Gastric cancer

Gastric cancer is cancer that starts in the stomach.

Causes
Several types of cancer can occur in the stomach. The most common type is called adenocarcinoma. It starts from one of the common cell types found in the lining of the stomach.

This article focuses on adenocarcinoma of the stomach.

Adenocarcinoma of the stomach is a common cancer of the digestive tract worldwide. It is uncommon in the United States. It occurs most often in men over age 40. This form of gastric cancer is common in eastern Asia, parts of South America, and eastern and central Europe.

The number of people in the United States who get this cancer has gone down over the years. Experts think the decrease may be because people are eating less salted, cured, and smoked foods.

You are more likely to get gastric cancer if you:

Have a family history of gastric cancer
Have an infection of the stomach by bacteria called Helicobacter pylori
Had a polyp larger than 2 centimeters in your stomach
Have inflammation and swelling of the stomach for a long time (chronic atrophic gastritis)
Have pernicious anemia
Smoke
Symptoms
Abdominal fullness or pain, which may occur after a small meal
Dark stools
Difficulty swallowing, which becomes worse over time
Excessive belching
General decline in health
Loss of appetite
Nause
Vomiting blood
Weakness or fatigue
Weight loss
Exams and Tests
Diagnosis is often delayed because symptoms may not occur in the early stages of the disease. Or, patients may self-treat symptoms that gastric cancer has in common with other, less serious gastrointestinal disorders (bloating, gas, heartburn, and fullness).

Tests that can help diagnose gastric cancer include:

Complete blood count (CBC) to check for anemia.
Esophagogastroduodenoscopy (EGD) with biopsy to examine the stomach tissue. EGD involves putting a tiny camera down the esophagus (food tube) to look at the inside of the stomach.
Stool test to check for blood in the stools.
Treatment
Surgery to remove the stomach (gastrectomy) is the only treatment that can cure the gastric adenocarcinoma. Radiation therapy and chemotherapy may help. Chemotherapy and radiation therapy after surgery may improve the chance of a cure.

For patients who cannot have surgery, chemotherapy or radiation can improve symptoms and may prolong survival, but will likely not cure the cancer. For some patients, a surgical bypass procedure may relieve symptoms.

Support Groups
You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.


Outlook (Prognosis)
Outlook varies based on how much the cancer has spread by the time of diagnosis. Tumors in the lower stomach are cured more often than those in the higher stomach. Chance of a cure also depends on how far the tumor has invaded the stomach wall and whether lymph nodes are involved.

When the tumor has spread outside the stomach, a cure is not possible. In this case, the goal of treatment is to improve symptoms.

When to Contact a Medical Professional
Call your health care provider if symptoms of gastric cancer develop.

Prevention
Screening programs are successful in detecting disease in the early stages in parts of the world where the risk of gastric cancer is much higher than in the United States. The value of screening in the United States and other countries with lower rates of gastric cancer is not clear.

The following may help reduce your risk of gastric cancer:

Do not smoke.
Eat a healthy foods rich in fruits and vegetables.
Take medicines to treat reflux disease (heartburn), if you have it.
Take antibiotics if you are diagnosed with H. pylori infection.
Alternative Names
Cancer - stomach; Stomach cancer; Gastric carcinoma; Adenocarcinoma of the stomach

References
Gunderson LL, Donohue JH, Alberts SR. Cancer of the stomach. In: Abeloff MD, Armitage JO, Niederhuber JE et al., eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2008:chap 79.

Rustgi AK. Neoplasms of the esophagus and stomach. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 198.

National Cancer Institute. PDQ Gastric cancer treatment. Bethesda, MD: National Cancer Institute. Date last modified 12/23/2011. Available at: http://cancer.gov/cancertopics/pdq/treatment/isletcell/HealthProfessional. Accessed November 16, 2012.

Update Date: 11/17/2012
Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.