Stomach (Gastric) Cancer

Gastric cancer is a disease in which malignant cells form in the lining of the stomach. Age, diet, and stomach disease can affect the risk of developing gastric cancer.

Possible signs of gastric cancer include indigestion and stomach discomfort or pain.  The prognosis (chance of recovery) and treatment options depend on the stage and extent of the cancer (whether it is in the stomach only or has spread to lymph nodes or other places in the body) and the patient’s general health.

When gastric cancer is found very early, there is a better chance of recovery. Gastric cancer is often in an advanced stage when it is diagnosed. At later stages, gastric cancer can be treated but rarely can be cured.

Our patients with gastric cancer are treated at the Moores Gastrointestinal Cancer Unit. See the Gastrointestinal Cancer Unit for more information.

You can also review the tabs at top of this page for information on gastric cancer types, symptoms and risks, diagnosis, and treatment.

Types of stomach cancer

The stomach has five layers; as a cancer grows deeper into the layers, the outlook for survival lessens. Most stomach cancers start in the mucosa layer where stomach acid and digestive enzymes are made. Under this is the submucosa, which is surrounded by muscle called the muscularis. The subserosa and serosa are the two outermost layers of the stomach.

The types of stomach cancer are:

• Adenocarcinoma (about 90 to 95% of malignant stomach cancers)
  
• Lymphoma
  
• Gastrointestinal stromal tumors (GIST)
  
• Carcinoid tumors
  

Symptoms

Cancers starting in different sections of the stomach may cause different symptoms and spread in different ways.

Symptoms may include:

• Indigestion and stomach discomfort
• A bloated feeling after eating
• Mild nausea
• Loss of appetite
• Heartburn

In more advanced stages of stomach cancer, there may be:

• Blood in the stool
• Vomiting
• Weight loss
• Pain
• Jaundice (yellowing of the skin and eyes)
• Ascites (a build up of fluid in the abdomen)
• Trouble swallowing

Risk factors

The risk of developing stomach cancer is slightly higher in men than women. Although there is no one risk factor directly related to stomach cancer, physicians recommend a diet without heavily smoked or salted foods, and one rich in fruits and vegetables. In addition to diet, older age and stomach disease (such as helicobacter pylori infector or chronic gastritis) may predispose an individual to stomach cancer.

A variety of tests are used in screening for stomach cancer, including:

• Medical history and physical exam
• Blood tests
• A double-contrast barium radiograph (also called an upper GI
• Visualization with an endoscope

UCSD is a leader in endoscopic procedures. Dr. Thomas Savides, Director of the UCSD Endoscopic Ultrasound (EUS) program, says EUS can be used to tell if superficial cancers are amenable to endoscopic resection (removal), a procedure also known as EMR. EUS also helps determine the depth of invasion before surgery.

Stages of stomach cancer

• Stage IA: Cancer has spread completely through the innermost mucosal layer of the stomach wall
• Stage IB: Cancer has spread completely through the mucosal layer and is found in up to six lymph nodes near the tumor, or it has spread to the muscularis (middle) layer of the stomach wall
• Stage II: Cancer has spread completely through the mucosal layer and is found in seven to 15 lymph nodes near the tumor, or it has spread to the muscularis layer and is found in up to six lymph nodes near the tumor, or it has spread to the serosal (outermost) layer but not to lymph nodes or other organs
• Stage IIIA: Cancer has spread to the muscularis layer and is found in seven to 15 lymph nodes near the tumor, or to the serosal layer and is found in one to six lymph nodes, or to organs next to the stomach but not to lymph nodes or other parts of the body
• Stage IIIB: Cancer has spread to the serosal layer and is found in seven to 15 lymph nodes near the tumor
• Stage IV: Cancer has spread to organs next to the stomach and to at least one lymph node, or to more than 15 lymph nodes or other parts of the body.

Unfortunately, due to a lack of specific symptoms, many stomach cancers are found in an advanced stage at diagnosis. At UCSD, medical oncologist Dr. Tony Reid is exploring innovative treatments, such as immune therapy that boosts the body’s ability to fight cancer.

Surgery offers the best option for cure with stomach cancer.  In many instances, UCSD surgeons with expertise in minimally invasive procedures will be able to perform laparoscopic surgery, allowing you a faster recovery time.

You may need to have all of your stomach removed in a procedure called a total gastrectomy.  After the operation, your esophagus will be joined to your small intestine.  If the tumor is fairly small, a partial gastrectomy (surgical resection of a portion of your stomach) can be performed.  If the tumor has grown outside the stomach, other organs, such as the spleen, may need to be removed.

In nearly all patients, chemotherapy (drugs) and radiation therapy are also recommended. Chemotherapy options include the use of cis platinum, Oxaliplatin, 5-FU, Xeloda and Taxanes.  In addition, novel combinations with agents that choke off the blood supply to the tumor and that specifically home in on tumor cells are being explored at UCSD.  See clinical trials for additional options.