Stomach cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Aug 2025

Last updated: 29 Jul 2025

Stomach cancer presenting symptoms can include weight loss and abdominal pain. Patients with proximal or gastroesophageal junction tumors may present with dysphagia.

Esophagogastroduodenoscopy with biopsy demonstrating carcinoma is required to confirm the diagnosis. Staging based on imaging is essential.

Early-stage disease is treated with surgery alone.

Treatment for locally advanced disease includes surgery followed by postoperative chemoradiation or chemotherapy after surgery.

Metastatic disease is treated with chemotherapy, immunotherapy, or chemoradiation and supportive care measures. Treatment is influenced by tumor biomarker expression.

Common complications are gastric bleeding and gastric outlet obstruction.

Definição

Stomach cancer is a neoplasm that can develop in any portion of the stomach and may spread to the lymph nodes and other organs. Most tumors are adenocarcinomas. Other histologic types include lymphoma, leiomyosarcoma, neuroendocrine tumors, and squamous cell carcinomas, but these are uncommon and are not discussed in this topic.

História e exame físico

Principais fatores diagnósticos

abdominal pain
weight loss
lymphadenopathy

Detalhes completos

Outros fatores diagnósticos

age 50-70 years
male sex
smoking
family history
nausea
dysphagia
lower gastrointestinal bleeding

Detalhes completos

Fatores de risco

pernicious anemia
Helicobacter pylori
N-nitroso compounds
diet low in fruits and vegetables
high-salt diet
smoking
family history

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

esophagogastroduodenoscopy with biopsy
CT of chest/abdomen/pelvis
CBC
comprehensive metabolic panel
H pylori testing/screening
molecular and pathological tests

Detalhes completos

Investigações a serem consideradas

endoscopic ultrasound
laparoscopy
PET/CT scan
liquid biopsy

Detalhes completos

Algoritmo de tratamento

AGUDA

localized: suitable for surgery

localized: not suitable for surgery

advanced and metastatic disease

Colaboradores

Autores

Ahmed Abdelhakeem, MD

Fellow Physician

Department of Hematology and Oncology

Mayo Clinic - Mayo Clinic Comprehensive Cancer Center

Jacksonville

Declarações

AA declares that he has no competing interests.

Mariela Blum Murphy, MD

Associate Professor

Department of GI Medical Oncology

University of Texas

MD Anderson Cancer Center

Houston

Declarações

MBM declares that she has no competing interests.

Agradecimentos

Dr Ahmed Abdelhakeem and Dr Mariela Blum Murphy would like to gratefully acknowledge Dr Valerie Reed and Dr Prajnan Das, previous contributors to this topic.

Declarações

VR and PD declare that they have no competing interests.

Revisores

Theodore Hong, MD

Director

Gastrointestinal Radiation Oncology

Massachusetts General Hospital Cancer Center

Boston

Declarações

TH declares that he has no competing interests.

Andreas Leodolter, MD

Head of Department

Department of Gastroenterology

Sana Klinikum

Remscheid

Germany

Declarações

AL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: gastric cancer [internet publication].Texto completo

Lordick F, Carneiro F, Cascinu S, et al. Gastric cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Oct;33(10):1005-20.Texto completo Resumo

Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010 May;11(5):439-49. Resumo

Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012 Jul 1;30(19):2327-33. Resumo

Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006 Jul 6;355(1):11-20.Texto completo Resumo

Bang YJ, Van CE, Feyereislova A, et al; ToGA Trial Investigators. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010 Aug 28;376(9742):687-97. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Peptic ulcer disease
- Benign esophageal stricture
- Achalasia
Mais Diagnósticos diferenciais
Diretrizes
- NCCN clinical practice guidelines in oncology: gastric cancer
- NCCN clinical practice guidelines in oncology: genetic/familial high-risk assessment: colorectal, endometrial, and gastric
Mais Diretrizes
Folhetos informativos para os pacientes
Endoscopy (upper gastrointestinal)
Mais Folhetos informativos para os pacientes
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Stomach cancer

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

localized: suitable for surgery

localized: not suitable for surgery

advanced and metastatic disease

Colaboradores

Autores

Ahmed Abdelhakeem, MD

Declarações

Mariela Blum Murphy, MD

Declarações

Agradecimentos

Declarações

Revisores

Theodore Hong, MD

Declarações

Andreas Leodolter, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice