Stomach cancer often causes vague symptoms early on (indigestion, early satiety, discomfort), which is why prompt investigation of persistent complaints matters. A major risk factor is chronic infection with Helicobacter pylori (H. pylori). Diagnosis is mainly by gastroscopy and biopsy, with staging by CT and other tests. Treatment is multimodal and individualised: from endoscopic removal of very early tumours or surgery (gastrectomy with lymph node clearance), to a combination of perioperative chemotherapy and surgery, and systemic/targeted therapies in advanced disease. Decisions are made by a multidisciplinary team.
Stomach cancer is insidious, because in its early stages it often causes no characteristic symptoms — or causes complaints that are easily put down to "simple indigestion". The good news is that, when it is diagnosed early, the treatment options are significantly greater.
What is stomach cancer
It is a malignant tumour that starts in the wall of the stomach (most often an adenocarcinoma). It can develop in various parts of the stomach and, if untreated, spread to neighbouring organs, lymph nodes or the peritoneum.
Risk factors
- Helicobacter pylori (H. pylori) infection — one of the most important factors.
- A diet high in salt, smoked and preserved foods and low in fruit and vegetables.
- Smoking and excessive alcohol consumption.
- Family/hereditary history, chronic atrophic gastritis, previous gastric surgery, older age.
Symptoms and alarm signs
In the early stages the symptoms are vague: indigestion, early satiety, upper-abdominal discomfort. Signs that need prompt investigation include: unexplained weight loss, anaemia, difficulty swallowing, persistent vomiting or blood (black stools or vomiting blood).
Diagnosis and staging
Gastroscopy with biopsy is the key test for diagnosis. For staging, a CT scan and, where appropriate, endoscopic ultrasound, PET/CT or diagnostic laparoscopy are used, so that the right treatment can be planned.
Treatment
Management is multimodal and depends on the stage:
- Very early tumours: in selected cases, endoscopic removal of the mucosa.
- Localised disease: surgical removal (partial or total gastrectomy) with lymph node clearance. In suitable cases this is done laparoscopically or robotically.
- Locally advanced disease: often perioperative chemotherapy (before and after surgery).
- Advanced/metastatic disease: systemic therapies (chemotherapy, targeted therapies such as anti-HER2, immunotherapy). In selected cases of peritoneal disease, CRS/HIPEC may be considered.
Prevention and early diagnosis
Eradicating H. pylori when detected, a balanced diet with less salt and more fruit and vegetables, stopping smoking and limiting alcohol all help. Above all, timely gastroscopy for persistent or worrying symptoms saves time — and lives. See the full page on stomach cancer and the services.
What are the first symptoms of stomach cancer?
They are often vague and non-specific early on: indigestion, an early feeling of fullness, discomfort in the upper abdomen. Later, weight loss, anaemia, difficulty swallowing or vomiting may appear. Persistent symptoms should be investigated.
What role does H. pylori play?
It is a major risk factor; chronic infection can lead to changes that increase the risk. Eradicating it reduces the risk and is recommended in appropriate cases.
How is it diagnosed?
Mainly by gastroscopy with a biopsy. Staging is completed with a CT scan and, in selected cases, endoscopic ultrasound or diagnostic laparoscopy.
What is the treatment?
It depends on the stage: from endoscopic removal (in very early tumours) or surgery (gastrectomy with lymph node clearance), to a combination of perioperative chemotherapy with surgery, and systemic or targeted therapies in advanced disease. Decisions are made by a multidisciplinary team.
Does the whole stomach always have to be removed?
No. The extent of surgery (partial or total gastrectomy) depends on the tumour's location and stage, while very early tumours may be treated endoscopically. The decision is individualised.