What you should know about stomach cancer

By Jessica Saenz

Stomach cancer, also known as gastric cancer, is relatively rare, accounting for 1.5% of new cancer diagnoses in the U.S. each year, according to the National Cancer Institute. As stomach cancer rates have trended downward over the past few decades, awareness has fallen behind in comparison to other types of cancer.

Learn about this disease and the symptoms and risk factors that could help you stay alert:

Stomach cancer can affect any part of the stomach

"There are two main types of stomach cancer: cardia stomach cancer and noncardia," says Lionel Kankeu Fonkoua, M.D., a Mayo Clinic medical oncologist. Cardia stomach cancer, also known as gastroesophageal junction cancer, is the most common type of stomach cancer in the U.S. Named for its proximity to the heart, the cardia is the area where the stomach meets the esophagus — the gastroesophageal junction.

Cardia stomach cancer is more common in the U.S. due to risk factors associated with the upper stomach, including chronic acid reflux and Barrett's esophagus, according to Dr. Kankeu Fonkoua.

In people diagnosed with Barrett's esophagus, the cells that compose the lining of the stomach begin to replace the lining of the lower esophagus due to gastroesophageal reflux. Over time, gastroesophageal reflux disease, also known as GERD, can damage the lower esophagus, which can increase the risk of Barrett's esophagus. Most people with Barrett's esophagus will never develop cardia stomach cancer, but it's important to monitor the condition for changes or precancerous cells.

While cardia stomach cancer is most common in the U.S., other parts of the world, including Asia, have higher rates of noncardia stomach cancer, partly due to the prevalence of Helicobacter pylori bacterial infections and carcinogens from smoked and heavily salt-preserved foods.

Some stomach cancer risk factors may be in your control

People over 55 account for most cases of stomach cancer, and it is more common in men. The risk increases with age and family history. While factors like age and sex are not within your control, you can make lifestyle changes to limit your risk, including maintaining a healthy weight.

"Obesity carries a threefold to fourfold risk," says Dr. Kankeu Fonkoua. In addition, diets high in salt intake and low in fruits and vegetables pose an additional risk.

People who are overweight or obese also have a higher chance of developing Barrett's esophagus. If you were diagnosed with Barrett's esophagus, Dr. Kankeu Fonkoua says it's important to monitor the condition closely with your health care provider, especially if combined with other risk factors, such as an excess of abdominal fat, uncontrolled acid reflux or smoking.

Ethnicity also can be a factor for increased risk. Stomach cancer in the U.S. is more common in Hispanic Americans, African Americans, Native Americans, and Asian/Pacific Islanders, according to the American Cancer Society.

Know your medical history, get regular checkups and monitor symptoms

The symptoms of stomach cancer can be vague and difficult to distinguish from other gastrointestinal disorders. "They range from abdominal pain, weight loss, nausea, vomiting, heartburn that doesn't go away, or a feeling of early satiety — feeling full when you've only eaten a small amount," says Dr. Kankeu Fonkoua.

In more advanced cases, patients might suffer from anemia or experience dark, tarry stools, also known as melena, which can indicate the presence of bleeding higher up in the gastrointestinal tract.

"Those are some of the symptoms that will typically prompt an evaluation," says Dr. Kankeu Fonkoua. "If there's something that's alarming and doesn't go away, bring it to the attention of your primary care provider."

"As of today, we don't have a screening test for stomach cancer," says Dr. Kankeu Fonkoua. "So, the best way to prevent stomach cancer is to identify the populations that are at greatest risk."

Help your health care provider help you by being honest about your risk factors. This will allow your health care provider to address warning signs head-on and help you make lifestyle changes to reduce your risk for stomach cancer as you age.

If you have a family history of stomach cancer or are affected by conditions related to stomach cancer, such as acid reflux, it is crucial to discuss this with your health care provider, get regular physical exams, and monitor new or ongoing symptoms. These are the best early detection measures available.

Greatly improved treatments offer new hope

Treatment for stomach cancer depends on the location, stage and aggressiveness of the cancer. Thanks to improved therapies, successful treatment of later stages is possible, but in general, stomach cancer that is detected early is easier to treat.

Early stage cancer that hasn't spread to other organs can often be treated with surgery alone. In later stages, chemotherapy and radiation also may be used in combination with surgery.

If the cancer is recurring or difficult to eradicate, patients might want to know about life expectancy, but Dr. Kankeu Fonkoua says currently published stomach cancer survival rate data are outdated.

"I try not to talk about survival rates," says Dr. Kankeu Fonkoua. "They're outdated and not really reflective of the most recent treatments."

One of the most exciting therapies shifting outcomes for patients with advanced stomach cancer harnesses the power of your immune system. Typically, the immune system has trouble recognizing cancer cells as dangerous, but immunotherapy uses drugs to teach the body to identify and kill cancer cells.

"Cancer cells are very smart and find ways to evade or put brakes on the immune system," says Dr. Kankeu Fonkoua. "This type of therapy is designed to release those brakes and unleash the immune system to go after the cancer. We've seen some dramatic and durable responses in some patients."

Among other promising treatments for stomach cancer is targeted drug therapy. "This is a type of therapy that targets a specific mutation or protein that tends to be overexpressed in the cancer," says Dr. Kankeu Fonkoua.

Survival rates are improving along with stomach cancer treatments because experts at Mayo Clinic and all over the world are working toward better odds for people with stomach cancer.

"I've been on the other side of this battle with stomach cancer as a family member, as a caregiver," says Dr. Kankeu Fonkoua. "I know how overwhelming and stressful this can be. But there's an army of cancer providers, researchers and investigators who are working every day to improve outcomes."

Learn More

Watch Dr. Kankeu Fonkoua discuss stomach cancer in this "Mayo Clinic Q&A" podcast video:

Learn more about stomach cancer and find a stomach cancer clinical trial at Mayo Clinic.