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Stomach Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Stomach Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the stomach

The stomach is located in the upper abdomen and plays a central role in digesting food. When food is swallowed, it is pushed down the muscular tube that connects the throat with the stomach called the esophagus and enters the stomach. The muscles in the stomach mix the food and release gastric juices that help break down and digest the food. The food then moves into the small intestine for further digestion.

Types of stomach cancer

Stomach cancer, also called gastric cancer, begins when cells in the stomach become abnormal and grow uncontrollably. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread. Cancer can begin in any part of the stomach, and it can spread to nearby lymph nodes and other areas of the body, such as the liver, bones, lungs, and a woman’s ovaries.

Most stomach cancers are a type called adenocarcinoma, which means that the cancer started in the glandular tissue that lines the inside of the stomach. Other types of cancerous tumors that form in the stomach include lymphoma, gastric sarcoma, and carcinoid tumors, but these are rare.

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If you would like additional introductory information, explore these related items. Please note these links take you to other sections on Cancer.Net:

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Stomach Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 22,220 (13,730 men and 8,490 women) in the United States will be diagnosed with stomach cancer. It is estimated that 10,990 deaths (6,720 men and 4,270 women) from this disease will occur this year.

The incidence of stomach cancer varies in different parts of the world. Although stomach cancer is decreasing in Western countries, it is still one of the most common cancer types worldwide. 

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. The five-year survival rate of people with stomach cancer is about 28%. This statistic reflects the fact that most people with stomach cancer are diagnosed after the cancer has already spread to other parts of the body. If stomach cancer is found before it has spread, the five-year survival rate is generally higher but depends on the stage of the cancer found during surgery. 

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with stomach cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics. 

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2014

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Stomach Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing stomach cancer:

Age. Stomach cancer occurs most commonly in people older than 55. Most people diagnosed with stomach cancer are in their 60s and 70s.

Gender. Men have twice the risk of developing stomach cancer, compared with women.

Bacteria. A common bacterium called Helicobacter pylori, also called H. pylori, which causes stomach inflammation and ulcers, is considered one of the primary causes of stomach cancer. Testing for H. pylori is available and an infection can be treated with antibiotics. Testing for H. pylori is recommended if you have had a first-degree relative, such as a parent, sibling, or child who has been diagnosed with stomach cancer.

Family history/genetics. People who have a parent, child, or sibling who has had stomach cancer are at increased risk. In addition, certain inherited genetic disorders, such as hereditary diffuse gastric cancer, hereditary non-polyposis colorectal cancer (HNPCC or Lynch syndrome), and familial adenomatous polyposis (FAP) may increase the risk of stomach cancer. Learn more about genetics and cancer.

Race. Stomach cancer is more common in black, Hispanic, and Asian people than in white people.

Diet. Eating a diet high in salt has been linked to an increased risk of stomach cancer. This includes foods preserved by drying, smoking, salting, or pickling and foods high in added salt. Eating fresh fruits and vegetables may help lower the risk.

Previous surgery or health conditions. People who have had stomach surgery or have one of the following conditions have a higher risk of stomach cancer: pernicious anemia, which is a severe decrease in red blood cells that occurs when the body does not have enough B12 usually because the stomach is not able to properly absorb the vitamin; or achlorhydria, which is a lack of hydrochloric acid in the gastric juices, which help digest food.

Occupational exposure. Exposure to certain dusts and fumes may increase the risk of developing stomach cancer.

Tobacco and alcohol. Tobacco use and excessive alcohol consumption may increase the risk of developing stomach cancer.

Obesity. Excess body weight increases a man’s risk of developing stomach cancer. It is not clear whether obesity increases a woman’s risk of stomach cancer.

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Stomach Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with stomach cancer may experience the following symptoms or signs. Sometimes, people with stomach cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

Stomach cancer is usually not found at an early stage because it often does not cause specific symptoms. When symptoms do occur, they may be vague and can include:

  • Indigestion or heartburn
  • Pain or discomfort in the abdomen
  • Nausea and vomiting, particularly vomiting up solid food shortly after eating
  • Diarrhea or constipation
  • Bloating of the stomach after meals
  • Loss of appetite
  • Sensation of food getting stuck in the throat while eating

Symptoms of advanced stomach cancer may include:

  • Weakness and fatigue
  • Vomiting blood or having blood in the stool
  • Unexplained weight loss

It’s important to remember that these symptoms can also be caused by many other illnesses, such as a stomach virus or an ulcer. People with any of the symptoms listed above should talk with their doctor. 

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Stomach Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to other parts of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose stomach cancer:

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

Endoscopy. This test allows the doctor to see the inside of the body. The person may be sedated, and the doctor inserts a thin, lighted, flexible tube called a gastroscope or endoscope through the mouth, down the esophagus, and into the stomach and small bowel. Sedation is giving medication to become more relaxed, calm, or sleepy. The doctor can remove a sample of tissue during an endoscopy and check it for signs of cancer.

Endoscopic ultrasound. This test is similar to an endoscopy, but the gastroscope has a small ultrasound probe on the end that produces a detailed image of the stomach wall. An ultrasound uses sound waves to create a picture of the internal organs. The ultrasound image helps doctors determine how far the cancer has spread into the stomach and nearby lymph nodes, tissue, and organs, such as the liver.

X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

Barium swallow. In a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is usually given as a solution to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

LaparoscopyA laparoscopy is a minor surgery in which the surgeon inserts a scope into the abdominal cavity to evaluate spread of the stomach cancer to the lining of the abdominal cavity or liver. This pattern of cancer spread often cannot be seen on a CT or PET scan.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. 

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

Stomach Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery.

There are different stage descriptions for different types of cancer. This section covers staging of adenocarcinoma, the most common type of stomach cancer. Staging is different for gastric lymphoma, sarcoma, and carcinoid tumors.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor, how deeply has it grown, and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for stomach cancer:

Tumor. Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the how far the tumor has grown into the stomach. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below:

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a primary tumor in the stomach.

Tis: This stage describes a condition called carcinoma (cancer) in situ. The cancer is found only in cells on the surface of the inner lining of the stomach called the epithelium and has not spread to any other layers of the stomach.

T1: The tumor has grown into the lamina propria, muscularis mucosae, or the submucosa, which are the inner layers of the wall of the stomach.

T1a: The tumor has grown into the lamina propria or muscularis mucosae.

T1b: The tumor has grown into the submucosa.

T2: The tumor has grown into the muscularis propria, the muscle layer of the stomach.

T3: The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach, but it has not grown into the lining of the abdomen, called the peritoneal lining, or into the serosa, which is the outer layer of the stomach.

T4: The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into the peritoneal lining or serosa or the organs surrounding the stomach.

T4a: The tumor has grown into the serosa.

T4b: The tumor has grown into organs surrounding the stomach.

Node. The “N” in the TNM staging system is for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes inside the abdomen are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. The overall prognosis for patients with stomach cancer is based on how many regional lymph nodes show signs of cancer. If six lymph nodes or fewer have cancer, the prognosis is better than if more than 15 lymph nodes contain cancer cells.

NX: Regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to one to two regional lymph nodes.

N2: The cancer has spread to three to six regional lymph nodes.

N3: The cancer has spread to seven or more regional lymph nodes.

N3a: The cancer has spread to seven to 15 regional lymph nodes.

N3b: The cancer has spread to 16 or more regional lymph nodes.

Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part or parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: This is also called carcinoma in situ. The cancer is found only on the surface of the epithelium. The cancer has not grown into any other layers of the stomach and is considered an early cancer (Tis, N0, M0).

Stage IA: The cancer has grown into the inner layer of the wall of the stomach, but it has not spread to any lymph nodes or other organs (T1, N0, M0).

Stage IB: Stomach cancer is called stage IB in either of these two conditions:

  • The cancer has grown into the inner layers of the wall of the stomach and has spread to one to two lymph nodes but not elsewhere (T1, N1, M0).
  • The cancer has grown into the outer muscular layers of the wall of the stomach, but the cancer has not spread to the lymph nodes or other organs (T2, N0, M0).

Stage IIA: Stomach cancer is called stage IIA for any one of these conditions:

  • The cancer has grown into the inner layer of the wall of the stomach and has spread to three to six lymph nodes but not elsewhere (T1, N2, M0).
  • The cancer has grown into the outer muscular layers of the wall of the stomach and has spread to one to two lymph nodes but not elsewhere (T2, N1, M0).
  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the peritoneal lining or serosa. It has not spread to any lymph nodes or surrounding organs (T3, N0, M0).

Stage IIB: Stomach cancer is called stage IIB for any one of these conditions:

  • The cancer has grown into the inner layers of the wall of the stomach and has spread to seven or more lymph nodes but not elsewhere. (T1, N3, M0).
  • The cancer has invaded the outer muscular layers of the wall of the stomach and has spread to three to six lymph nodes but not elsewhere (T2, N2, M0).
  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the peritoneal lining or serosa and has spread to one to two lymph nodes but not elsewhere (T3, N1, M0).
  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into the peritoneal lining or serosa, but it has not spread to any lymph nodes or surrounding organs (T4a, N0, M0).

Stage IIIA: Stomach cancer is called stage IIIA for any one of these conditions:

  • The cancer has grown into the outer muscular layers of the stomach wall and has spread to seven or more lymph nodes but not to other organs (T2, N3, M0).
  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the peritoneal lining or serosa. It has spread to three to six lymph nodes but not to other organs (T3, N2, M0).
  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into the peritoneal lining or serosa and has spread to one to two lymph nodes but not to other organs (T4a, N1, M0).

Stage IIIB: Stomach cancer is called stage IIIB for any of these conditions:

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the peritoneal lining or serosa. It has spread to seven or more lymph nodes but has not invaded any surrounding organs (T3, N3, M0).
  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into the peritoneal lining or serosa and has spread to three to six lymph nodes but has not spread elsewhere (T4a, N2, M0).
  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into nearby organs or structures. It may or may not have spread to one to two lymph nodes but not to distant parts of the body (T4b, N0 or N1, M0).

Stage IV: Stage IV stomach cancer describes a cancer of any size that has spread to distant parts of the body in addition to the area around the stomach (any T, any N, M1).

Recurrent cancer. Recurrent cancer is cancer that has come back after treatment. It may be a localized recurrence, meaning it comes back in the place where it started, or it may be a distant metastasis, which means it comes back in another part of the body. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Japanese staging system

Stomach cancer is much more common in Japan and other parts of Asia and South America than in the United States. Japan has a different method of staging stomach cancer, based on where the lymph nodes with cancer are located around the stomach. This is different from the U.S. system, which uses the number of lymph nodes and not their location.

Surgery for stomach cancer may be described using the Japanese system. The type of surgery is identified by which lymph nodes are removed in addition to the stomach. Learn more about surgery for stomach cancer in the Treatment Options section.

  • D0: no lymph nodes were removed
  • D1: the lymph nodes closest to the stomach were removed
  • D2: lymph nodes from a wider area were removed

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Stomach Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For stomach cancer, the team of doctors may include a gastroenterologist, who is a doctor who specializes in the gastrointestinal tract including the stomach and intestines, a surgeon, a medical oncologist, and a radiation oncologist.

Stomach cancer may be treated with surgery, radiation therapy, chemotherapy, or targeted therapy. Descriptions of these common treatment options for stomach cancer are listed below. Often, a combination of these treatments is used. It can be difficult to cure stomach cancer because it is often not detected until it is at an advanced stage.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The type of surgery used depends on the stage of the cancer (see Stages).

For a very early stage (T1a) cancer, some doctors may recommend a non-surgical treatment called endoscopic mucosal resection, which is the removal of the tumor with an endoscope (see Diagnosis). In early stages (stages 0 or I), when the cancer is still only in the stomach, surgery is used to remove the part of the stomach with cancer, called a subtotal or partial gastrectomy, as well as the nearby lymph nodes. In a partial gastrectomy, the surgeon connects the remaining part of the stomach to the esophagus or small intestine.

If the cancer has spread to the outer stomach wall with or without having spread to the lymph nodes, surgery plus chemotherapy or chemotherapy and radiation therapy may be used (see below). The surgeon can perform a subtotal gastrectomy or a total gastrectomy, which is the removal of all of the stomach. During a total gastrectomy, the surgeon attaches the esophagus directly to the small intestine.

Gastrectomy is a major surgery and can have serious side effects. After this surgery, the patient will only be able to eat a small amount of food at a time. One common side effect is a group of symptoms known as dumping syndrome, which includes cramps, nausea, diarrhea, and dizziness after eating. This happens when food enters the small intestine too fast. The doctor can suggest ways to avoid this and can prescribe medication to help control these symptoms. The symptoms usually lessen or disappear in a few months, but they may be permanent for some people. Patients who have had their entire stomach removed will need regular injections of vitamin B12 because they will no longer be able to absorb this essential vitamin through their stomach.

Regional lymph nodes are often removed during surgery because the cancer may have spread to those lymph nodes. This is called a lymphadenectomy. There is still debate as to how many lymph nodes should be removed. In Europe and especially in Japan, more lymph nodes are removed than in the United States.

When the cancer is diagnosed as Stage IV, surgery is typically not recommended as the main treatment (see Metastatic stomach cancer, below).

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Patients with stomach cancer usually receive external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.

Side effects from radiation therapy include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce cancer-related symptoms. It also may be combined with radiation therapy. Currently, there is no single standard chemotherapy treatment regimen that is used worldwide. However, most chemotherapy treatments are based on the combination of at least two drugs, fluorouracil (5-FU, Adrucil) and cisplatin (Platinol). Newer drugs similar to 5-FU, such as capecitabine (Xeloda), and similar to cisplatin, such as oxaliplatin (Eloxatin), appear to work equally well. Other drugs commonly used include docetaxel (Docefrez, Taxotere), epirubicin (Ellence), irinotecan (Camptosar), and paclitaxel (Taxol).

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. 

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments.

A patient with later-stage cancer whose stomach tumor has too much of the protein HER2, called HER2-positive cancer, may benefit from receiving trastuzumab (Herceptin) with chemotherapy.

For patients whose tumor has grown while receiving initial chemotherapy, the drug called ramucirumab (Cyramza) was approved in 2014 as an additional treatment. Ramucirumab is a type of targeted therapy called an anti-angiogenic. It is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Metastatic stomach cancer

If cancer has spread to another location in the body, it is called metastatic cancer (stage IV in the Stages section).

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

The goal of treatment at this stage is typically to lengthen a patient’s life and care for the symptoms of the cancer since metastatic stomach cancer is not considered curable. Any treatment, including chemotherapy or radiation therapy, is considered palliative therapy. Surgery is rarely used, and the main treatment is usually chemotherapy. It is important to note that studies show that the use of palliative chemotherapy for stomach cancer can improve both the length and quality of life. 

Given the inability to cure metastatic stomach cancer, this diagnosis is stressful and at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recovery

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Stomach Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with stomach cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating stomach cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with stomach cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for stomach cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Stomach Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about stomach cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Chemoprevention. This is the use of drugs or nutrients to lower a person’s risk of developing cancer. Early research suggests that using antibiotics to treat H. pylori infections (see Risk Factors) can prevent changes to stomach cells that may lead to cancer.

Combination therapy. The combination of chemotherapy, radiation therapy, and surgery may reduce the chance that stomach cancer will return. Doctors may give chemotherapy before surgery, called neoadjuvant therapy, or after surgery, called adjuvant therapy. In addition, doctors may also combine radiation therapy and chemotherapy after surgery. Doctors are also looking at giving both radiation therapy and chemotherapy before surgery.

Newer chemotherapy treatments. Chemotherapy with multiple combinations of drugs is being increasingly used for people with stomach cancer, because they work slightly better when used together than as single drugs. As outlined in the Treatment Options section, drugs such as paclitaxel, docetaxel, irinotecan, oxaliplatin, as well as oral medications such as S-1 (TS-1) and capecitabine are being studied in combination with other types of chemotherapy.

Targeted therapies. The various types of targeted therapies being researched for stomach cancer are described below.

  • Drugs that target the gene c-MET, which makes a protein that some tumors use to grow and spread, are being researched.
  • Bevacizumab (Avastin) when combined with chemotherapy did not help lengthen patients’ lives in a recently completed clinical trial.
  • Researchers studied drugs that block epidermal growth factor receptor (EGFR). However, two recently completed trials of either panitumumab or cetuximab combined with chemotherapy did not lengthen patients’ lives.

Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current stomach cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding stomach cancer, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Stomach Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for stomach cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery. Family members and friends often play an important role in the care of a person with stomach cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Stomach Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for stomach cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.

People who have had their entire stomach removed can feed themselves, but it is important for them to re-learn how to eat and take food in after this major surgery. Talk with your doctor about this type of rehabilitation.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

People recovering from stomach cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Stomach Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What is my diagnosis? What does this mean?
  • What stage is the cancer?
  • Can you explain my pathology report (laboratory test results) to me?
  • What are my options for treatment?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities? Will my eating habits need to change?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Stomach Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Stomach Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a cancer specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

- Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

- Read more about the first steps to take when newly diagnosed with cancer.

- Find out more about clinical trials as a treatment option.

- Learn more about coping with the emotions that cancer can bring, including those within a family or a relationship.

- Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with this type of cancer.

- Explore next steps a person can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Stomach Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.