Stomach cancer

Diagnosis

To diagnose stomach cancer, a healthcare professional might ask about your symptoms and order a test to look inside the stomach, called an upper endoscopy. Other tests might include a biopsy procedure to get some stomach tissue for testing, blood tests and imaging tests. If you have a strong family history of stomach cancer, you might have screening tests to look for stomach cancer before it causes any symptoms.

Stomach cancer screening

Sometimes tests are used to look for stomach cancer in people who don't have symptoms. This is called stomach cancer screening. The goal of screening is to detect stomach cancer when it's small and more likely to be cured.

In some parts of the world where stomach cancer is common, stomach cancer screening is standard. In the United States, stomach cancer screening is only for people with a high risk, such as those with a strong family history of stomach cancer.

Stomach cancer screening often involves upper endoscopy exams to detect the cancer.

Stomach cancer diagnosis

Tests and procedures used to diagnose and detect stomach cancer include:

• Upper endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the upper digestive system. A healthcare professional passes the tube down your throat and into your stomach to look for signs of cancer.
• Biopsy. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A healthcare professional often does the biopsy during an upper endoscopy procedure. The health professional can pass cutting tools through the endoscopy tube to get the tissue samples.
• Pathology tests. Tissue collected in a biopsy goes to a lab for testing. In the lab, doctors called pathologists look at the cells with a microscope to decide whether the cells are cancer and, if so, what type of cancer they are. Other tests might look at genetic changes inside the cancer cells, which can help the healthcare team choose a treatment.

Stomach cancer staging

Once you're found to have stomach cancer, the next step often is to have imaging tests to see if the cancer has spread. This information is used to give the cancer a stage, which the healthcare team uses to make a treatment plan.

Tests and procedures used to find the stage of stomach cancer include:

• Blood tests. A blood test looks for signs of disease in a sample of blood. A blood test can't diagnose stomach cancer. It may give your healthcare professional clues about your health. For example, blood tests that measure liver function might show changes caused by stomach cancer that spreads to the liver.
• Endoscopic ultrasound. Endoscopic ultrasound is a procedure that combines endoscopy and ultrasound to create images of the digestive tract and nearby organs and tissues. It also is called EUS. To get the pictures, a healthcare professional puts a flexible, lighted tube with an ultrasound probe down the throat and into the stomach. The pictures can show how deep the cancer has grown into the stomach wall. They also may show whether the nearby lymph nodes and organs show signs of cancer.
• Other imaging tests. Imaging tests make pictures that may show the size of the cancer in the stomach. Imaging tests also help the healthcare team look for signs of cancer in nearby lymph nodes or in other parts of the body, such as the liver and lungs. Tests may include CT scan and positron emission tomography (PET).
• Surgery. Sometimes imaging tests don't give a clear picture of the extent of the cancer, so surgery is needed to see inside the body. Surgery can look for cancer that has spread, called metastatic cancer. Surgery might help your healthcare team make sure there are no small bits of cancer on the liver or in the belly.

Other tests may be used in certain situations.

Treatment

Stomach cancer treatments include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy and palliative care. Treatment options for stomach cancer, also called gastric cancer, may depend on the cancer's location within the stomach and its stage. Your healthcare team also thinks about your overall health and your preferences when making a treatment plan.

Surgery

The goal of surgery for stomach cancer is to remove all of the cancer. For small stomach cancers, surgery might be the first treatment. Other treatments might be used first if the stomach cancer grows deeper into the stomach wall or spreads to the lymph nodes.

Operations used to treat stomach cancer include:

• Endoscopic mucosal resection. Endoscopic mucosal resection (EMR) is a technique to remove irregular tissue from the digestive tract. It might be used to cut away very small cancers from the inside lining of the stomach. To remove the cancer, a healthcare professional passes a tube down the throat and into the stomach. Cutting tools go through the tube to cut out the cancer. EMR might be an option for treating stage 0 and stage 1 cancers that are growing on the inner lining of the stomach.
• Subtotal gastrectomy. A subtotal gastrectomy is surgery to remove part of the stomach. The surgeon removes the part of the stomach affected by cancer and some of the healthy tissue around it. It's typically used for stomach cancers that are closer to the small intestine. The surgeon also might remove some nearby lymph nodes.
• Total gastrectomy. A total gastrectomy is surgery to remove the entire stomach. It involves removing all of the stomach and some surrounding tissue. The surgeon connects the esophagus to the small intestine to allow food to move through the digestive system. Total gastrectomy is a treatment for stomach cancers that are closer to the esophagus. The surgeon also might remove some nearby lymph nodes.

Small stage 1 stomach cancers often can be cut away from the inner lining of the stomach. But if the cancer grows into the muscle layer of the stomach wall, this might not be an option. Some stage 1 cancers may need surgery to remove all or some of the stomach.

For stage 2 and stage 3 stomach cancers, surgery might not be the first treatment. Instead, treatment might start with other options to shrink the cancer and make it easier to remove completely. Treatment might start with chemotherapy, immunotherapy, or a combination of chemotherapy and radiation therapy. Surgery for stage 2 and stage 3 stomach cancers often involves removing some or all of the stomach and also some lymph nodes.

If stage 4 stomach cancer grows through the stomach and into nearby organs, surgery is sometimes used to help control symptoms.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Types of chemotherapy used for stomach cancer include:

• Chemotherapy to the whole body. Systemic chemotherapy involves giving the medicines to the whole body. The medicines can be given through a vein or taken in pill form.
• Chemotherapy to the belly. Local chemotherapy involves giving the medicines to one part of the body. For stomach cancer, the healthcare team may give the medicine to the belly to treat cancer that spreads to the lining of the abdominal cavity. This lining is called the peritoneum. Localized chemotherapy procedures include hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Chemotherapy might not be needed for stage 1 stomach cancer. It might not be needed if surgery removed all of the cancer and there's a low risk of cancer coming back.

Systemic chemotherapy is often used before surgery to treat stage 2 and stage 3 stomach cancers. It might help shrink the cancer so that it's easier to remove.

Systemic chemotherapy might continue after surgery to lower the risk that the cancer may come back. The risk of cancer coming back after surgery is higher if the cancer cells are found deep within the stomach wall or if the cancer spreads to the lymph nodes.

Chemotherapy can be used alone or it can be combined with radiation therapy.

If surgery isn't an option, systemic chemotherapy might be recommended instead. It might be used if the cancer is too advanced or if you're not healthy enough to have surgery. Chemotherapy might help control cancer symptoms.

Localized chemotherapy with HIPEC or PIPAC might be an option for advanced stomach cancer that spreads to the peritoneum. These treatments are experimental and may be available through clinical trials.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The beams can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine gives the radiation treatment to precise points on your body.

Radiation therapy is often done at the same time as chemotherapy. Sometimes healthcare professionals call this chemoradiation.

Radiation therapy might not be needed for stage 1 stomach cancer. It might not be needed if surgery removed all of the cancer and there's a low risk that the cancer will come back.

Radiation is sometimes used before surgery to treat stage 2 and stage 3 stomach cancers. It can shrink the cancer so that it's easier to remove. Sometimes radiation is used after surgery if the cancer wasn't removed completely.

Radiation can help relieve stomach cancer symptoms if the cancer is advanced or surgery isn't possible.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific molecules in the cancer cells. By blocking these molecules, targeted treatments can cause cancer cells to die. Your healthcare team might test your cancer cells to see if they have the molecules that the medicine targets.

For stomach cancer, targeted therapy is often used with systemic chemotherapy. Targeted therapy is typically used for advanced stomach cancer. This might include stage 4 stomach cancer and cancer that comes back after treatment.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Your healthcare team may test your cancer cells to see if they're likely to respond to this treatment.

Immunotherapy might be used before surgery for stage 2 and stage 3 cancers. The treatment can help shrink the cancer to make it easier to remove. Sometimes immunotherapy kills all of the cancer and surgery may not be needed.

Immunotherapy also may help treat advanced stomach cancers, such as stage 4 stomach cancers and cancers that come back after treatment.

Palliative care

Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. Healthcare professionals work as a team to give palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with other treatments, people with cancer may feel better and live longer.

Coping and support

A stomach cancer diagnosis can be overwhelming and frightening. It may take time to adjust to the initial shock of your diagnosis. In time you'll find ways to cope. Until then, it might help to:

• Learn enough to make decisions about your care. Ask your healthcare professional to write down the details of your cancer. This can include the type, the stage and your treatment options. Use those details to find more information about stomach cancer. Learn about the benefits and risks of each treatment option.
• Find a good listener. Finding someone who is willing to listen to you talk about your hopes and fears can be helpful as you manage a cancer diagnosis. This could be a friend or family member. A counselor, medical social worker or clergy member also may offer helpful guidance and care.
• Connect with other cancer survivors. Ask your healthcare team about support groups in your area. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.
• Stay active. Being diagnosed with cancer doesn't mean you have to stop doing the things you enjoy or usually do. For the most part, if you feel well enough to do something, go ahead and do it.

Preparing for your appointment

Start by making an appointment with a doctor or other healthcare professional if you have any symptoms that worry you. If your healthcare professional thinks that you may have a condition that affects the stomach, you may be referred to a gastroenterologist. This is a doctor who diagnoses and treats digestive system conditions.

Once stomach cancer is diagnosed, you may be referred to other specialists. This might be a cancer doctor, also called an oncologist, or a surgeon who specializes in operating on the digestive tract.

It's a good idea to be prepared for your appointment. Here's some information to help you get ready, and what to expect.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Note what seems to improve or worsen your signs and symptoms. Keep track of which foods, medications or other factors influence your signs and symptoms.
• Consider taking a family member or friend along. Sometimes it can be hard to absorb all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your healthcare professional is limited, so prepare a list of questions. List your questions from most important to least important in case time runs out. For stomach cancer, some basic questions to ask include:

• What type of stomach cancer do I have?
• How advanced is my stomach cancer?
• What other kinds of tests do I need?
• What are my treatment options?
• How successful are the treatments?
• What are the benefits and risks of each option?
• Is there one option you feel is best for me?
• How will treatment affect my life? Can I continue to work?
• Should I seek a second opinion? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask other questions you think of during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you questions. Being ready to answer them may allow more time later to cover other points you want to address. Your health professional may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?