Stomach Cancer

Stomach cancer, also called gastric cancer, starts in the stomach. In the U.S., most stomach cancer is found at the top of the stomach where it connects with the esophagus.

Compared to other cancers, stomach cancer is relatively rare, representing less than 2 percent of all cancer diagnoses in the U.S.

Types & Stages

There are several different types of stomach cancer. They are grouped together depending on where in your stomach the cancer starts:

• Adenocarcinoma, which starts in stomach glands. This is the most common type of stomach cancer.
• Gastrointestinal stromal tumors (GIST), a type of sarcoma that starts in specialized nerve cells in the stomach.
• Carcinoid tumors, a type of neuroendocrine tumor that starts in nerve-like cells that also make hormones. Some carcinoid tumors in the stomach make high levels of stomach acid or a hormone called gastrin.
• Primary gastric lymphoma, a type of non-Hodgkin lymphoma that starts in the immune cells that scan the stomach for infections.

If you are diagnosed with stomach cancer, your doctor will run tests to find out what stage it is. The stage means how big the tumor or tumors are and whether they have spread outside of the stomach. Early-stage stomach cancer is small and confined to the stomach. Late-stage stomach cancer has spread to other parts of the body.

Knowing the stage of your cancer will help your doctor figure out the best treatment for you.

Signs & Symptoms

Stomach cancer may not cause noticeable symptoms when it is in the early stages.

When stomach cancer becomes more advanced, it can cause symptoms like:

• bloating
• nausea
• belly pain
• feeling very tired
• blood in your stool

Causes & Risk Factors

There are several things that raise your risk of developing adenocarcinoma of the stomach, including:

• Chronic infection with H. pylori. This bacterial infection can cause chronic inflammation in the stomach.
• Smoking tobacco. If you smoke, your risk of getting stomach cancer is higher than someone who doesn’t smoke.
• Eating a diet that is low in fruits and vegetables or high in salty or smoked foods.
• Working in the rubber or coal industry.
• Lynch syndrome. This is a genetic disease that causes DNA mutations to build up and can cause cancer in multiple organs.

The only factor known to raise the risk of developing GIST is NF1 syndrome, a genetic disorder that is passed down in families.

Factors that raise the risk of carcinoid tumors in the stomach include:

• Genetic disorders like MEN1 syndrome and NF1 syndrome. These disorders are passed down in families.
• Conditions that change how much stomach acid your body makes. This includes atrophic gastritis, pernicious anemia and Zollinger-Ellison syndrome.

Factors that raise the risk of primary gastric lymphoma include:

• Chronic infection with H. pylori. This bacterial infection can cause ulcers and inflammation in the stomach. It is linked with a type of gastric lymphoma known as MALToma (mucosa-associated lymphoid tissue gastric lymphoma).
• Gastric lymphoma has also been linked to other infections, namely Campylobacter jejuni bacteria, Epstein-Barr virus, hepatitis B virus and human T-cell leukemia virus type 1.
• Celiac disease, an autoimmune disease caused by the body’s overreaction to gluten.

Not everyone with these risk factors will develop stomach cancer. Sometimes people with no risk factors develop stomach cancer.

Screening

If you don’t have any risk factors or signs of stomach cancer, screening tests are not recommended for you.

If you are at higher risk for stomach cancer, such as if you have a genetic disease that is linked to stomach cancer, your doctor may recommend regular screening to look for stomach cancer. This is usually done with an endoscopy.

Diagnosis

At Stony Brook Cancer Center, our doctors use a combination of tests to diagnose stomach cancer, such as:

• Endoscopy. For this test, a thin, flexible tube with a small video camera on the end (an endoscope) is inserted down your throat and into your stomach. During an endoscopy, doctors can remove suspicious tissue to examine it under a microscope (a biopsy).
• Barium swallow. For this test, you will drink a liquid that contains barium. The barium helps your esophagus show up better on the X-ray.
• Other imaging tests, like ultrasound and CT, to take pictures of your stomach and nearby organs.
• Tests to check for an H. pylori infection. These tests check your stool, breath, or stomach for signs of H. pylori bacteria. Your doctor may order this test if they suspect that you have gastric lymphoma.

Treatment

What treatment you will get depends on many factors, including the type of stomach cancer you have and where your tumor or tumors are located.

If you have adenocarcinoma of the stomach, your treatment may include:

• Surgery to remove all or part of the stomach.
• CRS-HIPEC (cytoreductive surgery and heated intraperitoneal chemotherapy), a combination of surgery and chemotherapy for abdominal tumors. First, all visible cancer cells are removed with surgery, and then remaining cancer cells are killed with heat and chemotherapy. Stony Brook University Hospital is the only hospital on Long Island to provide CRS-HIPEC.
• Radiation therapy. At Stony Brook Medicine, most of our radiation treatments are given with x-rays and electron beams generated by machines called linear accelerators.
• Chemotherapy, a type of drug that stops the growth of cancer cells.
• Targeted therapy, which is therapy that is targeted to the genetic or molecular changes in your tumors.
• Immunotherapy, a type of therapy that helps your immune system find and attack your tumors.

If you have GIST, your treatment may include:

• Watchful waiting, meaning your doctor will closely monitor you but will not start treatment until cancer symptoms appear or change.
• Surgery to remove the tumor and some of the tissue around it.
• Targeted therapy, which is therapy that is targeted to the genetic or molecular changes in your tumors.

If you have carcinoid tumors in the stomach, your treatment may include:

• Endoscopic surgery to remove the tumor (using a long, thin flexible tube with a small video camera on the end). If the tumor has spread, part of the stomach may also need to be removed.
• Medicines to lower stomach acid (called proton pump inhibitors) and/or medicines to lower levels of gastrin. You may get this treatment if your carcinoid tumors make high levels of stomach acid or a hormone called gastrin.
• Radioactive drugs, also called radiopharmaceuticals or peptide receptor radionuclide therapy, which are drugs that deliver radiation directly to cancer cells. A radioactive drug called Lutathera slips into neuroendocrine tumors and releases a radioactive substance that kills the cancer cells. Lutathera treatment requires significant training and a high level of expertise and coordination by a multidisciplinary team. The Stony Brook Cancer Center team is proud to be able to offer this in-demand treatment to patients since 2019.
• Hormone therapy, a type of drug that stops your tumors from making extra hormones.
• Radiation therapy. At Stony Brook Medicine, most of our radiation treatments are given with x-rays and electron beams generated by machines called linear accelerators.
• Chemotherapy, a type of drug that stops the growth of cancer cells.
• Targeted therapy, which is therapy that is targeted to the genetic or molecular changes in your tumors.

If you have primary gastric lymphoma, your treatment may include:

• Medicines to lower stomach acid (called proton pump inhibitors) and antibiotics, to treat H. pylori infection.
• Chemotherapy, a type of drug that stops the growth of cancer cells.
• Immunotherapy, a type of therapy that helps your immune system find and attack your tumors.
• Radiation therapy. At Stony Brook Medicine, most of our radiation treatments are given with x-rays and electron beams generated by machines called linear accelerators.

At Stony Brook Medicine, our Palliative Care Service is available to everyone, no matter the stage of your cancer. This specialized team helps patients and their families cope with the physical, emotional, and spiritual distress of cancer. They can provide relief from symptoms of stomach cancer and/or its treatment, such as pain, nausea, fatigue and loss of appetite.