This National Cancer Institute (NCI) booklet is about cancer* of the stomach. Stomach cancer is also called gastric cancer. Each year in the United States, about 13,000 men and 8,000 women are diagnosed with stomach cancer. Most are over 70 years old.
The StomachThe stomach is a hollow organ in the upper abdomen, under the ribs. It's part of the digestive system. Food moves from the mouth through the esophagus to the stomach. In the stomach, the food becomes liquid. Muscles in the stomach wall push the liquid into the small intestine. The wall of the stomach has five layers:
This picture shows the stomach and nearby organs.
Cancer CellsCancer begins in cells, the building blocks that make up tissues. Tissues make up the stomach and other organs of the body. Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth, polyp, or tumor. Tumors in the stomach can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:
Stomach cancer usually begins in cells in the inner layer of the stomach. Over time, the cancer may invade more deeply into the stomach wall. A stomach tumor can grow through the stomach's outer layer into nearby organs, such as the liver, pancreas, esophagus, or intestine. Stomach cancer cells can spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may be found in lymph nodes near the stomach. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis. See the Staging section for information about stomach cancer that has spread.
Risk FactorsWhen you're told that you have stomach cancer, it's natural to wonder what may have caused the disease. But no one knows the exact causes of stomach cancer. Doctors seldom know why one person develops stomach cancer and another doesn't. Doctors do know that people with certain risk factors are more likely than others to develop stomach cancer. A risk factor is something that may increase the chance of getting a disease. Studies have found the following risk factors for stomach cancer:
Most people who have known risk factors do not develop stomach cancer. For example, many people have an H. pylori infection but never develop cancer. On the other hand, people who do develop the disease sometimes have no known risk factors.
SymptomsEarly stomach cancer often does not cause symptoms. As the cancer grows, the most common symptoms are:
Most often, these symptoms are not due to cancer. Other health problems, such as an ulcer or infection, can cause the same symptoms. Anyone who has these symptoms should tell their doctor so that problems can be diagnosed and treated as early as possible.
DiagnosisIf you have symptoms that suggest stomach cancer, your doctor will check to see whether they are due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems. Your doctor will ask about your personal and family health history. You may have blood or other lab tests. You also may have:
You may want to ask your doctor these questions before having a biopsy:
StagingIf the biopsy shows that you have stomach cancer, your doctor needs to learn the stage (extent) of the disease to help you choose the best treatment. Staging is a careful attempt to find out the following:
When stomach cancer spreads, cancer cells may be found in nearby lymph nodes, the liver, the pancreas, esophagus, intestine, or other organs. Your doctor may order blood tests and other tests to check these areas:
Sometimes staging is not complete until after surgery to remove the tumor and nearby lymph nodes. When stomach cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if stomach cancer spreads to the liver, the cancer cells in the liver are actually stomach cancer cells. The disease is metastatic stomach cancer, not liver cancer. For that reason, it is treated as stomach cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease. These are the stages of stomach cancer:
TreatmentThe choice of treatment depends mainly on the size and location of the tumor, the stage of disease, and your general health. Treatment for stomach cancer may involve surgery, chemotherapy, or radiation therapy. You'll probably receive more than one type of treatment. For example, chemotherapy may be given before or after surgery. It's often given at the same time as radiation therapy. You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for people at any stage of stomach cancer. See Taking Part in Cancer Research. You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat stomach cancer include gastroenterologists, surgeons, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian. Your health care team can describe your treatment choices, the expected results, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects, how to prevent or reduce these effects, and how treatment may change your normal activities. You and your health care team can work together to make a treatment plan that meets your needs. You may want to ask your doctor these questions before you begin treatment:
SurgeryThe type of surgery for stomach cancer depends mainly on where the cancer is located. The surgeon may remove the whole stomach or only the part that has the cancer. You and your surgeon can talk about the types of surgery and which may be right for you:
The time it takes to heal after surgery is different for each person, and you may be in the hospital for a week or longer. You may have pain for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief. Many people who have stomach surgery feel tired or weak for a while. Your health care team will watch for signs of bleeding, infection, or other problems that may require treatment. The surgery can also cause constipation or diarrhea. These symptoms usually can be controlled with diet changes and medicine. See the Nutrition section for information about eating after surgery. You may want to ask your doctor these questions before having surgery:
ChemotherapyMost people with stomach cancer get chemotherapy. Chemotherapy uses drugs to kill cancer cells. It may be given before or after surgery. After surgery, radiation therapy may be given along with chemotherapy. The drugs that treat stomach cancer are usually given through a vein (intravenous). You'll probably receive a combination of drugs. You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment. The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
Some drugs used for stomach cancer also may cause a skin rash, hearing loss, and tingling or numbness in your hands and feet. Your health care team can suggest ways to control many of these side effects. You may want to read the NCI booklet Chemotherapy and You. You may want to ask your doctor these questions before having chemotherapy:
Radiation TherapyRadiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy is usually given with chemotherapy to treat stomach cancer. The radiation comes from a large machine outside the body. You'll go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Side effects depend mainly on the dose and type of radiation. External radiation therapy to the chest and abdomen may cause a sore throat, pain similar to heartburn, or pain in the stomach or the intestine. You may have nausea and diarrhea. Your health care team can give you medicines to prevent or control these problems. It's common for the skin in the treated area to become red, dry, tender, and itchy. You're likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay active, unless it leads to pain or other problems. Although the side effects of radiation therapy can be distressing, your doctor can usually treat or control them. Also, side effects usually go away after treatment ends. You may find it helpful to read the NCI booklet Radiation Therapy and You. You may want to ask your doctor these questions before having radiation therapy:
Second OpinionBefore starting treatment, you might want a second opinion from another doctor about your diagnosis and treatment plan. Some people worry that their doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion. If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you'll have more information and perhaps a greater sense of control. You may also feel more confident about the decisions you make, knowing that you've looked carefully at your options. It may take some time and effort to gather your medical records and see another doctor. Usually it's not a problem if it takes you several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this possible delay with your doctor. Some people with stomach cancer need treatment right away. There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists. Also, you can request a consultation with specialists at the National Institutes of Health Clinical Center in Bethesda, Maryland. Specialists in the NCI Surgery Branch provide consultations and surgical care for people with stomach cancer. The telephone number is 301-496-4164. The NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp can tell you about nearby treatment centers. Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.
NutritionNutrition is an important part of your treatment for stomach cancer. You need the right amount of calories, protein, vitamins, and minerals to maintain your strength and to heal. However, when you have stomach cancer, it may be difficult to eat. You may be uncomfortable or tired, and you may not feel like eating. You also may have nausea, vomiting, constipation, or diarrhea from cancer treatment or pain medicine. Tell your health care team if you're losing weight or having any problems digesting your food. A dietitian can help you choose the foods and nutrition products that will meet your needs. Some people with stomach cancer are helped by receiving nutrition by IV (intravenous). A temporary feeding tube is rarely needed. You may want to read the NCI booklet Eating Hints. It contains many useful ideas and recipes.
Nutrition after Stomach SurgeryA registered dietitian can help you plan a diet that will meet your nutrition needs. A plan that describes the type and amount of food to eat after surgery can help you prevent weight loss and discomfort with eating. After stomach surgery, you may need to take daily supplements of vitamins and minerals, such as vitamin D, calcium, and iron. You may also need vitamin B12 shots. Some people have problems eating and drinking after stomach surgery. Liquids may pass into the small intestine too fast, which causes dumping syndrome. The symptoms are cramps, nausea, bloating, diarrhea, and dizziness. To prevent these symptoms, it may help to make the following changes:
You may want to ask a dietitian these questions about nutrition:
Supportive CareStomach cancer and its treatment can lead to other health problems. You can have supportive care before, during, and after cancer treatment. Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.
Cancer That Blocks the Digestive TractPeople with advanced stomach cancer may develop a tumor that blocks the passage of food through the digestive tract. Your health care team may suggest one or more of the following options:
PainCancer and its treatments may cause pain. Your health care team or a pain control specialist can suggest ways to relieve or reduce pain. Radiation therapy and pain medicine may help. More information about pain control can be found in the NCI booklet Pain Control.
Follow-up CareYou'll need regular checkups after treatment for stomach cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor. Your doctor will check for return of the cancer. Also, checkups help detect health problems that can result from cancer treatment. Checkups may include a physical exam, blood tests, x-rays, CT scans, endoscopy, or other tests. If you had surgery on the stomach, your doctor may order blood tests to check the levels of certain vitamins and minerals, such as vitamin B12, calcium, and iron. You may find it helpful to read the NCI booklet Facing Forward: Life After Cancer Treatment. You may also want to read the NCI fact sheet Follow-up Care After Cancer Treatment.
Sources of SupportLearning that you have stomach cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to need help coping with the feelings that such a diagnosis can bring. Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities. Here's where you can go for support:
Taking Part in Cancer ResearchDoctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Clinical trials are designed to find out whether new approaches are safe and effective. Doctors are trying to find better ways to care for people with stomach cancer. They are studying many types of treatment and their combinations. Even if the people in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about stomach cancer and how to control it. Although clinical trials may pose some risks, doctors do all they can to protect their patients. If you're interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It describes how treatment studies are carried out and explains their possible benefits and risks. The NCI Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of stomach cancer. Information specialists at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp can answer questions and provide information about clinical trials. Also, you may wish to contact the NCI Surgery Branch at the National Institutes of Health Clinical Center in Bethesda, Maryland. The telephone number is 301-496-4164.
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