Overview

Stage 4 stomach cancer is cancer that starts in the stomach and spreads to a distant part of the body. It also is called metastatic stomach cancer or metastatic gastric cancer. The process of cancer spreading from where it started to another part of the body is called metastasis.

Metastatic stomach cancer is different from locally advanced stomach cancer, which has grown in or near the stomach but has not spread to distant parts of the body. It also is different from cancer that starts in another organ and spreads to the stomach. Metastatic cancer keeps the name of the cancer where it began.

Stomach cancer is a common cancer worldwide, and it is often diagnosed at an advanced stage. This is partly because early stomach cancer often causes no symptoms, or the symptoms can seem like those of common digestive conditions.

Stage 4 stomach cancer usually cannot be cured. But treatments can slow or control the cancer, relieve symptoms, improve quality of life and help people live longer. Certain features of the cancer may affect which treatments can be used.

Symptoms

Metastatic stomach cancer symptoms may come from the cancer in the stomach or from cancer that has spread to other parts of the body. Symptoms of stage 4 stomach cancer may include:

  • Losing weight without trying.
  • Ongoing pain, bloating or discomfort in the belly.
  • Feeling full after eating a small amount.
  • Nausea or vomiting.
  • Trouble swallowing.
  • Indigestion that doesn't go away.
  • Bleeding in the digestive tract.

As stomach cancer spreads, symptoms can depend on where the cancer has spread. The most common site of spread is the lining of the abdominal cavity, called the peritoneum. Cancer that spreads there can cause fluid to build up in the belly. This is called ascites.

Cancer that spreads to the liver can cause yellowing of the skin and whites of the eyes, called jaundice. It may make the liver larger. Swollen lymph nodes also may be a sign that the cancer has spread.

End-of-life symptoms

Near the end of life, symptoms may change as the body slows down. In people with advanced cancer, changes in the last weeks and days of life can include:

  • Increasing tiredness and weakness.
  • Sleeping more or being less alert.
  • Loss of appetite and eating or drinking less.
  • Shortness of breath.
  • Trouble swallowing.
  • Confusion or delirium.
  • Less urine output.

In the final hours or days, breathing also may change. Some people develop noisy breathing caused by fluid collecting in the throat or airways.

When to seek care

Talk with your healthcare professional if you have symptoms of stomach cancer that are new, getting worse or worrying you. These may include ongoing stomach pain, vomiting, trouble swallowing, blood in the stool, yellowing of the skin or eyes, or swelling in the belly.

Causes

It's not clear why some stomach cancers spread and become metastatic. Metastatic stomach cancer happens when cancer cells break away from the cancer in the stomach and travel to other parts of the body. Cancer cells can grow into nearby tissue. They also can enter blood vessels or lymph vessels and travel to other parts of the body. Stomach cancer most often spreads to the liver, lungs and lining of the abdominal cavity, called the peritoneum.

Risk factors

Risk factors for stomach cancer include:

Medical conditions and infections

  • Helicobacter pylori (H. pylori) infection. Long-term infection with this bacterium can cause inflammation and changes in the stomach lining that may lead to cancer.
  • Chronic atrophic gastritis. This is long-term inflammation that causes the stomach lining to become thinner. It increases the risk of stomach cancer.
  • Intestinal metaplasia. In this condition, cells in the stomach lining change to become more like cells that typically line the intestines. It increases the risk of stomach cancer.
  • Pernicious anemia. This autoimmune condition makes it hard for the body to absorb vitamin B-12. It is linked to an increased risk of stomach cancer.
  • Gastroesophageal reflux disease (GERD). GERD is linked to an increased risk of cancer in the upper part of the stomach.
  • Obesity. Obesity is linked to an increased risk of cancer in the upper part of the stomach.
  • Epstein-Barr virus (EBV) infection. EBV infection is associated with an increased risk of stomach cancer.

Personal and family factors

  • Older age. The risk of stomach cancer increases with age.
  • Male sex. Stomach cancer occurs more often in males than in females.
  • A family history of stomach cancer. Having a parent, sibling or child who has had stomach cancer raises the risk.
  • Certain inherited cancer syndromes. These include hereditary diffuse gastric cancer, gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS), Lynch syndrome, familial adenomatous polyposis, Peutz-Jeghers syndrome, and juvenile polyposis syndrome.
  • A history of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. This type of lymphoma starts in the stomach lining. People who have gastric MALT lymphoma have an increased risk of later having a type of stomach cancer called adenocarcinoma.

Lifestyle and diet

  • Cigarette smoking. Smoking raises the risk of stomach cancer.
  • A diet high in salted, smoked, preserved or ultraprocessed foods. These foods are linked to a higher risk of stomach cancer.
  • A diet low in fruits and vegetables. Eating few fruits and vegetables is linked to increased stomach cancer risk.
  • Heavy alcohol use. Heavy alcohol use may raise the risk of stomach cancer.

Complications

Stage 4 stomach cancer can cause complications from the cancer in the stomach and from cancer that has spread to other parts of the body. These may include:

  • Bleeding. A stomach tumor can bleed into the digestive tract. Ongoing bleeding may lead to low red blood cell count, a condition known as iron deficiency anemia. Treatment may be needed to control the bleeding.
  • Blockage where the stomach empties into the small intestine. A tumor can block the passage, making it difficult for food to leave the stomach. This may cause nausea, vomiting and trouble eating.
  • Malnutrition. Stomach cancer can make it difficult to eat or take in enough nutrients.

  • Complications caused by cancer in other organs. Cancer that spreads to the liver can cause jaundice or swelling in the belly. Cancer that spreads to the lungs can cause shortness of breath.

    Cancer that spreads to the lining of the abdominal cavity, called the peritoneum, can lead to a buildup of fluid in the belly, called ascites.

By Mayo Clinic Staff