This information is provided by SSCHRC to help you understand stomach cancer and its management. It is written in a patient-friendly and medically accurate style.
Stomach cancer, also known as gastric cancer, is a type of cancer that is relatively uncommon but can be serious. As its early symptoms often mimic common, less serious issues such as indigestion or heartburn, the disease is sometimes not detected until it has reached an advanced stage, which can lead to poorer outcomes.
The term 'stomach' in a medical context refers specifically to the muscular, sac-like organ in the upper abdomen. This organ receives food from the oesophagus (food pipe) and mixes it with gastric juices to begin the digestive process.
Stomach cancer develops when cells within the stomach's inner lining begin to divide and grow uncontrollably, forming a tumour. As the cancer progresses, this tumour can invade and damage nearby tissues, block the passage of food, or break away and spread (metastasise) to other organs.
Globally, most stomach cancer cases develop in the main part of the stomach, known as the body. It can also occur in the distal stomach, near where the stomach meets the small intestine. In some regions, cancers affecting the gastroesophageal junction (cardia), where the stomach connects to the oesophagus, are becoming more frequent.
The type of stomach cancer depends on the cell in which it originates. The main types include:
These are the most common type, making up about 90% of all stomach cancer cases. They begin in the mucosal (inner) layer of the stomach lining and grow outwards, invading the other layers of the stomach wall.
This cancer affects a specific type of cell (Interstitial cells of Cajal) in the gastrointestinal tract, most often in the stomach or small intestine. They are sometimes referred to as gastric sarcomas.
Also known as neuroendocrine tumours, these affect the hormone-producing cells of the stomach.
According to cancer registry estimates, about 60,000–65,000 new cases of stomach (gastric) cancer are diagnosed in India each year, most commonly in older adults, and the overall five-year survival rate is generally lower than in Western countries due to many cases being diagnosed at a later stage, which can negatively affect outcomes.
While the exact cause remains unknown, certain factors are known to increase the risk of developing stomach cancer. These include:
Stomach cancer is rarely passed down genetically. However, having close relatives with stomach cancer or a hereditary cancer syndrome, such as Hereditary Diffuse Gastric Cancer syndrome (caused by CDH1 mutation), hereditary non-polyposis colon cancer (HNPCC), or Li-Fraumeni syndrome, may increase personal risk. Genetic testing may be used to identify a genetic predisposition.
Important Note: It is important to remember that not everyone with these risk factors will develop stomach cancer. If you have concerns about your risk factors, please discuss them with your doctor.
Early-stage stomach cancer is often asymptomatic. When symptoms do appear, they are frequently mistaken for less serious digestive problems, which is why the cancer may not be diagnosed until it is advanced.
Important Note: Experiencing these symptoms does not automatically mean you have stomach cancer. However, if any of these signs persist for more than two weeks, you should consult your doctor.
Stomach cancer can be difficult to diagnose, especially early on, because initial symptoms are often vague or non-existent until the disease has progressed. Early and accurate diagnosis is crucial for successful treatment and better patient outcomes.
If your doctor suspects stomach cancer based on your symptoms, they will conduct an examination and ask about your health, lifestyle (including smoking and drinking habits), and family medical history. One or more of the following tests may be used for diagnosis, staging, or monitoring treatment effectiveness:
While no single blood test can definitively diagnose stomach cancer, tests can provide important health indicators. A complete blood count (CBC) can check for anaemia, which may signal internal bleeding from the tumour. Doctors may also check for tumour markers, such as cancer antigen 125 (CA-125) and carcinoembryonic antigen (CEA), which are sometimes produced by cancerous cells.
A stool sample is examined for tiny, invisible traces of blood, which can suggest bleeding within the stomach.
A thin, flexible tube called an endoscope, fitted with a camera, is inserted through the mouth, down the oesophagus, and into the stomach. This allows the doctor to visually inspect the stomach lining for signs of cancer. The endoscope may also be equipped with a tool to remove tissue samples (biopsy).
This involves removing a small amount of tissue for examination under a microscope to confirm the presence of cancer cells. For stomach cancer, biopsies are usually performed during an endoscopy.
An endoscope equipped with a small ultrasound device is inserted into the stomach. The ultrasound creates images of the stomach wall using sound waves, helping the doctor assess how deeply the cancer has invaded the walls or check for pre-cancerous changes.
These scans allow doctors to see the inside of the abdomen and stomach, helping to confirm the tumour's location and check if the cancer has spread to nearby organs. Common imaging tests include:
This is a minimally invasive procedure performed under general anaesthesia to determine the extent of the disease. A thin tube with a camera is inserted into the abdominal cavity, allowing doctors to inspect the abdominal organs for signs of cancer spread. A saline solution may also be used to 'wash' the abdominal cavity (peritoneum washing); the fluid is then analysed for cancer cells. This can detect cancer not visible on other scans.
Cancer staging describes the size of the primary tumour and how far the cancer has spread within the body. Knowing the stage is vital for the care team to develop an appropriate treatment plan and helps determine the patient's prognosis.
The internationally recognised TNM system describes cancer based on three main factors, each assigned a number to reflect the extent of the disease:
After all staging procedures are complete, your doctor will determine the TNM stage and explain how it impacts your treatment and prognosis.
The TNM classification is often simplified into four main stages (I–IV), with some cancers also having a Stage 0. Higher numbers indicate more advanced cancer that is generally more challenging to treat.
Reflects abnormal cells found only in the mucosa (carcinoma in situ) that have not spread to nearby normal tissue. This is considered pre-cancerous.
Cancers are typically small and confined to the area where they began.
Cancers have spread to nearby tissue and/or lymph nodes.
Cancers have spread more extensively to nearby tissue and/or lymph nodes.
Cancer has spread to distant areas of the body (metastatic cancer), such as the lungs, liver, distant lymph nodes, and the abdominal lining. Stage IV cancer often cannot be cured but can frequently be managed like a chronic disease.
At SSCHRC, we believe in a customised approach to stomach cancer treatment, aiming for the highest chances of success while prioritising your quality of life. Our comprehensive treatments include state-of-the-art surgery, advanced radiation therapy, chemotherapy, targeted therapy, and immunotherapy.
Treatment plans for stomach cancer often involve a combination of therapies. A dedicated team of specialists, including oncologists, radiation oncologists, and surgeons, works collaboratively to determine the most effective plan for each patient. This integrated approach, supported by advanced skill and technology, ensures you receive the best possible care with minimal impact on your body.
Your recommended treatment will depend on several factors, including the type and stage of the cancer, the location of the tumour, and your overall health. One or more of the following therapies may be suggested to treat the cancer or help relieve symptoms.
Surgery is the most common treatment for stomach cancer. It is sometimes performed with the intent to cure the cancer. However, in some advanced cases, surgery may be palliative—performed primarily to relieve symptoms rather than to cure the disease.
Surgical techniques for stomach cancer include:
Surgery is often combined with chemotherapy and radiation. Where all three are necessary, SSCHRC's standard approach often involves giving chemotherapy and radiation before surgery (neoadjuvant chemoradiation therapy). This helps shrink the tumour and kill cancer cells before the operation, which is often better tolerated and more successful.
Chemotherapy uses drugs to kill rapidly dividing cells, including cancer cells. At SSCHRC, chemotherapy for stomach cancer is often administered before surgery to shrink the tumour. It may also be given after surgery to destroy any remaining cancer cells that were not visible during the operation. For more advanced stomach cancer, especially if it has spread, chemotherapy may be used, often in combination with other therapies.
Chemotherapy methods include:
Radiation therapy uses precisely focused, high-energy beams to destroy cancer cells. We utilise the most precise methods of radiation therapy to target the stomach cancer while protecting surrounding healthy organs. These methods include:
Immunotherapy harnesses the patient's own immune system to fight the cancer. For stomach cancer, patients may receive a checkpoint inhibitor, a type of immunotherapy that prevents the immune system from prematurely shutting down before the cancer is completely eliminated.
Targeted therapy works by stopping or slowing the growth and spread of cancer at a cellular level. Cancer cells rely on specific molecules (often proteins) to survive, multiply, and spread. Targeted therapies are specifically designed to interfere with these molecules or the cancer-causing genes that produce them.
This type of testing classifies cancerous tumours based on their unique genetic makeup. The results help your doctor identify the most suitable immunotherapies, targeted therapies, or clinical trials for that specific cancer.