Stomach Cancer - Diagnosis and Treatment

Diagnosis

Figuring Out How Far Stomach Cancer Has Spread

After doctors diagnose gastric cancer, they check how much the cancer has grown and if it has spread to other areas. They use several medical tests to gather information for treatment planning.

Tests for Staging:

Blood Tests: Doctors use blood tests to check overall health and look for problems like liver function. If tissue samples cannot be collected safely, they may use special blood tests to look for tumor DNA.
Endoscopy with Ultrasound: Using endoscopic ultrasonography, doctors combine a tiny camera and sound waves to see how deep the cancer has gone into stomach tissue and if lymph nodes are involved. During this procedure, they may use a needle to collect tissue samples from nearby lymph nodes.
Imaging Scans:
- CT (Computed Tomography) Scans: These scans show detailed pictures inside the body. Doctors use them to see if cancer is present in organs like the liver or if it has spread to lymph nodes.
- PET (Positron Emission Tomography) Scans: PET scans highlight areas with fast-growing cells, which may show that cancer has spread.
Surgery (Diagnostic Laparoscopy): If scans do not give clear answers about cancer spread, surgeons may perform an operation to look directly inside the belly.

Staging helps doctors group cancer based on how advanced it is.

Stage	Description
0	Cancer is tiny and only on the inside surface of the stomach.
1	Tumor has started growing into the stomach wall but hasn’t spread far.
2-3	Growth goes deeper into the stomach wall or to nearby lymph nodes.
4	Cancer has spread to other organs or distant body parts (metastatic).

Stomach cancer often spreads to lymph nodes near the stomach, the liver, and the lining around the abdomen (peritoneum).

Key Points:

Early-stage cancer (Stage 0 or 1) usually means the tumor is smaller and easier to treat.
Advanced stages (Stage 3 or 4) show wider spread, which may make treatment more challenging.

Types of Gastric Tumors:

Doctors also check if tumors are in the lower part of the stomach (distal) or near where the food tube meets the stomach (proximal/gastroesophageal junction). The tumor location affects treatment options.

Learning About Your Outlook With Stomach Cancer

A person’s outlook, or prognosis, depends on several important factors. Doctors review these factors to help patients and families understand what to expect.

Main Factors Affecting Prognosis:

Factor	Details
Cancer stage	Higher stages mean cancer has spread further.
Type of tumor	Different subtypes (adenocarcinoma, others) grow and spread differently.
Tumor location	Proximal vs. distal stomach tumors may affect outcomes and treatment options.
Complete removal	Surgery that takes out all the cancer increases the chance of a cure.
Body’s health	Stronger general health means more treatment options and better recovery chances.
Family or genetic risks	Some people have genetic syndromes that affect prognosis, such as Li-Fraumeni syndrome.

Cancer Type: Adenocarcinoma is common, but other tumor types can behave differently.
Stage (Spread of the Cancer): The earliest stages have the best chance for a cure.
Tumor Location: Tumors at the gastroesophageal junction or other stomach areas may have different outcomes.
Patient’s Overall Health: Other health problems, such as heart or lung conditions, affect recovery and treatment choices.
Treatment Response: Tumors that shrink after chemotherapy or radiation often have better outcomes.
Surgical Outcome: If the surgeon removes all the cancer, the chances for long-term wellness improve.
Genetic Background: Some rare inherited conditions—like Li-Fraumeni syndrome, hereditary diffuse gastric cancer, or Lynch syndrome—can affect risk and outcome.

If doctors cannot cure stomach cancer, treatment may still slow cancer growth, relieve symptoms, and improve quality of life. Even if a cure is unlikely, chemotherapy, targeted medicines, and other therapies can help people live longer.

Patients should communicate regularly with their care team. Sharing health updates helps the team adjust the treatment plan as needed.

Finding Stomach Cancer Before Symptoms Appear

Doctors face challenges in detecting gastric cancer early because people often do not feel sick at first. In some cases, screening can help find problems when treatment is easier.

Screening and Early Detection:

What is Screening?
Screening means checking for cancer before any signs or symptoms appear. The goal is to find tumors while they are still small and have not spread.
Who Should Be Screened?
In the United States, general screening for everyone is not common because stomach cancer is rare. Doctors usually screen only people at high risk.
Who Has a Higher Risk?
People with these situations may need extra attention:
- Family history of stomach cancer
- Inherited syndromes, such as hereditary diffuse gastric cancer, Peutz-Jeghers syndrome, familial adenomatous polyposis, and Lynch syndrome
- Chronic stomach problems like atrophic gastritis (thinning of the stomach lining)
- Past infection with Helicobacter pylori (H. pylori), a bacteria linked to stomach tumors
- History of other cancers related to genetic syndromes

Screening Test	How It Helps
Upper Endoscopy (EGD)	Directly looks for small tumors or suspicious areas.
Biopsy during endoscopy	Takes small tissue samples for lab testing.
Imaging, such as CT or X-rays	Sometimes used to spot early signs of tumors.
Blood tests	Not used for general screening, but may offer clues.

Why Early Diagnosis Matters:

Finding cancer before symptoms allows more effective treatment.
Early-stage tumors are usually smaller and less likely to have spread.
Some countries with higher rates of gastric cancer, such as those in Asia, recommend regular screening for more people.

Risk Factors to Watch:

Modifiable Risks (Things You Can Change):
- Smoking tobacco
- Heavy alcohol use
- Eating lots of salty, smoked, or pickled foods
- Poor diet low in fruits and vegetables
Other Risks:
- Chronic infection with H. pylori bacteria
- History of stomach surgeries or long-standing inflammation

Prevention Tips:

People can lower their chances of getting stomach cancer by quitting smoking, cutting back on alcohol, and eating a healthy diet.

How Stomach Cancer Can Be Found Early:

Targeted screening for high-risk people
Early attention to unusual stomach symptoms, even minor ones
Regular check-ups for those with genetic risks
Endoscopic exams as advised by doctors
Discussing family history with a healthcare provider

Screening is not routine for everyone. Doctors recommend it for people with risk factors or a family history.

Doctors encourage informed discussions about screening and risk. Modern diagnostic tools—such as endoscopy, biopsy, and imaging—can help catch some cancers before symptoms appear.

For those at risk, regular checkups and open communication with medical teams help catch stomach problems early, when more effective care is possible.

Treatment

Surgical Options

Surgeons aim to remove as much of the disease as possible during stomach cancer surgery.

For very early-stage tumors that are small and limited to the stomach lining, doctors may use an endoscope—a thin tube passed through the mouth—to cut out the tumor.

This minimally invasive technique works best when the cancer is still only on the surface layer.

If the cancer is larger or has grown deeper into the stomach wall, doctors may remove part or all of the stomach. This surgery is called gastrectomy. The extent of surgery depends on the tumor’s location.

If the cancer is near the connection with the small intestine, doctors may remove only the affected part of the stomach.

When the tumor is closer to the esophagus or if the disease has spread through most of the stomach, surgeons might remove the entire stomach.

Doctors often remove lymph nodes near the stomach during the operation to check for cancer spread. Sometimes, surgery can also relieve problems like blockage or pain when the disease is too advanced to be removed completely.

Surgery Type	When It Is Used	Goal
Endoscopic mucosal resection	Early cancers limited to lining	Remove tumor locally
Partial (subtotal) gastrectomy	Cancer in lower or middle stomach	Remove section of stomach
Total gastrectomy	Cancer in upper or whole stomach	Remove entire stomach
Lymph node removal	Any surgical stage	Check/treat spread to lymph nodes
Palliative surgery	Advanced disease, symptoms of blockage	Relieve symptoms

The treatment plan depends on how far the cancer has grown into the stomach wall, if it has reached nearby organs, and whether lymph nodes are involved.

Surgeons may sometimes remove parts of nearby organs if the cancer has spread beyond the stomach.

Medicine-Based Cancer Treatments

Doctors use chemotherapy drugs to kill cancer cells throughout the body. They may give these medicines through a vein or as a pill.

For stomach cancer, doctors often use chemotherapy before surgery to make the tumor smaller and easier to remove. This approach is called neoadjuvant chemotherapy.

After surgery, doctors may give chemotherapy—called adjuvant chemotherapy—to destroy any remaining cancer cells, especially if the tumor invaded muscle layers, involved lymph nodes, or if the surgical margins are unclear. Doctors can also combine chemotherapy with radiation.

In some cases, doctors use hyperthermic intraperitoneal chemotherapy (HIPEC). In this method, they place heated chemotherapy drugs directly in the abdomen after removing visible tumors.

HIPEC is still experimental and usually considered for advanced cases with cancer spread inside the belly.

Doctors may use systemic chemotherapy for people who cannot have surgery because the cancer is too advanced or due to other health problems. In these cases, chemotherapy helps control symptoms and improve quality of life.

Main chemotherapy points:

Neoadjuvant (Before surgery): Shrinks tumor.
Adjuvant (After surgery): Reduces chance of cancer returning.
HIPEC: Direct heated chemo for advanced cases.
Systemic (Pills/IV): Treats the whole body, helps control advanced disease.

Side effects are common and may include nausea, tiredness, hair loss, and a higher risk of infection.

Focused Radiation Treatment

Doctors use radiation therapy to send precise beams of energy, such as X-rays or protons, to kill cancer cells. For stomach cancer, they give radiation from outside the body in a controlled setting.

This treatment targets tumor areas while limiting exposure to normal tissues. If doctors remove the cancer completely in early stomach cancer, radiation is usually not needed.

Doctors may use radiation before surgery to shrink the tumor (neoadjuvant radiation) or after surgery to destroy any remaining cancer cells (adjuvant radiation).

Sometimes, doctors combine radiation with chemotherapy—this is called chemoradiation—which can help when cancer has grown deeply or into the lymph nodes.

Radiation treatment can also help ease symptoms in advanced stages, such as pain or difficulty eating.

Setting	Purpose
Before surgery	Make tumor smaller for easier removal
After surgery	Destroy remaining cancer cells
With chemotherapy	Enhanced effect (chemoradiation)
For advanced symptoms	Relieve pain, bleeding, or blockage

Common side effects include skin changes, fatigue, stomach pain, and digestive issues.

Precision Medicine Treatments

Targeted drug therapies focus on specific features or substances in cancer cells. These drugs block elements that help cancer grow or survive, so cancer cells die or stop dividing.

The healthcare team checks the cancer cells in the lab before starting this treatment. They look for the right markers to see if the therapy will work.

For stomach cancer, doctors usually use targeted medicines with chemotherapy in advanced cases or if the cancer returns. These drugs can be more selective than traditional chemotherapy, but they have their own side effects.

Possible targeted therapy approaches:

Blocking the growth signals in cancer cells
Preventing the development of new blood vessels that feed tumors
Attacking certain proteins that help cancer survive

Doctors decide if targeted therapy is right for a patient based on genetic and molecular tests.

Immune System-Based Therapy

Immunotherapy uses medicines to help the immune system find and kill cancer cells. Some stomach cancers hide from the immune system, but these treatments help the body’s defenses recognize and attack them.

Doctors most often use immunotherapy for advanced cancer that has spread or returned. These medicines are given by IV, sometimes as part of a clinical trial or with other treatments.

Immunotherapy works differently from chemotherapy. The main types block proteins that stop the immune system from attacking the cancer.

List of points about immunotherapy in stomach cancer:

Used for advanced or metastatic cases.
Relies on activating the body’s immune response.
More likely to be offered if other treatments have failed.
Requires specific testing to see if the cancer will respond.

Immunotherapy can cause unique side effects, such as organ inflammation, tiredness, or skin changes. The healthcare team watches for reactions and adjusts the plan as needed.

Symptom Relief and Support

Supportive care helps people with stomach cancer feel more comfortable and improve their quality of life. This support, called palliative care, addresses problems such as pain, trouble eating, nausea, and emotional stress.

A team of doctors, nurses, therapists, and other specialists provides this care. Palliative care can begin at any stage of stomach cancer and can go along with treatments like surgery, chemotherapy, or radiation.

It helps both patients and their families by focusing on relief from symptoms and side effects.

Examples of palliative care interventions:

Managing pain with medicines or nerve blocks
Assisting with nutrition and swallowing problems
Helping with mental health and coping
Offering social and spiritual support

Coping and Finding Support

Managing stomach cancer brings many physical and emotional challenges. Some people feel shocked or scared after learning about their diagnosis.

It helps to gather clear information about the cancer type, stage, and possible treatments. Health care providers can give details and help patients make informed choices.

Support from others is important. Joining a group or talking with people who have gone through similar experiences can help someone feel less alone.

Emotional support can make it easier to handle symptoms like weight loss or abdominal pain. Staying active may improve energy and mood. If possible, people should try to continue activities they enjoy.

Eating a balanced diet and keeping healthy habits may help well-being. Some people benefit from regular checkups or increased monitoring to manage symptoms and watch for changes.

Writing down questions to discuss with health care teams can help patients stay involved in their care.

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Check for special instructions. Ask if you need to follow any steps before your visit, such as fasting or avoiding certain medications.
Make a list of your symptoms. Write down all symptoms, even ones that do not seem related. Small changes can be helpful.
Record your medical background. Note major life events, recent stresses, changes in health, or a family history of stomach or digestive problems.
Prepare a list of medicines and supplements. Bring a written list or containers of everything you take, including vitamins or herbal products.
Track symptom patterns. Use a journal or table to see what makes your symptoms better or worse, such as foods, medicine, or activities.

Factor	What to Record
Symptoms	Including minor or unrelated symptoms
Medicines/Supplements	All you are currently taking
Dietary Habits	Any foods that worsen or improve symptoms
Stress/Events	Recent changes or stressful events

Bring someone with you. A family member or friend can help by listening, remembering important information, and offering support.
List questions for the doctor. Organize your questions so the most urgent are first. This makes sure the key topics are covered during your visit.

Sample questions might include:

What kind of stomach issue do I have?
How far has the problem progressed?
What tests will I need?
What treatments are available?
What side effects or risks should I know about?
Will treatment interrupt my daily life?
Should I get a second opinion?

Having a list helps you stay focused.

Questions the Doctor Might Ask

A care provider, such as a gastroenterologist or oncologist, often starts by reviewing your medical history. The doctor also performs a physical exam.

He or she may ask questions like:

When did your symptoms begin?
How often do you notice the symptoms?
Are the symptoms mild or severe?
Do certain foods, medicines, or habits improve your condition?
Is anything making things worse?

Having answers ready for these topics helps your doctor understand your situation more clearly. If you have had similar issues in the past or other health problems, share that information, too.

You may want to bring past medical records, including any previous test results.

Specialists may also ask about your family’s health history. This helps them find patterns that could affect your diagnosis and treatment plan.

Stomach Cancer – Diagnosis and Treatment