Stomach Cancer Awareness: Facts, Causes and Outlook on Prognosis

Stomach cancer, though less talked about than other common cancers, poses a significant health risk that deserves more attention. By raising awareness about stomach cancer, the goal is to empower patients and the community with vital knowledge on the facts, causes and prognosis of this disease. In this blog, we speak to Bashar Alasad, M.D., a board-certified medical oncologist at INTEGRIS Health Cancer Institute at Southwest Medical Center. 

The basics

At a glance: Stomach cancer, also known as gastric cancer, is a type of cancer that begins in the stomach. Often asymptomatic in its early stages, it can later show up as indigestion, stomach pain, nausea and weight loss. Key risk factors include Helicobacter pylori infection, smoking, family history and a diet high in smoked and salty foods. Diagnosing stomach cancer involves endoscopy and biopsies.

The origin of stomach cancer typically starts in the cells lining the stomach. 

• The most common type is adenocarcinoma, which begins in the mucus-producing cells of the stomach lining.

Symptoms usually don’t show up in early-stage stomach cancer cases.

• As it progresses, symptoms include a myriad of digestive-related issues, such as indigestion, stomach pain, nausea and vomiting.
• Some people also experience a loss of appetite and weight loss.

Risk factors include developing Helicobacter pylori bacteria, tobacco use, dietary choices and family history.

• Infections from Helicobacter pylori bacteria that go untreated or undetected can linger and cause long-lasting stomach inflammation that leads to an increased cancer risk.
• Consuming a diet high in smoked, salted and pickled foods can increase the risk of stomach cancer due to carcinogenic compounds.
• Tobacco use can damage the stomach lining and contribute to cancer development.
• A family history of stomach cancer can suggest a genetic component.

Diagnosis is usually made through endoscopy, imaging tests and biopsy of stomach tissue.

• Upper endoscopy uses a flexible tube with a camera to examine the stomach lining.
• Barium swallow involves drinking a barium solution that coats the stomach lining, which makes it visible on X-rays to identify abnormalities.

“Screening is usually recommended for individuals with gastric adenoma, pernicious anemia, intestinal metaplasia, familial gastric cancer or a genetic predisposition to gastric cancer or any other malignancy,” Alasad adds. “We use upper endoscopy or contrast radiography to screen high-risk populations for stomach cancer.” 

The facts

Why it matters: In the United States, stomach cancer is relatively uncommon compared to other cancers, accounting for about 1.5 percent of all new cancer diagnoses. It occurs more frequently in older adults, particularly those over 65, and is more common in men than women. Additionally, certain ethnic groups, including Hispanic Americans, African Americans and Asian/Pacific Islanders, experience higher rates of stomach cancer.

Gender and age play a role, as stomach cancer is more common among men and in older adults over the age of 65 (average age of 68).

• Women have higher levels of estrogen, a hormone that may protect against the development of stomach cancer.
• Men are more likely to engage in certain lifestyle behaviors, such as smoking or alcohol consumption, that increases the risk of stomach cancer.
• Older adults are also more likely to experience genetic cell mutations and are exposed to risk factors for longer.

Geography plays a role in stomach cancer risk due to a variety of environmental, dietary and cultural factors.

• Stomach cancer is more prevalent in East Asia, Eastern Europe and parts of Central and South America.
• This is primarily due to dietary habits – smoked, salted or pickled foods are consumed in higher amounts in East Asia and Eastern Europe.

Types of gastric cancer

What to know: Gastric cancer can be classified into several types based on the cells where the cancer begins. The stomach has five distinct layers of tissue. The innermost layer, the mucosa, secretes gastric juices and mucus to aid digestion and protect the stomach lining. This is where most stomach cancers originate.

Adenocarcinoma is the most common type and starts in the glandular cells of the mucosa. 

• It accounts for about 90 to 95 percent of cases.
• There are two types – intestinal type and diffuse type.
• Intestinal type adenocarcinoma is linked to chronic inflammation and is often associated with environmental factors such as diet and Helicobacter pylori infection.
• Diffuse type adenocarcinoma involves poorly defined, scattered cancer cells that don’t form gland-like structures and is mostly associated with genetic predispositions. 

Lymphoma originates in the immune system tissues found in the stomach wall. 

• Although rare, it is treated differently from other types of gastric cancer.
• Lymphomas are typically more responsive to chemotherapy and immunotherapy compared to adenocarcinomas. 

Gastrointestinal stromal tumors begin in the interstitial cells of Cajal (cells that coordinate smooth muscle contractions) in the stomach wall. 

• They can be benign or malignant and are often treated with targeted therapies.

Carcinoid tumors start in the hormone-producing cells of the stomach. 

• They are generally slow growing and less likely to spread compared to other types of gastric cancer.

Gastric cancer and foods to avoid

Key points: Diet can play a role in both the risk and management of gastric cancer. In general, limit your intake of processed meats, smoked and salted foods, fried foods and alcohol. 

“A diet with plenty of fruit, vegetables and fiber can provide protective factors against gastric cancer,” Alasad says. 

Processed meats contain preservatives such as nitrates and nitrites that have been linked to an increased risk of gastric cancer.

• Examples include salami, pepperoni, prosciutto and cured ham.

Smoked and salted foods can increase the risk due to the presence of carcinogenic compounds.

• Examples include smoked meats, smoked or salted fish, pickled vegetables and salted nuts.

High-salt diets can damage the stomach lining and increase the risk of gastric cancer. 

• Examples include chips, salted nuts, canned soups and packaged foods.

Fried foods contain unhealthy fats and compounds formed during high-temperature cooking, which may contribute to cancer risk.

• They also are generally high in sodium, which can damage the stomach lining over time when eaten regularly.

Excessive alcohol consumption can increase the risk due to various factors.

• Alcohol can irritate and damage the lining of the stomach, leading to inflammation.
• When alcohol is metabolized in the body, it is converted into acetaldehyde, a toxic compound that can damage DNA and proteins.

How long can you live with stomach cancer?

The bottom line: The prognosis for someone with stomach cancer can vary widely based on several factors, including the stage at which the cancer is diagnosed, overall health and how well the cancer responds to treatment.

Early detection matters.

• If detected before it spreads beyond the stomach, the chances of successful treatment and long-term survival are significantly higher.
• The five-year survival rate for localized stomach cancer is 75 percent, according to the American Cancer Society.

Advanced stages, where it has spread to other parts of the body, typically comes with a poor prognosis.

• The five-year survival rate for regional stomach cancer (spread to nearby tissue or lymph nodes) drops to 35 percent.
• Advanced stomach cancer that has spread to distant organs only has a five-year survival rate of seven percent.

Additional factors such as age, overall health and response to treatment also play a crucial role in determining life expectancy. 

• Some patients may live longer than average if they respond well to treatment.

Treatment advances, such as targeted therapy, have improved survival rates over the years.

• Targeted therapy attacks molecules essential for cancer cell growth, minimizing harm to normal cells and improving treatment efficacy.
• Tailored to tumor genetics, targeted therapies more effectively attack cancer cells with fewer side effects, enhancing patient quality of life and health during treatment.

Next steps: Trust your gut! If you’re experiencing stomach symptoms that may indicate stomach cancer or are at a higher risk of developing stomach cancer, consult with a gastroenterologist to discuss further steps. 

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