Gastric cancer

• Alternative Names

  Cancer - stomach; Stomach cancer; Gastric carcinoma; Adenocarcinoma of the stomach

• Causes, incidence, and risk factors

  Several different types of cancer can occur in the stomach. The most common type is called adenocarcinoma, which starts from one of the common cell types found in the lining of the stomach. There are several types of adenocarcinoma. Because other types of gastric cancer occur much less frequently, this article focuses on adenocarcinoma of the stomach.

  Adenocarcinoma of the stomach is a common cancer of the digestive tract worldwide, although it is relatively uncommon in the United States. It occurs most frequently in men over 40 years old. This form of gastric cancer is extremely common in Japan, Chile, and Iceland. The rate of most types of gastric adenocarcinoma in the United States has declined over the years. Experts think the decrease may be related to reduced intake of salted, cured, and smoked foods. Gastric adenocarcinoma occurs most frequently in men over age 40.

  Diagnosis is often delayed because symptoms may not occur in the early stages of the disease, or because patients self-treat symptoms that may be common to other, less serious gastrointestinal disorders (bloating, gas, heartburn, and a sense of fullness).

  Risk factors associated with gastric cancer are a family history of gastric cancer, infection, blood type A, smoking, a history of pernicious anemia, a history of chronic atrophic gastritis, and a prior history of an adenomatous gastric polyp larger than 2 centimeters.

• Symptoms
  • Abdominal pain
  • Dark stools
  • Difficulty swallowing, particularly difficulty that increases over time
  • Excessive belching
  • General decline in health
  • Loss of appetite
  • Nausea and vomiting
  • Premature abdominal fullness after meals
  • Unintentional weight loss
  • Vague abdominal fullness
  • Vomiting blood
  • Weakness or fatigue
• Signs and tests

  The following tests can help diagnose gastric cancer:

  • Complete blood count (CBC) to check for anemia
  • Esophagogastroduodenoscopy (EGD) with biopsy
  • Stool test to check for blood in the stools
  • Upper GI series
• Treatment

  Surgical removal of the stomach (gastrectomy) is the only curative treatment. Radiation therapy and chemotherapy may be beneficial. A recent study showed that for many patients, chemotherapy and radiation therapy given after surgery improve the chance of a cure.

  For patients in whom surgery is not an option, 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 provide relief of symptoms.

• Support Groups

  The stress of illness may often be eased by joining a support group with members who share common experiences and problems. See cancer - support group and gastrointestinal disorders - support group.

• Expectations (prognosis)

  The outlook varies widely. Tumors in the lower stomach are more often cured than those in the higher area -- gastric cardia or gastroesophageal junction. The depth to which the tumor invades the stomach wall and whether lymph nodes are involved influence the chances of cure.

  In circumstances in which the tumor has spread outside of the stomach, cure is not possible and treatment is directed toward improvement of symptoms.

• Complications
  • Fluid build up in the belly area (ascites)
  • Gastrointestinal bleeding
  • Spread of cancer to other organs or tissues
  • Weight loss
• Calling your health care provider

  Call your health care provider if symptoms of gastric cancer develop.

• Prevention

  Mass screening programs have been successful in detecting disease in the early stages in Japan, where the risk of gastric cancer is very high. 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:

  • Don't smoke
  • Eat a healthy, balanced diet rich in fruits and vegetables
  • Taking a medication to treat reflux disease, if present
• References

  Rustgi AK. Neoplasms of the stomach. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 202.

Review Date: 11/5/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.