Stomach cancer

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

Last reviewed: 21 Apr 2025

Last updated: 13 Sep 2024

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

Upper gastrointestinal endoscopy with biopsy demonstrating carcinoma is required to confirm the diagnosis. Staging based on imaging is required.

Early-stage disease is treated with surgery alone.

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

Definition

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 will not be discussed here.

History and exam

Key diagnostic factors

abdominal pain
weight loss
lymphadenopathy

Full details

Other diagnostic factors

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

Full details

Risk factors

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

Full details

Diagnostic tests

1st tests to order

upper gastrointestinal endoscopy with biopsy
CBC
comprehensive metabolic panel

Full details

Tests to consider

CT of chest/abdomen/pelvis
endoscopic ultrasound
laparoscopy
PET/CT scan

Full details

Treatment algorithm

ACUTE

localized: suitable for surgery

localized: not suitable for surgery

advanced and metastatic disease

Contributors

Authors

Ahmed Abdelhakeem, MD

Fellow Physician

Division of Hematology and Oncology

Mayo Clinic - Mayo Clinic Comprehensive Cancer Center

Jacksonville

Disclosures

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

Disclosures

MBM declares that she has no competing interests.

Acknowledgements

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.

Disclosures

VR and PD declare that they have no competing interests.

Peer reviewers

Theodore Hong, MD

Director

Gastrointestinal Radiation Oncology

Massachusetts General Hospital Cancer Center

Boston

Disclosures

TH declares that he has no competing interests.

Andreas Leodolter, MD

Head of Department

Department of Gastroenterology

Sana Klinikum

Remscheid

Germany

Disclosures

AL declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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

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.Full text Abstract

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. Abstract

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. Abstract

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.Full text Abstract

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. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Peptic ulcer disease
- Benign esophageal stricture
- Achalasia
More Differentials
Guidelines
- NCCN clinical practice guidelines in oncology: gastric cancer
- Japanese gastric cancer treatment guidelines 2021 (version 6)
More Guidelines
Patient information
Endoscopy (upper gastrointestinal)
More Patient information
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Stomach cancer

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

localized: suitable for surgery

localized: not suitable for surgery

advanced and metastatic disease

Contributors

Authors

Ahmed Abdelhakeem, MD

Disclosures

Mariela Blum Murphy, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Theodore Hong, MD

Disclosures

Andreas Leodolter, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice