify the exact stage of your condition until your treatment starts.
Your specialist may need to examine your stomach in more detail to see if the cancer has spread, particularly to the lining of the abdominal cavity (peritoneum). If it has, you may need to have a small operation called a laparoscopy. This procedure is carried out under a general anaesthetic, so you’ll be unconscious during it.
During the procedure, a thin viewing tube with a camera at the end (a laparoscope) will be inserted into your stomach through a small incision in the lower part of your tummy. In some cases, your specialist may need to examine more than one area of your stomach and make more than one incision.
Computerised tomography or positron emission tomography scans
During CT scans or PET scans, a series of X-ray images of your body are taken. A computer is then used to put the images together and create a detailed picture of the inside of your body.
These scans will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours anywhere else in the body. The scans can also help your doctors work out which type of treatment will be most effective and appropriate for you.
Liver ultrasound scan
If your specialist thinks your stomach cancer may have spread to your liver, you may need to have a liver ultrasound. This type of scan uses high-frequency sound waves to produce an image of your liver.
Staging and grading
After all of the tests have been completed and your test results are known, it should be possible to tell what stage and grade of stomach cancer you have.
Staging is a measurement of how far cancer has spread. There are a number of different ways stomach cancer can be staged. One method uses a numbering system from 1 to 4. The higher the number, the further the cancer has spread.
The majority of stomach cancers are at stage 3 or 4 when diagnosed, which means a cure isn’t usually possible.
Grading describes how quickly the cancer is likely to spread in the future. There are 3 grades of stomach cancer:
- low-grade – the cancer tends to grow slowly
- medium-grade – the cancer grows a bit faster
- high-grade – the cancer is aggressive and likely to grow quickly
Cancer Research UK has more information about the staging and grading of stomach cancer.
Treating stomach cancer
The treatments recommended for stomach cancer will depend on your general health and how far the cancer has spread.
Most hospitals use multidisciplinary teams made up of a number of different specialists (see below) who work together to plan and carry out the best treatment, tailored to your circumstances.
Feel free to discuss treatment with your care team at any time and ask questions.
Your treatment plan
The main treatments for stomach cancer are surgery, chemotherapy and radiotherapy. You may have 1 of these treatments or a combination.
If surgery is recommended, you may have chemotherapy beforehand. If the tumour is in the upper part of your stomach, including the junction between the oesophagus and stomach, you may also have radiotherapy prior to surgery.
Surgery is mainly used if stomach cancer is diagnosed at an early stage, whereas chemotherapy and radiotherapy tend to be used when the condition is diagnosed at a later stage.
Where possible, the primary aim of treatment is to completely remove the tumour and any other cancerous cells in your body. It’s estimated that a cure is possible in 20 to 30% of stomach cancer cases.
If it’s not possible to remove the tumour, your doctors will focus on trying to prevent it from getting any bigger and causing further harm to your body. This may be done using surgery or chemotherapy.
In some cases, it’s not possible to eliminate the cancer or slow it down. In this case, your treatment will aim to relieve your symptoms and make you as comfortable as possible, usually with surgery or radiotherapy.
A relatively new medication called trastuzumab (see below) can also be used to treat some types of advanced stomach cancer.
Your healthcare team will talk to you about which treatments are most suitable.
If you’re diagnosed with stomach cancer at an early stage, it may be possible for the cancer to be completely removed during surgery.
In some cases, it may be possible to pass a thin, flexible tube (endoscope) down your oesophagus (gullet), rather than making incisions in your tummy. This is known as endoscopic surgery, and can be used to remove a sample of the tumour for testing (biopsy). It can also be used to remove the tumour completely if stomach cancer is diagnosed at an early stage.
However, if your cancer has spread beyond your stomach, it may not be possible to remove it completely. If this is the case, you may still have surgery to remove any cancer blocking your stomach, to ease your symptoms. This will depend on whether your symptoms can be controlled and the risks and side effects of undertaking major surgery.
Any type of surgery for stomach cancer will involve a large operation and a long recovery time. If you have stomach cancer surgery, you’ll usually need to stay in hospital for around 2 weeks. You’ll also need several weeks at home to recover.
Surgery to remove your stomach
You may need to have part or all of your stomach removed.
Surgery to remove part of your stomach is known as a partial or sub-total gastrectomy, and surgery to remove all of your stomach is known as a total gastrectomy. In some cases, your surgeon may remove part of your oesophagus as well as all of your stomach, using a procedure known as an oesophagogastrectomy.
These operations may be carried out using either a large incision in your tummy (open surgery), or a number of smaller incisions through which surgical tools can be passed (laparoscopic or keyhole surgery). Both of these techniques are carried out under general anaesthetic, which means you’ll be unconscious throughout the procedure.
During these operations, your surgeon will also remove the lymph nodes (small glands that help fight infection) nearest to the cancer. It’s possible that your stomach cancer may have spread to these lymph nodes, and removing them helps prevent the cancer returning.
If your cancer is in the lower part of your stomach, you may have a partial gastrectomy to remove it.
After surgery, your stomach will be smaller than it was before the operation. However, the top part of your stomach, where your oesophagus feeds into it, won’t be affected.
Total gastrectomy or oesophagogastrectomy
If your cancer is in the middle or at the top of your stomach, you may need to have a total gastrectomy. If the cancer is close to the end of your oesophagus, where it meets your stomach, you may need to have an oesophagogastrectomy.
If you have a total gastrectomy, the end of your gullet will be joined to the top of your jejunum (the top part of your small intestine). If you have an oesophagogastrectomy, the remaining part of your gullet will be joined to your jejunum.
Surgery to ease your symptoms
If your stomach cancer has spread beyond your stomach, it may not be possible to remove it using surgery.
However, if your stomach has been significantly affected by cancer it can cause a blockage, which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting and feeling very full after eating.
If your stomach is blocked, there are a few options:
- stenting – a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic; after being inserted, the stent will be expanded and open up the stomach
- partial or total gastrectomy – to remove the blockage and improve your symptoms
- bypass surgery – an operation where part of your stomach above the blockage is joined to your small intestine, leaving the blocked part of your stomach out of your digestive system
Chemotherapy is a specialist treatment for cancer that uses medicines, called cytotoxic medicines, to stop cancer cells dividing and multiplying. As it circulates through your body, the medicine can target cancer cells in your stomach and any that may have spread to other parts of your body.
You may have chemotherapy for stomach cancer before surgery to reduce the amount of cancer that has to be removed during the operation. Chemotherapy can also be used after surgery to destroy any remaining cancer cells and prevent the cancer from coming back.
Chemotherapy can also help to slow the progression of cancer and ease the symptoms of more advanced stomach cancer, which may not be suitable for surgery.
If may be given orally (as tablets) or intravenously (by injection or a drip through a vein directly into your bloodstream), or a combination of both.
Intravenous chemotherapy is usually given in hospital, while oral chemotherapy is taken at home. Chemotherapy is often given in cycles, each usually lasting about three weeks.
Alternatively, chemotherapy may be administered through a small pump, which gives you a constant low dose over a few weeks or months. The pumps are portable and can be worn at home, which means fewer trips to hospital.
Side effects of chemotherapy
Chemotherapy works by preventing cancerous cells from growing rapidly. However, it also destroys non-cancerous cells such as hair follicles and red and white blood cells. Side effects may include:
- nausea and vomiting
- nerve damage (peripheral neuropathy)
- hair loss
- anaemia (a lack of red blood cells)
- weight loss
- skin changes – such as redness, swelling and a tingling sensation in the palms of the hands and/or soles of the feet
The side effects you experience after having chemotherapy will depend on the type of chemotherapy and the number of treatment sessions you need. You’ll be told who to contact if you’re experiencing serious side effects from chemotherapy, and it’s very important that this contact information is recorded carefully.
If you experience nausea and vomiting as a result of chemotherapy, you may be able to take anti-sickness medication to counter it. This may be given intravenously (by injection directly into your bloodstream) at the same time as your chemotherapy.
The side effects of chemotherapy will only last for as long as your course of treatment lasts. Once your treatment is over, the hair follicles and blood cells will repair themselves. This means your hair will grow back, although it might look or feel different from how it did before chemotherapy (for example, it may be a slightly different colour, or be softer or curlier than before).
Radiotherapy uses beams of high energy radiation to destroy cancer cells. It’s not often used to treat stomach cancer because there’s a risk that other organs close to your stomach might be damaged by the treatment.
However, if you have advanced stomach cancer that’s causing pain or bleeding, you may need to have radiotherapy. In some cases, following surgery, you may have chemotherapy and/or radiotherapy to help prevent the stomach cancer from recurring.
If a cancer is bleeding slowly and causing anaemia, a single fraction of radiotherapy can be used to try to prevent further bleeding.
If you need radiotherapy, your treatment will usually begin 2 or 3 months after surgery or chemotherapy, to give your body a chance to recover. This is a painless procedure where you lie under a radiotherapy machine while it directs radiation at your stomach. You’ll be positioned by a radiographer (a specialist in radiotherapy) so that the machine targets the cancer cells and avoids as much healthy tissue as possible.
Radiotherapy often involves having treatment sessions 5 days a week. Each session will only last a few minutes. The radiation doesn’t stay in your system afterwards, and it’s perfectly safe to be around others between your treatments.
How long you’ll need to have radiotherapy for will depend on how it’s used. Radiotherapy used after surgery to help prevent stomach cancer coming back usually lasts 5 weeks. If it’s being used to control symptoms of advanced stomach cancer, it may only last 1 or 2 weeks.
Side effects of radiotherapy
You may experience the following side effects after having radiotherapy:
- irritation and darkening of your skin where the treatment takes place
These side effects will usually improve within a few weeks of treatment finishing.
Trastuzumab (sold under the brand name Herceptin) is a medication used to treat breast cancer and some cases of advanced stomach cancer.
Some stomach cancers are stimulated by a type of protein called human epidermal growth factor receptor 2 (HER2). Trastuzumab works by blocking the effects of this protein. This doesn’t cure stomach cancer, but it can slow its growth and increase survival time.
If you’re diagnosed with advanced stomach cancer and tests show high levels of the HER2 protein in the cancerous cells, your doctors may recommend treatment with a combination of chemotherapy and trastuzumab.
Trastuzumab is given intravenously, through a drip, and you’ll have the treatment in hospital. Each treatment session takes up to 1 hour and you’ll usually need a session once every 3 weeks.
Trastuzumab can cause side effects, including heart problems. Therefore, it may not be suitable if you have a heart problem such as angina, uncontrolled high blood pressure (hypertension) or heart valve disease. If you need to take trastuzumab, you’ll also need regular tests on your heart to check for any problems.
Other side effects of trastuzumab may include:
- an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever
- aches and pains
Living with stomach cancer
Being diagnosed with cancer is a tough challenge for most people, but support is available to help you cope.
You may find the following advice helpful:
- keep talking to your friends and family – they can be a powerful support system
- talk to others in the same situation
- research your condition
- set reasonable goals
- take time out for yourself
Cancer charities, such as Macmillan Cancer Support, are a good source of information and support.
Getting back to normal after surgery can take time. It’s important to take things slowly and give yourself time to recover. During your recovery, avoid lifting heavy things such as children or shopping bags, and strenuous tasks such as housework. You may also be advised not to drive.
Some other treatments, particularly chemotherapy and radiotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Don’t be afraid to ask for practical help from family and friends.
After your treatment has finished, you’ll be invited for regular check-ups, usually every three months for the first year. During the check-up, your doctor will examine you and may arrange blood tests or scans to see how you’re responding to treatment.
Diet after surgery
If you’ve had an operation to remove part of your stomach (partial gastrectomy), you’ll only be able to eat small amounts of food for a while after your operation. This is because your stomach won’t be able to hold as much food as it could before the surgery, and your body will need to adjust to its new stomach capacity. You should gradually be able to increase the amount you eat as your stomach begins to expand.
If you’ve had surgery to remove all of your stomach (total gastrectomy), it may be some time before you can eat normally again. As with a partial gastrectomy, you’ll only be able to eat small amounts of food until your body adjusts. You may have to eat little and often, and make changes to the types of food you eat. Your care team will be able to advise you about what and when you should eat.
Having surgery to remove your stomach also means you’ll need to have regular injections of vitamin B12. Vitamin B12 is usually absorbed through your stomach from the food you eat and is needed to help prevent a condition called anaemia and nerve problems.
Looking after yourself
Eat regularly and healthily. You may not have time to sit down for every meal, but you should make time to do so at least once a day.
It’s understandable if there are times when you feel resentful, and then guilty for feeling so. You may also feel exhausted, isolated and worry about the person you care for. Remember: you’re human, and those feelings are natural.
Dealing with dying
If your stomach cancer can’t be cured, your GP will give you support and any necessary pain relief (often alongside chemotherapy or radiotherapy, which can be used to reduce your symptoms). This is called palliative care. Support is also available for your family and friends.