Stomach Cancer
Stomach cancer develops when abnormal cells in the stomach divide and grow uncontrollably, sometimes without symptoms in its early stages. Key risk factors include certain infections and diet. Treatment options include surgery, chemotherapy, immunotherapy and targeted therapies that aim to shrink tumors or stop their spread.
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What Is Stomach Cancer?
Stomach cancer, also called gastric cancer, occurs when abnormal cells in the stomach grow and divide uncontrollably. Although it can develop in any part of the stomach, in the U.S., it often starts near the gastroesophageal junction, where the esophagus meets the stomach.
This type of cancer tends to develop slowly, sometimes without symptoms in its early stages. When symptoms appear, they may mimic common stomach issues like indigestion or bloating. Other symptoms may include trouble swallowing, exhaustion and stomach pain. In more advanced stages, people might experience unexpected weight loss, vomiting blood or black stools.
Early detection increases the chance of successful treatment, often involving surgery. However, advanced stomach cancer is more challenging to treat and cure.
Types of Stomach Cancer
Stomach cancer comes in various forms and is most often located in the stomach lining or intestines. Each type of stomach cancer affects the body differently and requires unique treatment approaches.
- Adenocarcinoma
- The most common type of stomach cancer starts in the mucus-producing cells of the stomach lining. It comes in two forms:
Intestinal: Grows more slowly and has a better prognosis
Diffuse: Spreads faster and is more challenging to treat - Gastrointestinal stromal tumors (GIST)
- GISTs begin in the gastrointestinal tract. Some may be very small, harmless and slow-moving. But others may spread quickly. Some experts believe they may form a unique type of nerve cell.
- Neuroendocrine tumors (NETs)
- These rare tumors can grow anywhere in the body, though the small intestine is a common site. The exact cause of these tumors is unknown, but they occur when the DNA of neuroendocrine cells mutates.
- Lymphomas
- A common cause of gastrointestinal lymphoma is long-term intestinal lining inflammation caused by an infection. There are several types of gastrointestinal lymphoma, but the most common are mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphoma (DLBCL). However, this type of stomach cancer is rare because only 1% of gastrointestinal cancers are lymphomas.
Each type of stomach cancer requires specific diagnostic and treatment approaches to manage the disease effectively.
“[A] GIST prognosis tends to be better than that of adenocarcinoma, especially when targeted therapies are effective,” Dazhi Liu, Pharm.D, BCOP, and medical contributor for Drugwatch, said.
Stomach Cancer Statistics
Stomach cancer may be less common in the U.S. compared to other cancers, but it still impacts thousands of people each year. Understanding the prevalence and survival rates can help provide a clearer picture of how this disease affects individuals.
Many of these statistics come from the Surveillance, Epidemiology, and End Results (SEER) database, which tracks cancer survival rates in relation to the extent to which the cancer has spread. The National Cancer Institute manages this information.
- Prevalence
- Each year, about 1.5% of all new cancer diagnoses are stomach cancers.
- Age and risk
- About 60% of stomach cancers are diagnosed in those aged 65 or older, with the average age of diagnosis being 68. Men have a higher lifetime risk (1 in 101) than women (1 in 155).
- Five-year survival rates by SEER stage
Localized: 75% when the cancer is confined to the stomach
Regional: 35% survival rate if it has spread to nearby areas
Distant: 7% survival rate when the cancer has spread to distant organs
Overall: About 36% across SEER stages
The “five-year survival rate” refers to the percentage of people who are still alive at least five years after being diagnosed with cancer. It gives an idea of how successful treatment could be over that period.
“If the 5-year relative survival rate for a specific stage of stomach cancer is 70%, it means that people who have that cancer are, on average, about 70% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.”
Additionally, although the overall rates of stomach cancer in the U.S. have been declining annually, the rates have been increasing in young adults and people under 40. The reason for this is unclear, though it may relate to increased obesity rates, lifestyle habits and the increasing prevalence of antibiotic-resistant bacteria.
Treatment Strategies for Stomach Cancer
There are many treatment strategies for stomach cancer, ranging from surgical, intravenous (IV) injections and radiation therapy. Your cancer care team will work with you to create a treatment plan while considering factors including your stomach cancer stage, overall health and preferences.
- Surgery
- Chemotherapy
- Targeted Therapy
- Immunotherapy
- Radiation therapy
The plan will include information about your cancer, treatment goals, options, potential side effects and the length of your treatment.
“Stomach cancers require different approaches depending on the type,” Dr. Mark Anton, a bariatric surgeon and reconstruction specialist, told Drugwatch. “GISTs and lymphomas follow different treatment protocols than the more common adenocarcinomas.”
Surgical Options to Treat Stomach Cancer
Surgery is one of the main treatments for stomach cancer and often involves cutting out the cancerous tissues. The type of surgery used depends on the location and extent of the tumor. In some cases, surgery aims to remove the cancer entirely, while in others, it helps relieve symptoms and improve quality of life.
- Endoluminal Stent Placement
- A stent is placed to keep the passage between the esophagus and stomach or stomach and small intestine open if a tumor is blocking it.
- Endoluminal Laser Therapy
- A surgeon uses an endoscope — a thin, lighted tube — with a laser attached as if it were a knife so they can open a gastrointestinal blockage.
- Endoscopic Mucosal Resection
- This minimally invasive procedure uses an endoscope to remove irregular tissue from the stomach lining.
- Gastrojejunostomy
- This surgery bypasses a blocked stomach. After removing the part of the stomach affected by cancer, the surgeon connects the stomach directly to the small intestine, allowing food to pass through.
- Subtotal (Partial) Gastrectomy
- A surgeon removes about 80% of a patient's stomach in a subtotal gastrectomy. This includes the part of the stomach with cancer, nearby lymph nodes and sometimes parts of other organs.
- Total Gastrectomy
- During a total gastrectomy, the entire stomach, nearby lymph nodes and possibly parts of the esophagus or small intestine are removed. The esophagus is then directly attached to the small intestine, allowing food to pass through.
Each surgery comes with risks and benefits. You and your surgeon will choose the best approach based on the stage and location of the cancer.
Chemotherapy for Stomach Cancer
Chemotherapy is a standard treatment for stomach cancer, involving anti-cancer drugs administered either intravenously or as pills. These drugs spread through the bloodstream, reaching various parts of the body to attack cancer cells.
When given before surgery (neoadjuvant treatment), chemotherapy helps shrink tumors and may make surgery more effective. When given after surgery (adjuvant treatment), it targets any remaining cancer cells to reduce the risk of recurrence. If the cancer has spread or surgery isn’t an option, chemotherapy can help slow the disease’s progression and manage symptoms.
- Camptosar (irinotecan hydrochloride)
- Irinotecan hydrochloride causes irreparable breaks in cells' DNA, stopping the growth of cancer cells and other rapidly dividing cells.
- Carac (fluorouracil or 5-FU injection)
- Fluorouracil is a chemotherapy drug that disrupts cells' ability to create DNA and proteins by mimicking a DNA and RNA building block. This ultimately causes rapidly dividing cells and cancer cells to die.
- Cisplatin
- Cisplatin is an alkylating agent containing platinum. It damages the DNA of dividing cancer cells, preventing or slowing their growth and causing them to die.
- Doxorubicin hydrochloride
- Doxorubicin hydrochloride, an anthracycline chemotherapy drug, blocks the enzyme topoisomerase II. Doing so inhibits the growth of rapidly dividing cells, including cancer cells.
- Ellence (epirubicin hydrochloride)
- Epirubicin hydrochloride, an anthracycline chemotherapy drug, inhibits cells' ability to copy their DNA or produce RNA or proteins. It slows or stops the growth of cancer and rapidly dividing cells.
- Eloxatin (oxaliplatin)
- Oxaliplatin is an alkylating agent containing platinum that damages cells' DNA. This damage prevents the DNA from being copied, stopping their growth and causing them to die.
- Leucovorin calcium
- Leucovorin calcium is a folic acid analog. While it isn't a chemotherapy drug itself, it's used with chemotherapy drugs to enhance their effectiveness or reduce their side effects.
- Lonsurf (trifluridine and tipiracil hydrochloride)
- This chemotherapy combination involves trifluridine, which prevents DNA replication and halts cell division, and tipiracil hydrochloride, which enables trifluridine to destroy more cancer cells.
- Paclitaxel
- Paclitaxel is a taxane that interferes with cell structures called microtubules, which are involved in cell division. This interference stops the growth of cancer cells and other dividing cells.
- Taxotere (docetaxel)
- Docetaxel is a taxane that interferes with cell structures called microtubules, which are involved in cell division. This halts the growth of cancer cells and other dividing cells.
- Xeloda (capecitabine)
- Capecitabine is an antimetabolite chemotherapy drug that interferes with the production of DNA, RNA and proteins. It ultimately stops or slows the growth of cancer cells and causes them to die.
Chemotherapy is delivered in cycles, with rest periods between treatments to allow the body to recover. The most effective drug combinations depend on the cancer’s stage, the patient’s overall health and whether chemotherapy is paired with radiation.
Targeted Drug Therapy for Stomach Cancer
Targeted therapy identifies and attacks certain types of cancer cells. Doctors can use it alone or with other treatments.
Targeted drug therapy is usually for patients whose tumors have specific traits, like having too much of a growth protein called HER2, which can cause the cancer to grow and spread more quickly. Other targeted therapies focus on vascular endothelial growth factor (VEGF) proteins, which help the body make new blood vessels. If this protein is inhibited, it can stop or reduce the blood supply to tumors, eventually killing them. These drugs may work when chemotherapy doesn’t, though they may have unique side effects.
- Cyramza (ramucirumab)
- Blocks VEGF, stopping the formation of new blood vessels that feed tumors. Given by IV every two weeks.
- Enhertu (fam-trastuzumab deruxtecan)
- An antibody-drug conjugate that delivers chemo directly to HER2-positive cancer cells. Typically used after trastuzumab has already been tried.
- Herceptin (trastuzumab)
- Targets HER2-positive stomach cancers, slowing cancer cell growth. Given through IV every 2-3 weeks alongside chemotherapy.
- Vitrakvi (larotrectinib) and Rozlytrek (entrectinib)
- Target cancers with neurotrophic tyrosine receptor kinase (NTRK) gene changes. These are taken as daily pills.
Each drug is designed for specific genetic markers, making them more effective for certain patients.
Immunotherapy for Stomach Cancer
Immunotherapy uses medications to boost the immune system’s ability to recognize and destroy cancer cells.
One common type of immunotherapy for stomach cancer uses immune checkpoint inhibitors. Some of these drugs target an immune cell protein called PD-1, which helps prevent your immune cells from attacking your body’s healthy cells. However, some cancer cells interact with PD-1 in a way that makes them appear as normal cells to your immune system.
Immune checkpoint inhibitors block this process, making it easier for the immune system to recognize and attack cancer cells.
- Keytruda (pembrolizumab)
- This PD-1 inhibitor targets PD-1 to boost the immune response against cancer cells. Depending on the specific makeup of the cancer cells, it can be used alone or with other drugs during the first treatment for advanced stomach cancer. Patients receive this drug via IV every three or six weeks.
- Opdivo (nivolumab)
- Another PD-1 inhibitor, nivolumab, blocks the PD-1 protein on immune cells, helping the immune system attack cancer cells. It is often used for advanced stomach cancer, typically with chemotherapy.
Overall, immunotherapy can be a promising option for certain stomach cancer patients.
Treating Stomach Cancer With Radiation Therapy
Radiation therapy for stomach cancer uses powerful energy rays or particles to destroy cancer cells or stop them from growing. It is often used with chemotherapy before surgery to shrink the tumor and after surgery to eliminate any remaining cancer cells and lower the chances of the cancer coming back.
When surgery isn’t an option, radiation therapy can help slow cancer growth and ease symptoms like pain or difficulty eating. Techniques like three-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) target the cancer while limiting harm to nearby tissues.
Cancer radiation treatment is usually given over several weeks, five days a week. It can cause side effects like feeling sick, throwing up, diarrhea, irritated skin and tiredness. Sometimes, patients may need IV fluids or a feeding tube to stay nourished during treatment.
Drugs That May Influence Stomach Cancer Risk
You may have heard that heartburn drugs, over-the-counter pain relievers and antibiotics can increase or decrease your risk of getting stomach cancer. But this research is often conflicting. It’s important to talk to your doctor about any medications or supplements, their side effects and how they might interact with one another before using them.
Proton Pump Inhibitor (PPI) Heartburn Drugs
PPIs are common heartburn medications that reduce stomach acid and include several over-the-counter medications. Some of the most common OTC brands include Nexium, Prilosec and Prevacid.
“Use PPIs only when necessary and for the shortest duration possible,” Liu told Drugwatch. “Some studies showed long-term use of PPIs has been associated with an increased risk of stomach cancer, especially in patients with Helicobacter pylori infection who continue PPI use after H. pylori eradication.”
A 2024 study in the Journal of Clinical Medicine found that long-term use of proton pump inhibitors (PPIs) for over three months is associated with a higher risk of developing gastric cancer.
The study also highlighted that certain PPIs, like Prilosec (omeprazole) and Prevacid (lansoprazole), may have a stronger link to cancer than others, such as Protonix (pantoprazole) and Nexium (esomeprazole). However, the researchers emphasize that this needs further study, as this data comes from multiple studies that might not have had consistent standards.
Meanwhile, a study published in Cancer Epidemiology, Biomarkers, and Prevention found the opposite: PPI use of about six months correlated with a higher risk of stomach cancer, but three or more years of use showed no association with cancer.
A 2022 meta-analysis in the International Journal of Clinical Oncology also found PPIs were significantly associated with an increased risk of gastric cancer. However, the researchers said this association does not confirm causation.
No study is perfect, as it’s not possible to consider every factor involved with cancer, its risks and its treatments. The conflicting information between studies further highlights the importance of working closely with your medical team before taking any medications during cancer treatments or if you’re at a heightened risk of developing gastric cancer.
NSAIDs and Aspirin
Aspirin and other NSAIDs like ibuprofen may lower stomach and colon cancer risk, according to the American Cancer Society. But they can cause severe internal bleeding. Doctors don’t recommend taking NSAIDs solely for cancer prevention, as the risks may outweigh the benefits. Further research is needed to determine when, if ever, NSAIDs and aspirin would be suitable for cancer prevention.
Antibiotics and Eradicating H. Pylori Bacteria
Helicobacter pylori is a common bacterial infection that plays a prominent role in developing certain types of stomach cancer. However, efforts to eradicate it with antibiotic treatments have reduced stomach cancer rates.
Many people with H. pylori show no symptoms, though it can cause peptic (stomach) ulcers.
“Stomach cancer, in particular, has declined as Helicobacter pylori treatment, food handling improvements and reduced salt and nitrite intake have spread,” Anton said.
A 2024 study published in The Lancet revealed that using antibiotics to eliminate Helicobacter pylori decreased the likelihood of developing gastric cancer. This was especially true when doctors applied antibiotic treatment before precancerous lesions developed.
In addition, antibiotics not only lowered the risk of gastric cancer but also reduced the chances of cancer recurring after early-stage stomach cancer treatment.
However, the study also found that H. pylori is developing resistance to clarithromycin, Levaquin (levofloxacin) and Nuvessa (metronidazole) — all common antibiotics. There are concerns that resistance to other types of antibiotics will also occur, so monitoring your treatment is essential.
Risk Factors and Causes of Stomach Cancer
Lifestyle habits like an unhealthy diet and certain genetic factors are risk factors that can make stomach cancer more likely.
Lifestyle and Dietary Influences
Smoking, alcohol use and diet may affect your risk of developing stomach cancer. However, except for the risks associated with smoking, further studies need to be done regarding diet and alcohol consumption as they relate strictly to gastric cancer.
- Alcohol
- A 2024 study in the International Journal of Molecular Sciences stated that while reports have been contradictory over time, heavy alcohol consumption is likely linked to as much as a 58% higher stomach cancer risk, while light drinkers do not seem to face an elevated risk. Moderate drinkers might also have an increased risk of developing stomach cancer. The risk may be higher in men than women, though those findings vary by study.
- Diet
- A diet high in salt and processed foods may increase the risk of stomach cancer. Conversely, consuming vitamin C-rich fruits, vegetables, whole grains and green tea may lower this risk.
- Smoking
- According to the National Cancer Institute, current smokers have a significantly higher risk of developing stomach cancer. Quitting smoking reduces this risk over time, so stopping now if you do smoke could help lower your chances of developing stomach cancer.
Infections, Chronic Conditions and Stomach Cancer Risk
In addition to H. pylori infection, other health conditions such as chronic gastritis and pernicious anemia have been linked to increased gastric cancer risk.
- Atrophic Gastritis
- Gastritis is a chronic inflammation of the stomach lining. Inflammation can cause cells to change, becoming atrophic gastritis, which is when the cells lining the stomach start to thin. These changes can sometimes be reversed if the cause of the inflammation is treated. If the inflammation continues, those cells may become intestinal metaplasia, which is when the stomach lining cells change to resemble intestinal cells more closely. This can progress to dysplasia, which are precancerous cells that may, finally, develop into stomach cancer.
- Pernicious Anemia
- Pernicious anemia occurs when the stomach doesn't create enough of a protein called intrinsic factor. This prevents them from properly absorbing vitamin B12. This condition increases the risk of stomach cancer.
Genetic Factors and Stomach Cancer
A 2023 study in the New England Journal of Medicine found that inherited mutations in specific genes can increase stomach cancer risk, especially when combined with an H. pylori infection.
Certain hereditary conditions can also increase the likelihood of developing stomach cancer. For instance, though pernicious anemia is usually caused by atrophic gastritis or an autoimmune condition, it can be passed through families as congenital pernicious anemia. If you have a family history of any condition that could be related to stomach cancer, monitoring by medical professionals is advisable, even if you have no symptoms.
“Hereditary cancers account for a relatively small percentage of total cancer cases, usually estimated between 5-10%,” Ben Greulich, a cancer researcher and professor at Mercer University in Georgia, told Drugwatch. “But they dramatically increase a person’s chance of developing cancer, and often the cancer manifests earlier than normal.”
Prevention and Early Detection
Preventing stomach cancer involves living a healthy lifestyle and being aware of your risk factors. Some choices you could make to lower your chances of developing stomach cancer are quitting smoking, paying attention to stomach issues (especially chronic ones), having regular checkups and eating a healthy diet.
Treating Helicobacter pylori infections is another crucial step in prevention. This common bacterial infection is a leading cause of stomach cancer, and early intervention with antibiotics can significantly lower your risk of developing cancer.
If you are at a higher risk of developing stomach cancer because of family history, a condition like pernicious anemia or a genetic predisposition, regular screenings are crucial.
Early detection plays a critical role in improving outcomes. If you’re experiencing persistent symptoms like indigestion, bloating or unexplained weight loss, talk to your healthcare provider promptly. Understanding your risk factors and making healthy lifestyle choices is crucial to reducing the likelihood of developing stomach cancer.
Editor Lindsay Donaldson contributed to this article.
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