Signs and symptoms of stomach cancer may include:

• Belly pain.
• Feeling bloated after eating.
• Feeling full after eating small amounts of food.
• Feeling very tired.
• Heartburn.
• Indigestion.
• Losing weight without trying.
• Nausea and vomiting.
• Not feeling hungry when you would expect to be hungry.
• Trouble swallowing.

Stomach cancer doesn't always cause symptoms in its early stages. Also, symptoms don't seem to differ between women and men. When stomach cancer symptoms appear, they may include indigestion and pain in the upper part of the belly. Symptoms can feel mild or vague. Or you may feel full after eating just a small amount. But there's no single way stomach cancer feels. Also, most of the time mild symptoms like these that come and go aren't caused by stomach cancer.

Symptoms might not happen until the cancer is advanced. Later stages of stomach cancer might cause symptoms such as feeling very tired, losing weight without trying and vomiting blood.

Stomach cancer that spreads to other parts of the body is called metastatic stomach cancer. It causes symptoms specific to where it spreads. For example, when cancer spreads to the lymph nodes it might cause lumps you can feel through the skin. Cancer that spreads to the liver may block the bile ducts and cause yellowing of the skin and whites of the eyes. This condition is known as jaundice, and it may cause itching or other skin reactions. If cancer spreads within the belly, it might cause fluid to fill the belly. The belly might look swollen.

When to see a doctor

If you have symptoms that worry you, make an appointment with a doctor or other healthcare professional. Many conditions can cause symptoms that are like the ones caused by stomach cancer. Your healthcare professional might test for those other causes first before testing for stomach cancer.

It's not clear what causes stomach cancer. Healthcare professionals believe most stomach cancers start when something hurts the inside lining of the stomach. Examples include having an infection in the stomach and eating a lot of salty foods. Not everyone with these risk factors gets stomach cancer, though. So more research is needed to find out exactly what causes it.

A long-lasting infection with bacteria called H. pylori can be linked to some types of stomach cancer. But not everyone with H. pylori gets stomach cancer.

Stomach cancer starts when cells in the stomach get changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. It might start to grow deeper into the wall of the stomach. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Factors that increase the risk of stomach cancer include:

• A diet high in salty foods.
• A diet low in fruits and vegetables.
• Family history of stomach cancer.
• Family history of genetic syndromes that increase the risk of stomach cancer and other cancers, such as hereditary diffuse gastric cancer, Lynch syndrome, juvenile polyposis syndrome, Peutz-Jeghers syndrome and familial adenomatous polyposis.
• Growths of noncancerous cells in the stomach, called polyps.
• Infection in the stomach caused by H. pylori.
• Stomach-removal surgery, called gastrectomy.
• Smoking.
• Swelling and irritation of the inside of the stomach, called gastritis.

Heavy alcohol use may increase the risk of stomach cancer. Research hasn't clearly linked light or moderate alcohol use with stomach cancer, but alcohol is known to cause many other cancers and guidelines recommend limiting alcohol intake.

There's no sure way to prevent stomach cancer. Some risk factors, such as inherited gene changes, can't be changed. But there are steps you can take to lower the risk of stomach cancer.

To lower the risk of stomach cancer:

• Treat H. pylori infections. If you have this infection, get treatment to prevent complications.
• Don't smoke. If you smoke, quit. If you don't smoke, don't start. Smoking increases your risk of stomach cancer and many other types of cancer. Quitting smoking can be very hard, so ask your healthcare professional for help.
• Eat plenty of fruits and vegetables. Try to include fruits and vegetables in your diet each day. Choose a variety of colorful fruits and vegetables.
• Reduce the amount of salty foods you eat. Protect your stomach by limiting these foods.
• Tell your healthcare professional if stomach cancer runs in your family. People with a strong family history of stomach cancer might have stomach cancer screening. Screening tests can detect stomach cancer before it causes symptoms.

After a stomach cancer diagnosis, other tests might be needed to find out how far the cancer has spread. This is called staging. Tests may include blood tests, endoscopic ultrasound, CT or PET imaging, or laparoscopy. Staging tells the healthcare team about the size of the cancer and whether it has spread to nearby lymph nodes or to other parts of the body. The care team uses the stage to decide on treatment and get an idea of your outcome.

Staging terms

For the most common type of stomach cancer, called adenocarcinoma, the stages range from 0 to 4. Higher numbers mean the cancer has grown farther through the stomach, spread to nearby lymph nodes or spread to other parts of the body. Different stages may be used after the first treatment.

The stages also are different for other types of stomach cancer, including gastric lymphomas, neuroendocrine tumors and gastrointestinal stromal tumors.

Stage 0

This is the earliest stage of stomach cancer. Cancer cells or cells that are likely to become cancer are found only in the innermost lining of the stomach. The cells have not grown deeper into the layers of the stomach or spread to other parts of the body.

At this stage, the treatment is often aimed at removing the cells completely with a procedure or surgery.

Stage 1

In this stage, the cancer has grown into the layers of the stomach wall. The cancer may have spread to one or two nearby lymph nodes. The cancer has not spread to distant parts of the body.

Stage 1 is an early stage of stomach cancer. The cancer cells often can be cut away from the inner lining of the stomach. But if the cancer grows into the muscle layer of the stomach wall, this may not be an option. Some stage 1 cancers need surgery to remove all or some of the stomach. Chemotherapy and radiation may not be needed if surgery can remove all the cancer and there's a low risk of cancer coming back.

Stage 2

In this stage, the cancer has grown into the inner layers of the stomach wall, spread to nearby lymph nodes or both. Or the cancer has grown deeper into or through the stomach wall but hasn't spread to lymph nodes. At this stage, the cancer has not spread to distant parts of the body.

For stage 2 stomach cancers, surgery may not be the first treatment. Instead, treatment to shrink the cancer may be done first. This makes it easier to remove the cancer completely. Treatment options may include chemotherapy, immunotherapy, or a combination of chemotherapy and radiation therapy. Surgery often involves removing all or some of the stomach and some lymph nodes.

Stage 3

In stage 3, the cancer has grown deeper into or through the stomach wall and has spread to nearby lymph nodes. It hasn't spread to other parts of the body.

Surgery often involves removing all or some of the stomach and some lymph nodes. Immunotherapy may be used before surgery. This treatment can help shrink the cancer to make it easier to remove. Sometimes immunotherapy kills all the cancer cells, and surgery may not be needed.

Systemic chemotherapy is often used before surgery. Chemotherapy may help shrink the cancer so that it's easier to remove. Radiation also may be used before surgery to shrink the cancer. Sometimes it is used after surgery if the cancer wasn't removed completely.

Stage 4

Stage 4 means the stomach cancer has spread to distant parts of the body. It also is called metastatic stomach cancer. At this stage, the cancer may have spread to the lining of the abdomen, liver, lungs or lymph nodes outside the local area of the stomach. Because the cancer has spread to another part of the body, surgery often cannot remove it completely. But surgery is sometimes used to help control symptoms. Targeted therapy may be used with systemic chemotherapy for cancer that has spread to distant parts of the body or has come back after treatment.

TNM staging

To describe each stage in more detail, healthcare professionals commonly use the TNM system. This system looks at three key factors:

• T. The size of the primary tumor.
• N. Whether the cancer has spread to nearby lymph nodes.
• M. Whether the cancer has spread to other parts of the body, called metastasis.

Staging can be complex. If you're not sure what something means, ask your healthcare team to explain it in a way that makes sense to you.

How fast does stomach cancer spread?

How quickly a cancer grows or spreads varies from person to person. Some types of stomach cancer may be more aggressive than others. Staging for stomach cancer is a way to describe the extent of the cancer at diagnosis. But it does not tell you how quickly the cancer is growing or spreading. Different types of stomach cancer can spread in different ways. For example, cancer cells that form a mass versus ones that are more diffuse spread at different rates. Your healthcare team can tell you more about what the features of your cancer may mean for you.

Looking ahead

After a diagnosis of stomach cancer, the outlook is different for everyone. Treatment for stomach cancer continues to improve. Your healthcare team can help you identify options for your care. The options and goals of treatment depend on the stage and type of cancer, your health and how well the treatment kills the cancer cells.

Your experience with cancer is unique, and your care team supports you through each step. After treatment, regular follow-up with your care team can help manage your health and check for any signs that the cancer has come back.

Stomach cancer treatments include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy and palliative care. Treatment options for stomach cancer, also called gastric cancer, may depend on the cancer's location within the stomach and its stage. Your healthcare team also thinks about your overall health and your preferences when making a treatment plan.

Surgery

The goal of surgery for stomach cancer is to remove all of the cancer. For small stomach cancers, surgery might be the first treatment. Other treatments might be used first if the stomach cancer grows deeper into the stomach wall or spreads to the lymph nodes.

Operations used to treat stomach cancer include:

• Endoscopic mucosal resection. Endoscopic mucosal resection (EMR) is a technique to remove irregular tissue from the digestive tract. It might be used to cut away very small cancers from the inside lining of the stomach. To remove the cancer, a healthcare professional passes a tube down the throat and into the stomach. Cutting tools go through the tube to cut out the cancer. EMR might be an option for treating stage 0 and stage 1 cancers that are growing on the inner lining of the stomach.
• Subtotal gastrectomy. A subtotal gastrectomy is surgery to remove part of the stomach. The surgeon removes the part of the stomach affected by cancer and some of the healthy tissue around it. It's typically used for stomach cancers that are closer to the small intestine. The surgeon also might remove some nearby lymph nodes.
• Total gastrectomy. A total gastrectomy is surgery to remove the entire stomach. It involves removing all of the stomach and some surrounding tissue. The surgeon connects the esophagus to the small intestine to allow food to move through the digestive system. Total gastrectomy is a treatment for stomach cancers that are closer to the esophagus. The surgeon also might remove some nearby lymph nodes.

Small stage 1 stomach cancers often can be cut away from the inner lining of the stomach. But if the cancer grows into the muscle layer of the stomach wall, this might not be an option. Some stage 1 cancers may need surgery to remove all or some of the stomach.

For stage 2 and stage 3 stomach cancers, surgery might not be the first treatment. Instead, treatment might start with other options to shrink the cancer and make it easier to remove completely. Treatment might start with chemotherapy, immunotherapy, or a combination of chemotherapy and radiation therapy. Surgery for stage 2 and stage 3 stomach cancers often involves removing some or all of the stomach and also some lymph nodes.

If stage 4 stomach cancer grows through the stomach and into nearby organs, surgery is sometimes used to help control symptoms.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Types of chemotherapy used for stomach cancer include:

• Chemotherapy to the whole body. Systemic chemotherapy involves giving the medicines to the whole body. The medicines can be given through a vein or taken in pill form.
• Chemotherapy to the belly. Local chemotherapy involves giving the medicines to one part of the body. For stomach cancer, the healthcare team may give the medicine to the belly to treat cancer that spreads to the lining of the abdominal cavity. This lining is called the peritoneum. Localized chemotherapy procedures include hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Chemotherapy might not be needed for stage 1 stomach cancer. It might not be needed if surgery removed all of the cancer and there's a low risk of cancer coming back.

Systemic chemotherapy is often used before surgery to treat stage 2 and stage 3 stomach cancers. It might help shrink the cancer so that it's easier to remove.

Systemic chemotherapy might continue after surgery to lower the risk that the cancer may come back. The risk of cancer coming back after surgery is higher if the cancer cells are found deep within the stomach wall or if the cancer spreads to the lymph nodes.

Chemotherapy can be used alone or it can be combined with radiation therapy.

If surgery isn't an option, systemic chemotherapy might be recommended instead. It might be used if the cancer is too advanced or if you're not healthy enough to have surgery. Chemotherapy might help control cancer symptoms.

Localized chemotherapy with HIPEC or PIPAC might be an option for advanced stomach cancer that spreads to the peritoneum. These treatments are experimental and may be available through clinical trials.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The beams can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine gives the radiation treatment to precise points on your body.

Radiation therapy is often done at the same time as chemotherapy. Sometimes healthcare professionals call this chemoradiation.

Radiation therapy might not be needed for stage 1 stomach cancer. It might not be needed if surgery removed all of the cancer and there's a low risk that the cancer will come back.

Radiation is sometimes used before surgery to treat stage 2 and stage 3 stomach cancers. It can shrink the cancer so that it's easier to remove. Sometimes radiation is used after surgery if the cancer wasn't removed completely.

Radiation can help relieve stomach cancer symptoms if the cancer is advanced or surgery isn't possible.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific molecules in the cancer cells. By blocking these molecules, targeted treatments can cause cancer cells to die. Your healthcare team might test your cancer cells to see if they have the molecules that the medicine targets.

For stomach cancer, targeted therapy is often used with systemic chemotherapy. Targeted therapy is typically used for advanced stomach cancer. This might include stage 4 stomach cancer and cancer that comes back after treatment.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Your healthcare team may test your cancer cells to see if they're likely to respond to this treatment.

Immunotherapy might be used before surgery for stage 2 and stage 3 cancers. The treatment can help shrink the cancer to make it easier to remove. Sometimes immunotherapy kills all of the cancer and surgery may not be needed.

Immunotherapy also may help treat advanced stomach cancers, such as stage 4 stomach cancers and cancers that come back after treatment.

Palliative care

Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. Healthcare professionals work as a team to give palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with other treatments, people with cancer may feel better and live longer.

A stomach cancer diagnosis can be overwhelming and frightening. It may take time to adjust to the initial shock of your diagnosis. In time you'll find ways to cope. Until then, it might help to:

• Learn enough to make decisions about your care. Ask your healthcare professional to write down the details of your cancer. This can include the type, the stage and your treatment options. Use those details to find more information about stomach cancer. Learn about the benefits and risks of each treatment option.
• Find a good listener. Finding someone who is willing to listen to you talk about your hopes and fears can be helpful as you manage a cancer diagnosis. This could be a friend or family member. A counselor, medical social worker or clergy member also may offer helpful guidance and care.
• Connect with other cancer survivors. Ask your healthcare team about support groups in your area. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.
• Stay active. Being diagnosed with cancer doesn't mean you have to stop doing the things you enjoy or usually do. For the most part, if you feel well enough to do something, go ahead and do it.

Start by making an appointment with a doctor or other healthcare professional if you have any symptoms that worry you. If your healthcare professional thinks that you may have a condition that affects the stomach, you may be referred to a gastroenterologist. This is a doctor who diagnoses and treats digestive system conditions.

Once stomach cancer is diagnosed, you may be referred to other specialists. This might be a cancer doctor, also called an oncologist, or a surgeon who specializes in operating on the digestive tract.

It's a good idea to be prepared for your appointment. Here's some information to help you get ready, and what to expect.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Note what seems to improve or worsen your signs and symptoms. Keep track of which foods, medications or other factors influence your signs and symptoms.
• Consider taking a family member or friend along. Sometimes it can be hard to absorb all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your healthcare professional is limited, so prepare a list of questions. List your questions from most important to least important in case time runs out. For stomach cancer, some basic questions to ask include:

• What type of stomach cancer do I have?
• How advanced is my stomach cancer?
• What other kinds of tests do I need?
• What are my treatment options?
• How successful are the treatments?
• What are the benefits and risks of each option?
• Is there one option you feel is best for me?
• How will treatment affect my life? Can I continue to work?
• Should I seek a second opinion? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask other questions you think of during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you questions. Being ready to answer them may allow more time later to cover other points you want to address. Your health professional may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Your healthcare team uses your cancer's stage and other factors to estimate your prognosis. The prognosis is how likely it is that the cancer will be cured. Prognosis sometimes is referred to as outlook or likely outcome. For stomach cancer, the prognosis for early-stage cancer is good. As the stage gets higher, the chances of a cure get lower. Even when stomach cancer can't be cured, treatments may slow the cancer's growth, help you live longer and make you more comfortable.

Survival statistics

Stomach cancer survival rates are based on large groups of people. They don't take into account your specific situation, and they can't predict what will happen to you.

For all people diagnosed with stomach cancer, the five-year survival rate is about 40%.

Survival rates five years and 10 years after diagnosis vary based on how far the cancer has spread:

• No spread. About 78% of people are alive five years after diagnosis. About 66.5% are alive 10 years after diagnosis.
• Spread to nearby tissue or lymph nodes only. About 39% of people are alive five years after diagnosis. About 27% are alive 10 years after diagnosis.
• Spread to other, distant parts of the body. About 8% of people are alive five years after diagnosis. About 5% are alive 10 years after diagnosis.

Many factors can affect your prognosis. If you like, ask your healthcare team about your outlook and how serious your cancer is. Your care team understands your overall health and may be able to give a more personal prognosis.

What you can do

Cancer survival rates may cause worry, but these rates vary widely. And the rates don't tell the whole story for each person. Talk to your care team about your specific factors. Your care team can help you learn what factors affect your outlook and what you can do to support your health during treatment.