Frequently Asked Questions about Stomach Cancer

Q: What is stomach cancer?
A:In everyday speech, the word "stomach" is often used to refer to the area of the body between the chest and the hips. For instance, people with pain in the appendix, small intestine, colon, or gallbladder might say they have a "stomach ache." The medical term for this area is the abdomen and doctors would describe the pain as "abdominal pain."

The difference is important because the stomach is only one of many organs in the abdomen that cancer can start in. So stomach cancer should not be confused with cancers in other organs in the same area. These other cancers can cause different symptoms. They are treated differently and have a different outlook for survival (prognosis).

Cancer can start in any part of the stomach. Symptoms, treatment options, and the outlook for survival all depend on where the cancer starts in the stomach. Most of the time stomach cancer starts in the mucosa and slowly grows out into the other layers. Stomach cancer tends to grow slowly over many years. Before a true cancer starts, there are usually changes that take place in the lining of the stomach (the mucosa). These early changes rarely cause symptoms and often are not noticed.

Q: Who gets stomach cancer?
A: The American Cancer Society's most recent estimates for stomach cancer in the United States are for 2009:

• 21,130 new cases of stomach cancer
• 10,620 deaths from stomach cancer

Two out of 3 people found to have stomach cancer are older than 65. The risk of a person getting stomach cancer in their lifetime is about 1 in 100, but it is slightly higher for men than for women.

Stomach cancer is much more common in other countries. It was once a leading cause of cancer deaths in the United States, but it is now much less common. The reasons for this decline are not completely known, but they may be linked to more use of refrigeration for food storage and less use of salted and smoked foods. Some doctors think that an important factor is the use of antibiotics to treat infections in children. These drugs can kill the bacteria (called H. pylori), which may be a major cause of this disease.

Q: What are there different types of stomach cancer?
A: Most cancers of the stomach are of a type called adenocarcinomas. This cancer starts from cells that form the lining of the innermost layer, the mucosa. The term "stomach cancer" almost always refers to this type of cancer.

Other stomach tumors - Lymphomas, gastrointestinal stromal tumors (often called GIST), and carcinoid tumors are other, much less common, tumors that are found in the stomach. The treatment and outlook for these cancers are different from that of adenocarcinoma and are not covered here. The ACS has separate information about these cancers. Please call if you would like this other information.

Q: Who is at risk for stomach cancer?
A: Scientists have found some risk factors that make a person more likely to develop stomach cancer. Some of these can be controlled, others can't.

• Bacteria infection: Infection with bacteria called Helicobacter pylori (H. pylori) seems to be a major cause of stomach cancer. Long-term infection with this germ may lead to inflammation and pre-cancerous changes to the inner layer of the stomach. This germ is also linked to some types of lymphoma of the stomach. But most people who carry this germ in their stomachs never get cancer.
• Gender: Stomach cancer is more common in men than women.
• Age: There is a sharp increase in stomach cancer after age 50. Most people are in their late 60s or older when their cancer is found.
• Ethnicity: In the United States, stomach cancer is more common in Hispanic Americans and African Americans than in non-Hispanic whites. It is most common in Asian/Pacific Islanders.
• Where a person lives: Stomach cancer is most common in Japan, China, Southern and Eastern Europe, and South and Central America. This disease is less common in Northern and Western Africa, Melanesia, South Central Asia, and North America.
• Diet: An increased risk of stomach cancer is seen with diets high in smoked foods, salted fish and meats, and pickled vegetables. On the other hand, eating whole grain products and fresh fruits and vegetables that contain vitamins A and C seems to lower the risk of stomach cancer.
• Tobacco use: Smoking about doubles the risk of stomach cancer for smokers.
• Obesity: Being very overweight (obese) is a possible cause of cancers of the upper part of the stomach, but the link is not yet clear.
• Earlier stomach surgery: Stomach cancer is more likely to be found in people who have had part of their stomach removed to treat other problems, such as ulcers.
• Pernicious anemia: In this disease, the stomach doesn't make enough of a protein that allows the body to absorb vitamin B12 from foods. This can lead to a shortage of red blood cells (anemia). Patients with this disease also have an increased risk of stomach cancer.
• Menetrier disease: This rare disease involves changes in the stomach lining that might be linked to a risk of stomach cancer.
• Type A blood: For unknown reasons, people with type A blood have a higher risk of getting stomach cancer.
• Family history: People with several close relatives who have had stomach cancer are more likely to get this disease. Also, some families have a gene change (mutation) that puts them at greater risk for getting colorectal cancer, as well as a slightly higher risk of stomach cancer.
• Some types of stomach polyps: Polyps are small mushroom-like growths on the lining of the stomach. Most types of polyps do not increase the risk of stomach cancer. But one type (called adenomatous polyps or adenomas) sometimes develops into stomach cancer.
• Epstein-Barr virus: This virus causes "mono" (infectious mononucleosis). It has been found in the stomach cancers of some people.
• Certain types of work: Workers in the coal, metal, and rubber industries seem to have a higher risk of getting stomach cancer.

While there are many risk factors for stomach cancer, we do not know exactly how these factors cause cells of the stomach to become cancer. Scientists are trying to learn how and why certain changes take place in the lining of the stomach and what part H. pylori plays in stomach cancer.

They are also looking at how gene changes (mutations) can cause normal stomach cells to change and form cancers. Most of the gene changes that are linked to stomach cancer take place after birth. Very few are inherited.

Q: What are the symptoms of stomach cancer?

People who have stomach cancer rarely have symptoms in the early stages of the disease. This is one of the reasons why stomach cancer is so hard to find early. The signs and symptoms of this cancer can include:

• unintended weight loss
• no desire to eat (lack of appetite or anorexia)
• pain in the area of the stomach (abdominal pain)
• vague discomfort in the abdomen, often above the navel
• a sense of fullness just below the chest bone after eating a small meal
• heartburn, indigestion, or ulcer-type symptoms
•  nausea
• vomiting, with or without blood
• swelling or fluid build-up in the abdomen

Of course, many of these symptoms can be caused by problems other than cancer. But if you have any of these problems and they don't go away, you should check with your doctor.

Q: What is the staging of stomach cancer?
A: Staging is the process of finding out how far the cancer has spread. This is very important because the treatment and the outlook for your recovery depend on the stage of the cancer.  After stage 0 (cancer that has not grown beyond the inner layer of cells that line the stomach), stages are labeled using Roman numerals I through IV (1-4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.  After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. This will help you both decide on the best treatment for you.

Q: Should everyone get a second opinion?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. Here are some of those reasons.

• You don’t feel comfortable with the treatment decision.
• The type of cancer is rare, such as with uterine sarcoma.
• There are different ways to treat the cancer.
• You aren’t able to see a cancer expert.

Q: What’s new in stomach cancer research?
A: There is always research going on in the area of stomach cancer. Scientists are looking for causes and ways to prevent this cancer, and doctors are working to improve treatments. Some things that doctors are currently looking at include:

* Risk factors such as differences in diet and types of H. pylori
* Prevention with the use of antioxidants and antibiotics
* Staging
* Sentinel lymph node mapping
* New surgery techniques
* New chemo drugs
* Immunotherapy

Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who participate in these studies get to use treatments before the U.S. Food and Drug Administration (FDA) approves them. People who join trials also help researchers learn more about cancer and help future cancer patients.