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Stomach Cancer - Introduction

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE:You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Lineagotica’s Guide to Stomach Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About the stomach

The stomach is located in the upper abdomen and plays a central role in digesting food. When food is swallowed, it is pushed down the muscular tube called the esophagus, which connects the throat with the stomach. Then, the food enters the stomach. The stomach mixes the food and releases gastric juices that help break down and digest the food. The food then moves into the small intestine for further digestion.

Types of stomach cancer

Stomach cancer, also called gastric cancer, begins when healthy cells in the stomach become abnormal and grow out of control. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Cancer can begin in any part of the stomach. It can also spread to nearby lymph nodes and other parts of the body, such as the liver, bones, lungs, and a woman’s ovaries.

Most stomach cancers are a type called adenocarcinoma. This means that the cancer started in the glandular tissue that lines the inside of the stomach. Other types of cancerous tumors that form in the stomach include lymphoma, gastric sarcoma, and neuroendocrine tumors, but these are rare.

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If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Lineagotica:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with stomach cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Statistics

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE:You will find information about the number of people who are diagnosed with stomach cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 27,510 (17,230 men and 10,280 women) in the United States will be diagnosed with stomach cancer.

It is estimated that 11,140 deaths (6,800 men and 4,340 women) from this disease will occur this year.

Stomach cancer occurs most often in older people. About 60% of people who are diagnosed are older than age 64. The average age of diagnosis is 68.

The incidence of stomach cancer varies in different parts of the world. Although stomach cancer is decreasing in the United States, it is still one of the most common cancer types and one of the top causes of cancer deaths worldwide.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with stomach cancer is 31%. This statistic reflects the fact that most people with stomach cancer are diagnosed after the cancer has already spread to other parts of the body. If stomach cancer is found before it has spread, the 5-year survival rate is generally higher but depends on the stage of the cancer found during surgery.

If the cancer is diagnosed and treated before it has spread outside the stomach, the 5-year survival rate is 68%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 31%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 5%.

It is important to remember that statistics on the survival rates for people with stomach cancer are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2019, and the ACS website (January 2019).

Stomach Cancer - Risk Factors

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE: You will find out more about the factors that increase the chance of developing stomach cancer. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing stomach cancer:

  • Age. Stomach cancer occurs most commonly in people older than 55. Most people diagnosed with stomach cancer are in their 60s and 70s.

  • Gender. Men are twice as likely to develop stomach cancer as women.

  • Bacteria. A common bacterium called Helicobacter pylori, also called H. pylori, causes stomach inflammation and ulcers. It is also considered one of the main causes of stomach cancer. Testing for H. pylori is available and an infection can be treated with antibiotics. Testing for H. pylori is recommended if you have had a first-degree relative, such as a parent, sibling, or child, who has been diagnosed with stomach cancer or an H. pylori infection. Other family members could have it as well, and the infection should be treated if found.

  • Family history/genetics. People who have a parent, child, or sibling who has had stomach cancer have a higher risk of the disease. In addition, certain inherited genetic disorders, such as hereditary diffuse gastric cancer, Lynch syndrome, hereditary breast and ovarian cancer (HBOC), and familial adenomatous polyposis (FAP) may increase the risk of stomach cancer. Learn more about genetics and cancer.

  • Race/ethnicity. Stomach cancer is more common in black, Hispanic, and Asian people than in white people.

  • Diet. Eating a diet high in salt has been linked to an increased risk of stomach cancer. This includes foods preserved by drying, smoking, salting, or pickling and foods high in added salt. Eating fresh fruits and vegetables may help lower the risk.

  • Previous surgery or health conditions. People who have had stomach surgery, pernicious anemia, or achlorhydria have a higher risk of stomach cancer. Pernicious anemia is a severe decrease in red blood cells caused when the stomach is not able to properly absorb vitamin B12. Achlorhydria is a lack of hydrochloric acid in the gastric juices, which help digest food.

  • Occupational exposure. Exposure to certain dusts and fumes may increase the risk of developing stomach cancer.

  • Tobacco and alcohol. Tobacco use and drinking a lot of alcohol may increase the risk of developing stomach cancer.

  • Obesity. Excess body weight increases a man’s risk of developing stomach cancer. It is not clear whether obesity increases a woman’s risk of stomach cancer.

The next section in this guide is Symptoms and Signs. It explains the body changes or medical problems that stomach cancer can cause. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Symptoms and Signs

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with stomach cancer may experience the following symptoms or signs. Sometimes, people with stomach cancer do not have any of these changes. Or, the cause may be a different medical condition that is not cancer.

Stomach cancer is usually not found at an early stage because it often does not cause specific symptoms. When symptoms do occur, they may be vague and can include those listed below. It is important to remember that these symptoms can also be caused by many other illnesses, such as a stomach virus or an ulcer.

  • Indigestion or heartburn

  • Pain or discomfort in the abdomen

  • Nausea and vomiting, particularly vomiting up solid food shortly after eating

  • Diarrhea or constipation

  • Bloating of the stomach after meals

  • Loss of appetite

  • Sensation of food getting stuck in the throat while eating

Symptoms of advanced stomach cancer may include:

  • Weakness and fatigue

  • Vomiting blood or having blood in the stool

  • Unexplained weight loss

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. It is often started soon after diagnosis and continued throughout treatment. This may be called palliative care or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Diagnosis

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE:You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes options for diagnosing stomach cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose stomach cancer:

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options.

    For stomach cancer, testing may be done for PD-L1 and high microsatellite instability (MSI-H), which may also be called a mismatch repair deficiency. The results of these tests help doctors find out if immunotherapy is a treatment option (see Types of Treatment).

  • Endoscopy. An endoscopy allows the doctor to see the inside of the body with a thin, lighted, flexible tube called a gastroscope or endoscope. The person may be sedated as the tube is inserted through the mouth, down the esophagus, and into the stomach and small bowel. Sedation is giving medication to become more relaxed, calm, or sleepy. The doctor can remove a sample of tissue as a biopsy during an endoscopy and check it for signs of cancer.

  • Endoscopic ultrasound. This test is similar to an endoscopy, but the gastroscope has a small ultrasound probe on the end. An ultrasound uses sound waves to create a picture of the internal organs. An ultrasound image of the stomach wall helps doctors determine how far the cancer has spread into the stomach and nearby lymph nodes, tissue, and organs, such as the liver or adrenal glands.

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

  • Barium swallow. In a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is usually given both as a liquid to swallow and an injection into a patient's vein.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

  • Laparoscopy. A laparoscopy is a minor surgery in which the surgeon inserts a thin, lighted, flexible tube called a laparoscope into the abdominal cavity. It is used to find out if the cancer has spread to the lining of the abdominal cavity or liver. A CT or PET scan cannot often find cancer that has spread to these areas.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Stages

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE:You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery.

There are different stage descriptions for different types of cancer. This section covers staging of adenocarcinoma, the most common type of stomach cancer. Staging is different for gastric lymphoma, sarcoma, and neuroendocrine tumors.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How deeply has the primary tumor spread into the stomach wall?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for stomach cancer:

Tumor (T)

Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the how far the tumor has grown into the stomach wall. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

Stage may also be divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below:

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a primary tumor in the stomach.

Tis: This stage describes a condition called carcinoma (cancer) in situ. The cancer is found only in cells on the surface of the inner lining of the stomach called the epithelium and has not spread to any other layers of the stomach.

T1: The tumor has grown into the lamina propria, muscularis mucosae, or the submucosa, which are the inner layers of the wall of the stomach.

  • T1a: The tumor has grown into the lamina propria or muscularis mucosae.

  • T1b: The tumor has grown into the submucosa.

T2: The tumor has grown into the muscularis propria, the muscle layer of the stomach.

T3: The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach. It has not grown into the lining of the abdomen, called the peritoneal lining, or into the serosa, which is the outer layer of the stomach.

T4: The tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach. It has also grown into the peritoneal lining or serosa or the organs surrounding the stomach.

  • T4a: The tumor has grown into the serosa.
  • T4b: The tumor has grown into organs surrounding the stomach.

Node (N)

The “N” in the TNM staging system is for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes inside the abdomen are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. The overall prognosis for patients with stomach cancer is based on how many regional lymph nodes show signs of cancer. If 2 or fewer have cancer, the prognosis is better than if more than 3 to 6 or 7 or more lymph nodes contain cancer cells.

NX: Regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to 1 to 2 regional lymph nodes.

N2: The cancer has spread to 3 to 6 regional lymph nodes.

N3: The cancer has spread to 7 or more regional lymph nodes.

  • N3a: The cancer has spread to 7 to 15 regional lymph nodes.

  • N3b: The cancer has spread to 16 or more regional lymph nodes.

Metastasis (M)

The “M” in the TNM system describes whether the cancer has spread to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part or parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: This is also called carcinoma in situ. The cancer is found only on the surface of the epithelium. The cancer has not grown into any other layers of the stomach. This stage is considered an early cancer (Tis, N0, M0).

Stage IA: The cancer has grown into the inner layer of the wall of the stomach. It has not spread to any lymph nodes or other organs (T1, N0, M0).

Stage IB: Stomach cancer is called stage IB in either of these 2 conditions:

  • The cancer has grown into the inner layers of the wall of the stomach. It has spread to 1 to 2 lymph nodes but not elsewhere (T1, N1, M0).

  • The cancer has grown into the outer muscular layers of the wall of the stomach. It has not spread to the lymph nodes or other organs (T2, N0, M0).

Stage IIA: Stomach cancer is called stage IIA for any of these conditions:

  • The cancer has grown into the inner layer of the wall of the stomach. It has spread to 3 to 6 lymph nodes but not elsewhere (T1, N2, M0).

  • The cancer has grown into the outer muscular layers of the wall of the stomach. It has spread to 1 to 2 lymph nodes but not elsewhere (T2, N1, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach. It has not grown into the peritoneal lining or serosa or spread to any lymph nodes or surrounding organs (T3, N0, M0).

Stage IIB: Stomach cancer is called stage IIB for any of these conditions:

  • The cancer has grown into the inner layers of the wall of the stomach. It has spread to 7 to 15 lymph nodes but not elsewhere. (T1, N3a, M0).

  • The cancer has invaded the outer muscular layers of the wall of the stomach. It has spread to 3 to 6 lymph nodes but not elsewhere (T2, N2, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the peritoneal lining or serosa. It has spread to 1 to 2 lymph nodes but not elsewhere (T3, N1, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach. It has grown into the peritoneal lining or serosa, but it has not spread to any lymph nodes or surrounding organs (T4a, N0, M0).

Stage IIIA: Stomach cancer is called stage IIIA for any of these conditions:

  • The cancer has grown into the outer muscular layers of the stomach wall. It has spread to 7 to 15 lymph nodes but not to other organs (T2, N3a, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the peritoneal lining or serosa. It has spread to 3 to 6 lymph nodes but not to other organs (T3, N2, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach. It has grown into the peritoneal lining or serosa and has spread to 1 to 2 lymph nodes but not to other organs (T4a, N1, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into nearby organs or structures. It has not spread to any lymph nodes or distant parts of the body (T4b, N0, M0).

Stage IIIB: Stomach cancer is called stage IIIB for any of these conditions:

  • The cancer has grown into the inner layer of the wall of the stomach or the outer muscular layers of the stomach wall. It has spread to 16 or more lymph nodes but not to distant parts of the body (T1 or T2, N3b, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach but has not grown into the peritoneal lining or serosa. It has spread to 7 to 15 lymph nodes but has not invaded any surrounding organs (T3, N3a, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into the peritoneal lining or serosa. It has spread to 7 to 15 lymph nodes but has not spread elsewhere (T4a, N3a, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into nearby organs or structures. It may or may not have spread to 1 to 6 lymph nodes but not to distant parts of the body (T4b, N1 or N2, M0).

Stage IIIC: Stomach cancer is called stage IIIC for any of these conditions:

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and may have grown into the peritoneal lining or serosa. It has spread to 16 or more lymph nodes but not to distant parts of the body (T3 or T4a, N3b, M0).

  • The cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown into nearby organs or structures. It has spread to 7 or more lymph nodes but not to other parts of the body (T4b, N3a or N3b, M0).

Stage IV: Stage IV stomach cancer describes a cancer of any size that has spread to distant parts of the body in addition to the area around the stomach (any T, any N, M1).

Recurrent cancer: Recurrent cancer is cancer that has come back after treatment. It may be a localized recurrence, which means it has come back in the place where it started. Or it may be a distant metastasis, which means it has come back in another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Japanese staging system

Stomach cancer is much more common in Japan and other parts of Asia and South America than in the United States. Japan has a different method of staging stomach cancer, based on where the lymph nodes with cancer are located around the stomach. This is different from the U.S. system, which uses the number of lymph nodes and not their location.

Surgery for stomach cancer may be described using the Japanese system. The type of surgery is identified by which lymph nodes are removed in addition to the stomach. Learn more about surgery for stomach cancer in the Types of Treatment section.

  • D0: No lymph nodes were removed.

  • D1: The lymph nodes closest to the stomach were removed.

  • D2: Lymph nodes from a wider area were removed.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Types of Treatment

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with stomach cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for stomach cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For stomach cancer, this team may include the following doctors:

  • Gastroenterologist, a doctor who specializes in the gastrointestinal tract including the stomach and intestines

  • Surgeon or surgical oncologist, a doctor who specializes in treating cancer using surgery

  • Medical oncologist, a doctor who specializes in treating cancer with medication

  • Radiation oncologist, a doctor who specializes in giving radiation therapy to treat cancer

  • Pathologist, a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease

  • Radiologist, a medical doctor who specializes in using imaging tests to diagnose disease

Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Stomach cancer may be treated with surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy. Descriptions of the common types of treatments used for stomach cancer are listed below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Often, a combination of treatments is used for stomach cancer. It can be difficult to cure stomach cancer because it is often not found until it is at an advanced stage.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for stomach cancer because there are different treatment options. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. The type of surgery used depends on the stage of the cancer (see Stages).

For a very early stage (T1a) cancer, some doctors may recommend a non-surgical treatment called an endoscopic mucosal resection. This is the removal of the tumor with an endoscope (see Diagnosis).

In early stages (stages 0 or I), when the cancer is still only in the stomach, surgery is used to remove the part of the stomach with cancer and nearby lymph nodes. This is called a subtotal or partial gastrectomy. In a partial gastrectomy, the surgeon connects the remaining part of the stomach to the esophagus or small intestine.

If the cancer has spread to the outer stomach wall with or without having spread to the lymph nodes, surgery plus chemotherapy or chemotherapy and radiation therapy may be used (see below). The surgeon can perform a subtotal gastrectomy or a total gastrectomy, which is the removal of all of the stomach. During a total gastrectomy, the surgeon attaches the esophagus directly to the small intestine.

Gastrectomy is a major surgery and can have serious side effects. After this surgery, the patient will only be able to eat a small amount of food at a time. A common side effect is a group of symptoms called "dumping syndrome," which includes cramps, nausea, diarrhea, and dizziness after eating. This happens when food enters the small intestine too fast. The doctor can suggest ways to avoid this and can prescribe medication to help control these symptoms. The symptoms usually lessen or disappear in a few months, but they may be permanent for some people. Patients who have had their entire stomach removed may need regular injections of vitamin B12 because they may no longer be able to absorb this essential vitamin through their stomach. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have.

Regional lymph nodes are often removed during surgery because the cancer may have spread to those lymph nodes. This is called a lymphadenectomy. There is still debate as to how many lymph nodes should be removed. In Europe and especially in Japan, more lymph nodes are removed than in the United States.

When the cancer is diagnosed as Stage IV, surgery is typically not recommended as the main treatment (see Metastatic stomach cancer, below). Other types of treatment will be recommended instead.

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. People with stomach cancer usually receive external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.

Side effects from radiation therapy include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Talk with your radiation oncologist about the possible side effects you may experience and your recovery period.

Learn more about the basics of radiation therapy.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for stomach cancer include:

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce cancer-related symptoms. It also may be combined with radiation therapy. Currently, there is no single standard chemotherapy treatment regimen that is used worldwide. However, most chemotherapy treatments for stomach cancer are based on combinations of the following drugs:

  • Cisplatin (available as a generic drug)

  • Oxaliplatin (Eloxatin)

  • Fluorouracil (5-FU, Efudex)

Other drugs used include:

  • Capecitabine (Xeloda)

  • Docetaxel (Taxotere)

  • Epirubicin (Ellence)

  • Irinotecan (Camptosar)

  • Paclitaxel (Taxol)

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapy for stomach cancer includes:

  • HER2-targeted therapy. Some cancers may make too much of a protein called human epidermal growth factor receptor 2 (HER2). This type of cancer is called HER2-positive cancer. Trastuzumab (Herceptin, Herzuma, Ogivri, Ontruzant) plus chemotherapy may be an option for patients with later-stage HER2-positive stomach cancer.

  • Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. For patients whose tumor has grown while receiving initial chemotherapy, the drug ramucirumab (Cyramza) may be an additional option.

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

For patients with advanced stomach cancer that has PD-L1 or is MSI-H (see Diagnosis), pembrolizumab (Keytruda) may be an option for patients when chemotherapy does not work.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Metastatic stomach cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer (stage IV in the Stages section). If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

The goal of treatment at this stage is typically to lengthen a patient’s life and care for the symptoms of the cancer since metastatic stomach cancer is not considered curable. Any treatment, including chemotherapy or radiation therapy, is considered palliative therapy. Surgery is rarely used, and the main treatment is usually chemotherapy. It is important to note that studies show that the use of palliative chemotherapy for stomach cancer can improve both the length and quality of life.

Given the inability to cure metastatic stomach cancer, this diagnosis is stressful and at times, difficult to bear. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recovery

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Stomach Cancer - About Clinical Trials

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with stomach cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of stomach cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating stomach cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with stomach cancer.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for stomach cancer, learn more in the Latest Research section.

Lineagotica offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website. null

The next section in this guide is Latest Research. It explains areas of scientific research for stomach cancer. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Latest Research

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE: You will read about the scientific research being done to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about stomach cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Chemoprevention. Chemoprevention is the use of drugs or nutrients to lower a person’s risk of developing cancer. Early research suggests that using antibiotics to treat H. pylori infections (see Risk Factors) can prevent changes to stomach cells that may lead to cancer.

  • Combination therapy. The combination of chemotherapy, radiation therapy, and surgery may reduce the chance that stomach cancer will return. Doctors may give chemotherapy before surgery, called neoadjuvant therapy, or after surgery, called adjuvant therapy. In addition, doctors may also combine radiation therapy and chemotherapy after surgery. Doctors are also looking at giving both radiation therapy and chemotherapy before surgery.

  • Newer chemotherapy treatments. Chemotherapy with multiple combinations of drugs is being increasingly used for people with stomach cancer. Drug combinations work slightly better than single drugs. As outlined in the Types of Treatment section, drugs such as 5-FU, paclitaxel, docetaxel, irinotecan, oxaliplatin, as well as oral medications such as capecitabine are being studied in combination with other types of chemotherapy.

  • Molecular testing of the tumor. Researchers are looking at the genetic changes in tumor cells to identify specific genes, proteins, and other factors unique to the tumor. Patients with different types of tumors with the same genetic change are able to participate in clinical trials, called “basket trials”, with the goal of finding treatments that target that genetic change.

  • Targeted therapy. Previous research has shown that several types of targeted therapy do not work well for stomach cancer. These include drugs that target the gene c-MET, bevacizumab (Avastin, Mvasi), and drugs that block epidermal growth factor receptor (EGFR). However, research continues on this type of treatment approach (see Molecular testing of the tumor, above).

  • Immunotherapy. Immunotherapy is an expanding area of research for stomach cancer. Researchers are looking at different types of immunotherapy that block the CTLA4 and/or PD-1 pathways. A tumor can use these pathways to hide from the body’s immune system. Immunotherapy that blocks these pathways allow the immune system to identify and destroy the cancer.

  • Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current stomach cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research on stomach cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care” or "supportive care." It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for stomach cancer are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with stomach cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print out.

Looking for More on How to Track Side Effects?

Lineagotica offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Lineagotica:

  • Lineagotica Mobile: The free Lineagotica mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 36-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on diarrhea and rash that provide a tracking sheet to record the timing and severity of the side effect. These free fact sheets are available as a PDF, so they are easy to print out.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Follow-Up Care

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ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. People who have had their entire stomach removed can feed themselves, but it is important for them to re-learn how to eat after this major surgery. Talk with your doctor about this type of rehabilitation. Learn more about the importance of follow-up care.

Watching for recurrence

A goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Survivorship

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from stomach cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Lineagotica:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print out.

  • Lineagotica Patient Education Video: View a short video led by an ASCO expert that provides information about what comes after finishing treatment.

  • Survivorship Resources: Lineagotica offers an entire area of this website with resources to help survivors, including for those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Questions to Ask the Health Care Team

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Lineagotica’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What is my diagnosis? What does this mean?

  • What stage is the cancer?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

  • What are my options for treatment?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities? Will my eating habits need to change?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy, chemotherapy, targeted therapy, or immunotherapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Stomach Cancer - Additional Resources

Approved by the Lineagotica Editorial Board, 01/2019

ON THIS PAGE:You will find some helpful links to other areas of Lineagotica that provide information about cancer care and treatment. This is the final page of Lineagotica’s Guide to Stomach Cancer. Use the menu to go back and see other pages.

Lineagotica includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Lineagotica:

This is the end of Lineagotica’s Guide to Stomach Cancer. Use the menu to choose a different section to read in this guide.