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Stomach Cancer

Because stomach cancer gives no symptoms in its early phase, it is often diagnosed at an advanced stage. Treatment calls for surgery, chemotherapy and, in suitable patients, targeted therapy and immunotherapy to be planned together.

  • HER2 the first marker that changes treatment
  • H. pylori the most important treatable risk factor
  • Endoscopy the method that confirms the diagnosis

What is stomach cancer?

Stomach cancer starts in the cells lining the inner surface of the stomach and the great majority are of the adenocarcinoma type. It advances through the stomach wall and can spread to the lymph nodes and to the lining of the abdomen.

Early complaints closely resemble those of gastritis or an ulcer: indigestion, bloating, stomach pain. That resemblance is the main reason diagnosis is delayed. In patients whose complaints do not settle with treatment, or keep coming back, it is important that an endoscopy is performed.

Diagnosis and staging

The treatment plan is built once the diagnosis is confirmed and the extent of the disease is established.

  1. Endoscopy

    The basis of diagnosis

    Stomach cancer is diagnosed by pathological examination of the tissue sample taken during endoscopy. Tests that guide treatment, such as HER2, PD-L1 and MMR/MSI, are run on the same sample, which is why taking a sufficient biopsy matters.

  2. Staging

    Establishing the spread

    Computed tomography, and PET-CT in patients who need it, are used to look at whether the disease has gone beyond the stomach. Where spread to the abdominal lining is suspected, laparoscopy can be used to assess it. The stage determines whether surgery is appropriate.

  3. Pathology

    What do subtypes change?

    The intestinal and diffuse (signet ring cell) types follow different courses; the diffuse type tends to involve a wider area. This distinction in the pathology report affects both the surgical plan and what can be expected from treatment.

Treatment approaches

In operable stomach cancer the current standard approach is chemotherapy before and after surgery. That sequence aims both to shrink the tumour and to reduce the risk of recurrence after the operation.

In advanced disease treatment is carried out with drug therapy. In HER2 positive patients targeted therapy is added to chemotherapy, and in patients with a suitable PD-L1 level or MSI-high disease, immunotherapy. Nutritional support and treatment directed at symptoms are an inseparable part of the plan.

Risk factors and inherited links

Some of the risk factors in stomach cancer can be changed; a small share are inherited.

  1. H. pylori

    A treatable risk

    Helicobacter pylori infection raises the risk of stomach cancer and can be cleared with antibiotic treatment. A diet dominated by salted, pickled and processed foods, and smoking, are also among the factors that raise the risk.

  2. Inherited

    Familial stomach cancer

    A small share of cases are linked to conditions such as hereditary diffuse gastric cancer, associated with changes in the CDH1 gene, or Lynch syndrome. Where there is stomach cancer at a young age in the family, genetic counselling comes into question.

Frequently Asked Questions

I have stomach pain. Is it cancer?

In the great majority of cases stomach pain is caused by benign conditions such as gastritis, an ulcer or reflux. Even so, pain that does not settle with treatment, that recurs, or that comes with weight loss, difficulty swallowing or anaemia needs an endoscopy. The method that confirms the diagnosis is an endoscopic biopsy.

Does treating H. pylori prevent cancer?

Clearing the infection reduces the risk of stomach cancer, though it cannot be said to remove the risk completely. Treatment is recommended particularly for people with a family history of stomach cancer. It is important to confirm afterwards that the infection has cleared.

Why is chemotherapy given before the operation?

Chemotherapy before surgery can shrink the tumour and make the operation easier, treats microscopic spread at an early point, and shows how well the patient tolerates treatment. In operable patients this approach improves long term results.

How do I eat after my stomach has been removed?

After stomach surgery patients move to small, frequent meals, and some need B12 and iron supplements. When this process is planned with a dietitian, weight loss and complaints are markedly reduced.

There is stomach cancer in my family. Should I be screened?

There is no stomach cancer screening programme aimed at the general population. However, in people with a first degree relative who has had stomach cancer, testing for H. pylori is recommended, as is endoscopy where there are symptoms. If it has occurred at a young age and in more than one family member, genetic counselling should be considered.