Stomach cancer: symptoms, tests and treatment

Cancer Research UK describes stomach cancer as cancer that starts anywhere inside the stomach or in the stomach wall, and as abnormal cells growing and dividing in an uncontrolled way. The stomach is part of the digestive system, sitting between the food pipe and the small bowel.

It is different from the common stomach upset or indigestion that most people have from time to time. Most people with indigestion do not have cancer, which is why the key point is change that persists, worsens or is unusual for you.

The NHS lists symptoms that affect digestion: heartburn or acid reflux, problems swallowing, feeling or being sick, indigestion with a lot of burping, and feeling full very quickly when eating.

Other symptoms include loss of appetite or losing weight without trying, a lump at the top of the tummy, pain at the top of the tummy, tiredness, and darker than usual poo.

Cancer Research UK explains that stomach cancer can cause a blockage that makes food unable to pass, causing sickness. Rarely there is blood in vomit, which may be bright red or look like dark brown coffee grounds. Bleeding can also turn poo almost black and, over time, cause anaemia with tiredness and breathlessness. Iron tablets can darken poo too.

• Problems swallowing, a lump in the tummy, or weight loss without trying: see a GP.

• Symptoms that get worse or do not improve after 3 weeks: see a GP.

• If you already have reflux and your usual treatment stops working, tell your GP. The NHS says symptoms that change or do not feel normal for you should be checked.

• Vomiting for more than 2 days: the NHS advises contacting NHS 111.

The NHS says anyone can get stomach cancer and that the cause is not always clear. You may be more likely to get it if you are over 50, are a man, have had a Helicobacter pylori (H. pylori) infection, have certain stomach conditions such as long-term severe acid reflux, gastritis or pernicious anaemia, or have a brother, sister or parent who has had it.

Many stomach cancers are linked to lifestyle. The NHS suggests trying to stop smoking, lose weight if overweight, eat less salt, cut down on alcohol, and eat at least 5 portions of fruit and vegetables a day. Wearing protective clothing and masks is advised if your job exposes you to harmful chemicals, such as in the rubber industry or coal mining.

Most people start with a GP. Cancer Research UK says the GP asks about symptoms, may feel and listen to your tummy, and may arrange blood tests that check general health, liver and kidney function, and red blood cell counts. The GP may refer you for a gastroscopy or straight to a specialist. The NHS says an urgent referral does not mean you definitely have cancer.

A gastroscopy uses a long flexible tube with a camera and light. Cancer Research UK says doctors can check the stomach for growths and take biopsies. You are usually awake, with local anaesthetic spray in the throat, and may choose a sedative to feel drowsy.

If cancer is confirmed, a specialist upper gastrointestinal team may arrange a CT scan, endoscopic ultrasound, a PET-CT scan or a laparoscopy (keyhole operation) to check size, position and spread. Laboratory tests on the cancer cells can also guide treatment, for example looking for HER2 protein, PD-L1 or microsatellite instability.

The NHS says treatment depends on the type and size of the cancer, where it is, whether it has spread and your general health. It usually includes surgery and chemotherapy, and may include radiotherapy and targeted medicines.

Surgery can remove part or all of the stomach, sometimes with parts of nearby organs, if the cancer is found early or has not spread far. Cancer Research UK says very early cancer or abnormal cells in the lining may be removed through an endoscope. It describes surgery to remove the cancer as major surgery with a recovery in intensive care or high dependency first.

Chemotherapy may be given before and after surgery, alongside other treatments, or to control symptoms of advanced cancer. Radiotherapy is usually given with chemotherapy or for symptom control. Targeted medicines and immunotherapy may be used for advanced disease.

Where a cancer cannot be removed, procedures such as surgery, a stomach stent or laser therapy can relieve a blockage. The NHS says the aim is then to limit the cancer and its symptoms, with a palliative care team supporting comfort and practical needs.

Cancer Research UK stresses that no one can say exactly how long a person will live, and that statistics describe large groups, not individuals. Outlook depends on the stage at diagnosis. For England, it quotes five-year survival of around 65 out of 100 for stage 1 among people diagnosed between 2013 and 2017, and notes figures fall at later stages.

After surgery on the stomach, eating changes are common. The NHS says your care team will help you manage side effects, including changes to diet, and you will have regular check-ups and sometimes scans. If a symptom worries you between appointments, you do not need to wait for the next check-up.

On the NHS, suspected stomach cancer is usually investigated through an urgent suspected-cancer referral, and treatment is planned by a multidisciplinary team. Cancer Research UK notes that some people are diagnosed after becoming unwell and attending A&E.

A private gastroenterologist can arrange a gastroscopy sooner for symptoms that are worrying but not alarming. If cancer is found, treatment is often delivered in specialist upper GI units, so a private route usually leads to the same type of team.