Stomach Cancer

Dr. John Hunter examining a patient in clinic
Dr. John Hunter, a cancer surgeon and OHSU executive vice president, is among our stomach cancer experts. We offer the high level of experience needed for this complex illness.

At the OHSU Knight Cancer Institute, we offer expert, team-based care for all stages of this complex illness.

Advanced care is especially important for stomach cancer. With few clear symptoms, it is difficult to detect in early stages. When it’s found later, it’s more challenging to treat. If you need surgery, the American Cancer Society recommends seeking care from highly experienced surgeons such as ours.

We offer you:

  • A range of specialists working together to give you the best outcome possible.
  • The most advanced diagnostic techniques.
  • The latest treatments to address and manage every stage of stomach cancer.
  • Surgeons with advanced training from top cancer centers.
  • A full menu of support services, including cancer dietitians, to help you manage side effects of cancer and treatment.
  • Expert palliative care, to help you and your family relieve symptoms and anxiety at any stage of cancer.
  • Access to clinical trials to test promising new treatments.
  • A strong focus on research, including a world-class center to find cancer earlier.

Understanding stomach cancer

What is stomach cancer?

The stomach is a large J-shaped pouch that connects the esophagus, the body’s tube from the mouth, to the intestines. It is where food is partly digested before being passed to the small intestine. Stomach cancer, also known as gastric cancer, begins when abnormal cells in the lining of your stomach grow out of control.

Who gets stomach cancer?

An estimated 27,510 people are expected to be diagnosed with stomach cancer in the U.S. in 2019. The number of new cases per 100,000 people in the U.S. has steadily declined in recent decades. 

Doctors don’t know what causes stomach cancer, but they have identified risk factors that include:

  • Gender: Men are more likely to develop stomach cancer. 
  • Race and ethnicity: In the U.S., the disease is more common among Latinos, African-Americans and Asian/Pacific Islanders than in white people. 
  • Age: Stomach cancer rates increase sharply in people older than 50. 
  • Bacterial infection: H. pylori, a type of bacterial infection of the stomach’s inner lining, can lead to inflammation and ulcers. It is found in most stomach cancer patients.
  • Diet: Diets high in salted, pickled, fermented, smoked and preserved foods, including processed meats, can increase risk. Diets low in fresh fruit and vegetables also increase risk.
  • Smoking
  • Family history: Having a parent, sibling or child with stomach cancer increases risk.
  • Genetic syndromes: Several inherited genetic defects increase the risk. OHSU offers genetic counseling, testing and risk assessment to help patients identify and manage risk.
     

Stomach cancer outcomes

For patients whose cancer is found before it has spread, nearly 70% survive at least five years after diagnosis. Stomach cancer usually isn’t found until after that, though, so overall survival rates remain discouraging. Still, survival rates are averages and can’t predict the outcome for an individual. Five-year survival rates also, by definition, reflect the treatments that were available five or more years ago. 

Signs of hope: Survival rates are gradually climbing. Our Cancer Early Detection Advanced Research Center is dedicating hundreds of scientists to finding ways to detect cancer earlier.

Quality of life: Your Knight Cancer Institute care team will be devoted to giving you the longest and highest-quality life possible.

Stomach cancer symptoms

Early on, you might have no symptoms. Or you might have symptoms such as mild abdominal pain, nausea or heartburn, which rarely mean you have stomach cancer. Talk with your primary care doctor if symptoms persist.

Other signs and symptoms can include:

  • Fatigue
  • Feeling bloated after eating
  • Feeling full after eating small amounts of food
  • Severe, persistent heartburn
  • Severe indigestion that doesn’t go away 
  • Unexplained, persistent nausea
  • Persistent vomiting
  • Unexplained weight loss

Diagnosing stomach cancer

Tests at OHSU might include:

Blood chemistry studies: Tissues can release abnormal amounts of minerals, proteins or enzymes into the blood, a possible sign of disease.

Complete blood count, or CBC: A blood sample is checked for the number of red blood cells, white blood cells and platelets. The blood count also shows the amount of hemoglobin (the protein that carries oxygen in red blood cells).

Our interventional endoscopists (gastroenterologists with special training) do hundreds of these procedures a year. You can be confident that your diagnosis will be accurate.

Upper endoscopy: The doctor guides an endoscope, or flexible tube with a camera, down your throat to look at your esophagus, stomach and part of the small intestine. 

Endoscopic ultrasound: The endoscope has an ultrasound probe to provide detailed images. The patient is kept comfortable with sedation. 

X-rays with a barium swallow: You drink a chalky liquid (barium) that helps show details of the stomach on an X-ray. 

CT scan: Computed tomography uses X-rays from different angles to create detailed, cross-section images.

Your doctor removes a small tissue sample so it can be looked at under a microscope. This is often done during an endoscopic procedure, with tiny tools guided into place.

A doctor called a pathologist examines the tissue, checking for cancer cells, their type and how aggressive they might be.

Types of stomach cancer

This is the most common type of stomach cancer, making up 90-95% of cases. These cancers develop from the cells that form the mucosa, the innermost lining of the stomach. Gastric adenocarcinoma can take two forms:

  • Intestinal adenocarcinoma: This type is usually found in the lower stomach. It tends to arise from chronic inflammation and is closely linked with H. pylori infection.
  • Diffuse adenocarcinoma: In this aggressive form, cells scattered throughout the stomach grow and spread rapidly. It’s more commonly found in the upper or entire stomach.

These cancers of the immune system tissue are sometimes found in the wall of the stomach. About 4% of stomach cancers are lymphomas.

Gastrointestinal stromal tumors, also called GISTs, are tumors that start in the walls of the GI tract. Most GISTs, which can be noncancerous, are found in the stomach or small intestine.

  • Neuroendocrine (carcinoid) tumors make up about 3% of stomach cancers. They start in hormone-making cells of the stomach and seldom spread to other organs. 
  • Rare types that can start in the stomach include squamous cell carcinoma, small cell carcinoma and leiomyosarcoma. 

Stomach cancer staging

Staging helps your care team develop the most effective treatment recommendations. It measures factors such as:

  • Your age and overall health.
  • How many of your stomach’s layers the cancer has invaded.
  • Whether cancer has spread to your lymph nodes (bean-size structures that act as immune system filters).
  • Whether cancer has spread to other body parts, most commonly the liver.

Stomach cancer staging is very complex. This is a simple description for staging the main type of stomach cancer, an adenocarcinoma, after tissue has been directly examined. Find a detailed description at the American Cancer Society website.

Medical illustration of the layers of the stomach wall, with inset showing detail including (from innermost to outermost layer) the mucosa, submucosa, muscle layer, subserosa, and serosa.

Stage I: The tumor has invaded as far as the stomach’s muscle layer and has spread to as many as two nearby lymph nodes.

Stage II: Cancer has not reached the muscle layer but has spread to as many as 15 nearby lymph nodes. Or it has invaded as far as the stomach’s outer layer but to no lymph nodes. 

Stage III: The tumor has invaded as far as tissue next to the stomach and to as many as 16 or more nearby lymph nodes.

Stage IV: Cancer has spread to a distant part of the body. This stage is also called advanced or metastatic cancer.

Stomach cancer treatments

Surgery

If cancer hasn’t spread beyond the stomach wall or nearby lymph nodes, your care team will most likely recommend removing it with surgery. This, combined with other treatments, generally offers the only path to a cure. Surgery can also relieve symptoms of advanced cancer. 

Types of stomach cancer surgery include:

  • Endoscopic surgery: For early-stage cancers, your care team might be able to use endoscopy. Your doctor guides a flexible scope and tiny instruments down your throat to remove the cancer. 
  • Partial gastrectomy: Your doctor removes the part of the stomach and lymph nodes affected by cancer, and possibly some surrounding tissue as well.
  • Total gastrectomy: Your entire stomach, nearby lymph nodes and perhaps parts of other organs are removed. Your care team will create a new stomach pouch from your small intestine. The team will attach it to your esophagus (food pipe) to restore your digestive tract.
  • Palliative surgery for advanced cancer: Your care team can remove some of the tumor to stop bleeding and to prevent stomach openings from being blocked.
  • Other surgeries: Surgery can also place a feeding tube in your stomach. Or surgeons might place a stent (metal tube) in stomach openings to hold them open so food can go through.

Chemotherapy

Chemotherapy uses medications, usually given in a slow IV drip, to attack cancer cells nearly anywhere in your body. Sometimes it’s combined with radiation therapy. With stomach cancer, it may be used:

  • Before surgery (neoadjuvant chemotherapy), to shrink the tumor.
  • After surgery (adjuvant chemotherapy), to kill cancer cells circulating in your body.
  • For advanced cancer, to slow cancer growth and to control symptoms.

Radiation therapy

Radiation therapy uses beams of energy to target cancer cells. For stomach cancer patients, radiation is most often delivered using external beam radiation therapy, with the equipment outside your body. With stomach cancer, it may be used:

  • Before surgery (neoadjuvant radiation therapy), to shrink the tumor. 
  • After surgery (adjuvant radiation therapy), to kill any cancer cells that remain.
  • For advanced cancer, to control symptoms such as bleeding or a stomach blockage.

Targeted therapies

Targeted therapies are medications, usually taken by mouth, that affect specific traits in cancer cells. They can cause fewer side effects because they mostly leave healthy cells alone. 

Several targeted therapies are available for stomach cancer. One, Herceptin, binds to proteins on the surface of cancer cells, like a key fitting into a lock. This can block the cells from receiving chemical instructions to divide and grow, and it can instruct the cell to malfunction.

Learn more

For patients

Call 503-494-4373 to:

  • Request an appointment
  • Seek a second opinion
  • Ask questions

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Center for Health & Healing Building 2
3485 S.W. Bond Ave.
Portland, OR 97239
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