Stomach Cancer: Frequently Asked Questions

Here are some answers to frequently asked questions about stomach cancer:

What is stomach cancer?

Stomach cancer is when cancer is in cells that are part of your stomach. Because stomach cancer is rare, healthcare providers don’t routinely screen for it in the United States.

Stomach cancer is often diagnosed in its later stages because there are often no symptoms early on. This makes it harder to cure. Stomach ulcers, which are very common, are not the same as stomach cancer.

Who develops stomach cancer?

It’s found mostly in people older than 50 years of age. Stomach cancer is more common in men than in women. The disease is more common in Hispanic Americans and African-Americans than in non-Hispanic whites. Stomach cancer is also more common in some parts of the world. These include Japan, China, parts of Southern and Eastern Europe, and South and Central America.

What are the risk factors?

Certain factors may make one person more likely to get stomach cancer than another person. These are called risk factors. But just because a person has one or more risk factors does not mean that he or she will get stomach cancer. In fact, a person can have all of the risk factors and not get the disease. Or, a person can have no known risk factors and still get stomach cancer:

• Diet. Your risk may be higher if you eat a lot of foods that are smoked or not properly refrigerated, fish and meats that are very salty, high-starch and low-fiber foods, and vegetables that are pickled.

• Tobacco and alcohol use. People who use tobacco and drink a lot of alcohol are at a higher risk for getting stomach cancer. Specifically, this is a pack or more of cigarettes a day and two or more alcoholic drinks a day.

• Weight. Obesity is linked to many cancers, including stomach cancer.

• Stomach polyps. The risk for stomach cancer is higher in a person who has had small growths called polyps in the stomach.

• Stomach surgery. Those who have already had surgery to remove part of their stomach may be at greater risk.

• Helicobacter pylori infection. These bacteria often cause stomach ulcers. This can harm the stomach's lining. This leads to a higher risk of stomach cancer.

• Pernicious anemia. This type of anemia is caused by the body's inability to absorb vitamin B12. People with this issue have a higher risk of stomach cancer.

• Menetrier disease. This is a disease in which the stomach lining is overgrown and there is not enough stomach acid. For reasons that are unclear, people with Menetrier disease are at a slightly increased risk of stomach cancer.

• Family history. People who have first-degree relatives (mother, father, sister, or brother) who have had stomach cancer are more likely to get it.

• Type A blood. People with type A blood are at a slightly higher risk of getting stomach cancer. Researchers do not yet know why this is true.

What are the symptoms of stomach cancer?

People with early stomach cancer, meaning it’s small and hasn’t spread, do not usually have symptoms. But, as the cancer grows, it can cause symptoms. These can include:

• Unexplained weight loss

• Stomach pain or pain just above the belly button area

• Indigestion and vomiting

• Loss of or decrease in appetite

• Weakness or tiredness

• Blood in your vomit or stool

• A feeling of fullness after small meals

You should see a healthcare provider if you have any of these symptoms. The symptoms are most often a sign of something other than stomach cancer, but it’s important to make sure.

How is stomach cancer diagnosed?

You’ll have a physical exam. Your healthcare provider will also ask about your health and family medical history. He or she may also order these tests to make a diagnosis:

• Fecal occult blood test

• Upper endoscopy. You’ll have a biopsy during this test.

• Biopsy

• Upper GI series

• Endoscopic ultrasound (EUS)

How is stomach cancer treated?

Treatment depends on the size and spread of the cancer. You may have one or more of these treatments:

• Surgery

• Radiation

• Chemotherapy

• Targeted therapy

How much of the stomach is removed in people with stomach cancer?

There are two kinds of surgeries to remove stomach cancer. One kind removes only the part of the stomach that contains cancer. This is called a partial gastrectomy. The other removes the whole stomach. This is called a total gastrectomy. Which type you get, or if you get surgery at all, depends on the stage and type of stomach cancer you have.

How do I eat after surgery for stomach cancer?

You’ll likely meet with a registered dietitian to talk about what you can and cannot eat during and after treatment.

After a partial gastrectomy, most people will be able to eat much the same way they did before. Although they may have to make some changes to the way they eat.

A person who has had a total gastrectomy has had their whole stomach removed. They still swallow and eat in the same way because their surgeon connects the esophagus to the small intestine. The surgeon may place a small feeding tube (jejunostomy or J-tube) into the small intestine at the time of surgery. Nutrition is given through this tube for a while after surgery during recovery. You’ll need to make diet changes afterwards. For instance, most people find that they prefer to eat small meals more often, rather than large meals three times a day.

Should everyone get a second opinion for a diagnosis of stomach cancer?

Many people with cancer get a second opinion from another healthcare provider. There are many reasons to get a second opinion. They include:

• Not feeling comfortable with the treatment decision

• Being diagnosed with a rare type of cancer

• Having several options for how to treat the cancer

• Having the diagnosis made by a healthcare provider who is not a cancer expert

How can I get a second opinion?

There are many ways to get a second opinion:

• Ask a primary care provider. Your provider may suggest a specialist. This may be a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.

• Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

• Seek other options. Check with a local medical society, a nearby hospital or medical school, or support group to get names of healthcare providers who can give you a second opinion. Or ask other people who've had cancer for their suggestions.

What are clinical trials?

Clinical trials are studies of new kinds of cancer treatments. Healthcare providers run clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who join these studies often get to use treatments before the U.S. Food and Drug Administration (FDA) approves them for the public. People in trials also help researchers learn more about cancer and help future cancer patients.