If stomach cancer is diagnosed, the next step is to determine the stage of the cancer, which indicates how far it has spread, if at all.

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More than 26,000 people in the United States—approximately 16,000 men and 10,000 women—are diagnosed with stomach cancer every year, according to the American Cancer Society (ACS), and nearly 11,000 die from it. The cancer develops for unknown reasons and can be difficult to diagnose early, because its symptoms mimic those of other gastrointestinal diseases.

As with many cancers, people over age 55 are at increased risk. Men are almost twice as likely as women to get stomach cancer, and it is more common in African-Americans than in whites. Having the bacteria H. pylori in the stomach may raise the risk, but prompt treatment to eradicate the bacteria can reduce the risk. A diet high in preserved meats (such as bacon and deli meats) and low in fruits and vegetables may contribute to stomach cancer. Conversely, a healthy diet loaded with fruits, vegetables and whole grains, and low in saturated fat may help decrease the risk of developing stomach cancer, and is particularly important for people infected with H. pylori.

Stomach Cancer Symptoms

Stomach cancer often causes no symptoms at all. When symptoms are present, they are likely to include:

• Pain or discomfort in the abdomen
• Loss of appetite
• Nausea or vomiting
• Vomiting blood or bloody stools
• Weakness or fatigue
• Weight loss.

If you experience any of these symptoms, see your doctor.

Diagnosing Stomach Cancer

One or more diagnostic tests may be needed, such as a fecal occult blood test, an upper GI series, and/or an endoscopy. New research has suggested that looking for changes in certain chemicals in the breath could be used to identify both stomach and esophageal cancers.

If cancer is suspected, the doctor will take a small sample of tissue (biopsy) from the wall of the stomach during an endoscopy. The tissue will be examined under a microscope to look for changes in the cells that would indicate cancer. If stomach cancer is diagnosed, the next step is to determine the stage of the cancer, which indicates how far it has spread, if at all (stomach cancer can spread to nearby organs, such as the liver or pancreas). Staging of stomach cancer may be done with a computed tomography (CT) scan or ultrasound. Endoscopic ultrasound is also very good for this purpose.

Treating Stomach Cancer

Treatment for stomach cancer depends on a number of factors, including the size, location, and extent of the tumor, whether it has spread, and the patient’s general health. Options include surgery, chemotherapy, radiation therapy, and the newest weapon, targeted therapy. According to the ACS, using two or more approaches produces the best outcomes. Surgery is the most common treatment. If the cancer is in its early stages, the surgery may be performed endoscopically, using instruments that are inserted into the stomach via the throat. If only part of the stomach needs to be removed, the remaining portion will be connected to the esophagus or small intestine, but if the cancer has spread throughout the stomach, the entire stomach may need to be removed (total gastrectomy), along with lymph nodes and other organs. The esophagus is then attached to the small intestine. After this surgery, patients must eat small amounts of food often, and some need a feeding tube for liquid nutrition in order to receive sufficient calories.

With targeted therapy, certain drugs identify unique aspects of stomach cancer cells and target them for destruction. This treatment may be effective in patients who do not respond to chemotherapy.

Two types of targeted therapy are now used in stomach cancer. Many people are familiar with the monoclonal antibody trastuzumab (Herceptin) from its use in HER2-positive breast cancer. It also is effective in HER2-positive stomach cancer. HER2 is a growth-promoting hormone, and one in five stomach cancer patients have too much of it. Trastuzumab finds this protein on the surface of cancer cells and destroys the cells. It is usually given intravenously every two to three weeks, along with chemotherapy.

Ramucirumab (Cyramza) is a monoclonal antibody that targets specific proteins that allow cancers to grow and spread by creating new blood vessels. It is given intravenously every two weeks, and is generally reserved for patients with advanced stomach cancer that no longer responds to other drugs.

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