The early warning signs of stomach cancer are so subtle that most people don’t notice a problem until the disease has progressed.
“Stomach cancer is often diagnosed at a later stage,” says UNC Health surgical oncologist Michael Meyers, MD. “A lot of problems in the stomach come and go. People may think it’s indigestion that will go away. Or they may think they have reflux (heartburn) or an ulcer. Stomach cancer is not the first thing that comes to mind for most people.”
Only about 1.5 percent of all new cancers diagnosed in the U.S. are stomach cancer, also called gastric cancer. Still, more than 26,000 people receive a diagnosis of stomach cancer each year, making it the 16th most common cancer overall. More than 11,000 people in the U.S. die from stomach cancer annually.
The disease is treatable, especially if it hasn’t spread beyond the stomach, Dr. Meyers says. The American Cancer Society estimates that 70 percent of people with localized stomach cancer will survive for five years or longer. Survival rates are much lower if the cancer has spread, which is why Dr. Meyers encourages people to understand the signs and symptoms of stomach cancer so they can get diagnosed early.
1. Risks of stomach cancer.
Anyone can get stomach cancer, Dr. Meyers says, but it’s more common in certain racial and ethnic groups, including Hispanic, Black, Native American and Asian populations.
“We don’t know why, exactly,” he says. “There could be some dietary influence or genetics or environmental exposures. But knowing it’s more common in some ethnicities, we’re more likely to consider it as a diagnosis.”
Stomach cancer also is far more common in other areas of the world, including Asia, parts of Europe and South America. The reason for the difference is unknown, he says, but again, it could be tied to diet, environment or genetics.
“We routinely screen for colon cancer here, and in other countries, they routinely screen for stomach cancer,” he says. Colonoscopies do not detect stomach cancer.
Additional risk factors for stomach cancer include:
- Older age: Stomach cancer diagnoses are more common in people older than 60 (the average age of diagnosis is 68), and with people living longer, it’s a common diagnosis for people in their 80s, Dr. Meyers says
- Being a man: Men are more likely to develop stomach cancer than women; the lifetime risk of developing stomach cancer is about 1 in 96 for men versus 1 in 152 for women
- Infection with Helicobacter pylori (H. pylori), the bacterium responsible for most ulcers
- A history of ulcers or other damage to the stomach, including surgeries
- A diet high in salted fish and smoked or chargrilled meats
- A family history of stomach cancer, especially if more than one family member has been diagnosed, or someone was diagnosed younger than age 60
- Chronic reflux disease (heartburn)
“As our population has grown heavier and our diets have continued to include more processed foods, a larger percentage of people have reflux, which can increase the risk of stomach cancer,” Dr. Meyers says.
2. Symptoms of stomach cancer.
“The symptoms are subtle, and that’s why we often ignore them,” Dr. Meyers says. “But a lot of times, patients who are eventually diagnosed will say, ‘You know, I noticed I wasn’t able to eat as much, or certain foods gave me more stomach symptoms than I was used to.’”
Symptoms to watch for include:
- Poor appetite
- Unexplained weight loss
- Abdominal pain or a vague feeling of discomfort
- Feeling full after eating less than usual
- Heartburn or indigestion
- Vomiting, with or without blood
- Blood in the stool
- Feeling tired or weak (anemic)
“These are all symptoms of other conditions that are more common than stomach cancer, though, like a viral infection or an ulcer,” Dr. Meyers says.
His advice is to see your primary care doctor first, and if symptoms don’t clear up in a few weeks, your doctor may refer you to a gastroenterologist. They may perform an upper endoscopy, in which the doctor uses a thin tube with a light and video camera to look at the inner lining of the esophagus, stomach and duodenum (top of the small intestine). If a lesion or tumor is detected, a small sample of tissue may be taken to look for cancer cells. If cancer is detected, doctors will perform other tests to determine the extent of the cancer and where it is located.
3. Treatment options of stomach cancer.
If you are diagnosed with stomach cancer, your gastric surgeon and oncologist (cancer doctor) will work together to plan the best treatment for your stage of the disease.
If the tumor or lesion is small, your gastroenterologist may be able to remove it all with a scope that goes down your throat, instead of a more invasive surgery.
Although some patients are treated only with surgery or only with chemotherapy, most patients are treated with a combination, Dr. Meyers says. Frequently, chemotherapy is given before surgery.
“Chemo often gets the tumor to shrink, so it’s less likely cancer cells will be left behind,” he says.
Patients may receive chemotherapy after surgery, too. Radiation is sometimes used, but it is less common.
No matter the treatment plan, it is likely to be more successful the earlier the cancer is detected, Dr. Meyers says. “Don’t discount it just because it’s not as common as some other diseases.”
If you are having persistent abdominal pain or unexplained weight loss, talk to your doctor or find one near you.