Stomach Cancer Is Still a Risk for Many People

[Originally published: Nov. 22, 2022. Updated: Feb. 7, 2024]

Stomach cancer isn’t in the spotlight like other cancers, such as breast and colon cancers. Once the leading cause of cancer deaths in the United States, stomach cancer, also known as gastric cancer, has declined steadily over the past century. Today, stomach cancer accounts for about 1.5% of all new cancers in the U.S. each year, according to the American Cancer Society’s estimates for 2022.

Experts warn that because of the decline in stomach cancer incidence over time—and an accompanying lack of gastric cancer awareness—individuals at the highest risk for the disease might dismiss early gastric cancer symptoms, such as unexplained bloating, indigestion, anemia, and accompanying fatigue.

“Gastric cancer is still a serious and deadly disease that impacts thousands of people and their families,” says Kiran Turaga, MD, MPH, division chief of surgical oncology for Yale Medicine.

“The more awareness there is around symptoms and risk factors, the better able we are to provide proactive and personalized treatment plans to each patient,” says Nita Ahuja, MD, MBA, chair of the Department of Surgery, who is a member of the scientific advisory council for No Stomach for Cancer, which promotes awareness and research.

Below, Drs. Turaga and Ahuja share some insights about stomach cancer.

Like other cancers, stomach cancer develops when cells grow out of control. This usually happens slowly over many years, and it can arise in any of the stomach’s five parts, all of which are in the abdomen (and should not be confused with the colon, rectum, liver, pancreas, and small intestine). The stomach’s lining has five layers, and the degree to which a newly diagnosed gastric cancer invades these layers determines the stage of the disease. As many as 90-95% of cases are categorized as adenocarcinoma, a cancer that develops on the mucosa, or innermost layer, which produces ingredients that help with digestion.

As mentioned above, stomach cancer accounts for about 1.5% of all new cancers nationally each year. The American Cancer Society’s 2022 estimates include 26,380 new cases and 11,090 deaths from gastric cancer. Experts attribute the steady decline in U.S. rates to better food refrigeration and fewer Helicobacter pylori (H pylori) infections. However, it’s important to note that gastric cancer remains prevalent in other areas of the world, particularly in East Asia.

The average age of diagnosis is 68, although Dr. Turaga says he sees many patients in their 40s and 50s. The incidence of stomach cancer in younger people (called early-onset gastric cancer) has been increasing steadily, and in 2019 accounted for more than 30% of all gastric cancer in the United States. Genetically linked versions of stomach cancer can affect people at a young age.

The American Cancer Society lists the following symptoms of gastric cancer:

• Poor appetite
• Unexplained weight loss
• Abdominal pain
• Vague discomfort in the abdomen, usually above the navel
• Feeling full after a small meal
• Heartburn or indigestion
• Nausea
• Vomiting, with or without blood
• Swelling or fluid build-up in the abdomen
• Blood in the stool
• Feeling tired or weak, especially as a result of anemia
• Yellowing of the skin and eyes if stomach cancer spreads to the liver

“Many times, gastric cancer symptoms can be non-specific—things like heartburn, reflux, difficulty eating, or unexplained weight loss, and sometimes even having blood in your stool,” Dr. Turaga says. “So, it is important to have all symptoms assessed by a physician, especially in cases with a known family history of stomach cancer.”

Your risk for stomach cancer is influenced by several factors. In addition to genetics, the American Cancer Society reports the following risk factors:

• Age. The risk for stomach cancer increases as people reach their 60s, 70s, and 80s, although stomach cancer occurs in younger people as well.
• Sex. Gastric cancer is more common in men, whose chances of developing it are 1 in 96 (by comparison, 1 in 8 men will be diagnosed with prostate cancer during their lifetime). In women, the chance of developing stomach cancer is about 1 in 152.
• Ethnic background. In the U.S., stomach cancer is more common in Hispanic Americans, African Americans, Native Americans, and Asian/Pacific Islanders than in non-Hispanic whites.
• H pylori. This bacteria, which is also associated with peptic ulcer disease, is very common—about 30 to 40% of people will have H pylori bacteria, and many will never develop stomach cancer. But long-term infection can lead to pre-cancerous changes in the stomach’s inner lining. H pylori is also linked to some stomach lymphomas.
• Lifestyle. This includes smoking and drinking alcohol. In addition, such dietary habits as eating few or no fruits, drinking very hot liquids, and consuming large amounts of salted and pickled foods raise the risk of gastric cancer.
• Overweight and obesity. These conditions are related to 13 different kinds of cancer, including upper stomach cancer, according to the Centers for Disease Control and Prevention (CDC).

Known familial genetic factors contributing to stomach cancer include an inherited gene called CDH-1 that raises the risk of hereditary diffuse gastric cancer syndrome (HDGC). This condition carries a lifetime stomach cancer risk of up to 70%.

HDGC can be a precursor for cancer affecting the entire stomach and for lobular breast cancer, which begins in the breast’s milk-producing glands. A person with the CDH-1 mutation often has two or more first- or second-degree relatives diagnosed with stomach cancer at a young age, usually younger than 50, Dr. Turaga explains.

Inherited risk is associated with additional germline syndromes, including Lynch Syndrome, which also raises the risk of colorectal cancer in people younger than 50, and familial adenomatous polyposis, which causes many polyps in the colon from an early age.

“Certain mutations are highly correlated with cancer onset. However, as I tell my patients, your genes are not your destiny,” Dr. Turaga says, explaining that certain risk factors may prompt aggressive preventive measures such as surgery to remove the stomach before gastric cancer develops.

“Understanding the details of your immediate and extended family history can be an important tool in evaluating your risk for stomach cancer and other diseases, and in taking steps to optimize your unique health trajectory,” Dr. Ahuja says.

Currently, there are no routine screening guidelines for stomach cancer in the U.S. However, various diagnostic tests are available for a patient with symptoms or concerning family history. These include imaging tests such as PET scans and cross-sectional CT scans. “Diagnostic tools, such as endoscopic ultrasound, allow actual visualization of the stomach, including the layers of the stomach wall, which is especially helpful with some of the genetic conditions,” Dr. Turaga says.

Stomach cancer treatment is less invasive and more effective than it used to be. Advances in precision medicine and in physicians’ understanding of stomach cancer help determine the best treatment for each patient, which may include single or combination therapies, including chemotherapy, radiation therapy, targeted therapy, immunotherapy, and surgery.

Imaging tools have also made stomach cancer treatment decisions more precise, Dr. Turaga adds. “I think the biggest advance in this field is our understanding of how extensive a surgery like this needs to be—and whether it can be less extensive,” he says, adding that factors include the type and number of lymph nodes removed. “In certain cases, if the cancers are diagnosed very early, they can be cut out with the endoscope in a simple procedure.”

Most surgeries for stomach cancer are minimally invasive, performed through tiny incisions with robotic assistance. This has helped with completing surgery in a way that leads to fewer complications, which means improved quality of life for patients who must eat differently once their stomach—or a part of it—is removed.

“Recovering from stomach cancer surgery is unique in that it can have long-term consequences on diet and lifestyle, which is why selecting the right care team to help you before, during, and after surgery is so important,” Dr. Turaga says, adding that many patients who have part of their stomach removed have a close-to-normal quality of life once they recover.

“Trust your gut! If you have symptoms that don’t make sense—anemia or other gastrointestinal symptoms—don’t just keep popping antacids. Get them looked at by an expert at an established center,” Dr. Ahuja says.

Both Drs. Ahuja and Turaga agree that advances in science and medicine offer hope for every patient. They are optimistic that dedicated research in academic medical centers will bring more precise and effective screening, treatment, and management tools to the field.

“I tell patients that the field of cancer is evolving very fast,” says Dr. Turaga. “Having cared for patients for many years, I am seeing more and more people outlive their diagnosis, mainly because of advances in science.”

“It is very important that patients remember that there is hope and that there are gastric cancer specialists who have dedicated their careers to understanding this disease and the best treatment options possible,” Dr. Ahuja says.