Stomach cancer, also known as Gastric cancer, ranks as the fourth leading cause of cancer deaths and the fifth most frequently diagnosed cancer worldwide. 1
It involves the uncontrolled growth of cells in the stomach's lining. Adenocarcinoma is the most common type of stomach cancer, beginning in the lining of the stomach. As the disease progresses, it can grow deeper into the stomach wall or spread to other parts of the body, a process known as metastasis. This type of cancer is more often seen as people age, with men being two to three times more susceptible to developing adenocarcinoma than women. 2
Cancer in the lower or middle part of the stomach was once one of the most serious and common types of cancer affecting people. Thankfully, it has become less frequent in recent years. Now, cancers in the lower part of the stomach are less common, and more cases are seen in the upper part, especially around the area where the stomach connects to the oesophagus.1
This change in the pattern is partly due to treatment that eliminates the Helicobacter pylori bacteria, which causes ulcers and other changes in the lining of the lower stomach. As a result, successfully treating this infection has reduced the number of stomach cancers within that lower area.3
Although the exact causes of many types of cancer remain unclear, researchers have made progress in identifying factors that damage DNA in stomach cells and understanding how that damage leads to cancer. These factors include:
Helicobacter pylori (H. pylori) is a bacterium that resides in the inner lining of the stomach and is commonly found in the majority of the world's population. H. pylori infection frequently occurs in childhood and, if left untreated, can last throughout a person’s life.1,3
Whilst uncertain about how the bacteria are transmitted, researchers believe it is likely spread from one person to another via the oral-faecal route or through drinking contaminated water. The connection between bacteria and cancer isn't well established, but long-term inflammation from ulcers, which is sustained by persistent bacterial activity, may increase the risk of cancer.1,3
People who have pernicious anaemia or chronic atrophic gastritis (a condition in which the acid-producing glands of the stomach are slowly destroyed) are six times more likely to develop stomach cancer than other people.4
The WHO attributes 1.7 million deaths worldwide to low fruit and vegetable consumption, which means that incorporating sufficient fruits and vegetables in your daily diet may lower the risk of both stomach cancer and colorectal cancer.5
There is a threefold higher risk of inheriting stomach cancer if you have a close relative, such as a brother, sister or parent, who has a history of gastric cancer.2
Hereditary diffuse gastric cancer is one of the rare forms of stomach cancer associated with mutations in a gene called CDH1. CDH1 typically develop between the ages of 14–69, with an average age of onset of approximately 38 years.2
A parent with the defective gene has a 50% chance of passing it on to each child, and women with this syndrome also have an increased risk of getting a certain type of breast cancer. If someone in your family has gastric cancer, it would be wise to visit a doctor to review whether further screening and genetic testing are necessary.
While cancer cannot always be prevented, addressing its known contributors and risk factors may help in reducing the chances of developing it. Stomach cancer prevention can primarily be divided into primary and secondary prevention.
Gastric cancer can be prevented by lowering the occurrence of H. pylori infection and lifestyle modifications through improving dietary habits and physical activity.
Avoid eating food that is preserved by salting, smoking or pickling, since they often contain large amounts of nitrites and nitrates, which can be converted into cancer-causing compounds in our stomach
Early detection of cancer is achieved through Upper gastrointestinal endoscopy, which serves as the gold standard screening tool. Japan and Korea are examples of countries where mass-screening programs have been implemented and proved to be effective. Japan showed a 40-60% decrease in death rates in those who have been screened.3
People with gastric ulcer disease do have an increased risk of stomach cancer, although its exact connection is yet to be fully understood. Having ulcers doesn't necessarily put us at higher risk of stomach cancer, but having H. Pylori infection does.1,3
That's because long-term infection causes inflammation that can lead to precancerous changes in the stomach lining, which is seen in conditions such as atrophic gastritis.1,3
There is no solid evidence showing that eating spicy foods can directly lead to stomach cancer.
Spicy foods like peppers and chillies contain a compound called Capsaicin, which is commonly believed to irritate the stomach lining, which may increase the risk of stomach cancer. 6
Interestingly, when consumed in moderation, capsaicin has been shown to offer anticancer benefits. 6
Nevertheless, it is important to maintain a balanced diet and consume spicy foods in moderation to maintain good overall digestive health.
Symptoms of gastric cancer can often be subtle and non-specific during the early stages and can even mimic common digestive conditions such as Irritable Bowel Syndrome, gastritis, or indigestion. These symptoms can sometimes even go unnoticed and only be detected in the later stages when the cancer has advanced.
Occasionally, the first sign of a more serious problem is when the cancer spreads to other organs or tissues, for example, an enlarged liver, which causes jaundice or the pancreas or other tissues behind the stomach, causing back pain. At this stage, the symptoms generally become more prominent, where you will notice unexplained weight loss, persistent nausea or vomiting, and blood in your stool.
In contrast to common digestive conditions, these signs help to distinguish gastric cancer. However, diagnostic methods like endoscopy will be required to differentiate gastric cancer from other digestive conditions.
Therefore, it is advisable to see a doctor if you notice any of these early warning signs, especially if they persist for weeks.
If you undergo a total gastrectomy surgery (complete removal of the stomach), food or drink will not be permitted in the first few days to ensure maximal healing. Weight loss can occur throughout at least 2 months following the surgery. Therefore, it is advised to eat only small but more frequent meals to avoid too much weight loss. It is also recommended to adopt softer diets and focus on nutrient-dense foods to maintain strength and support recovery. 7
Without a stomach to absorb iron, you will also be given treatment to prevent anaemia.
Anaemia can result from loss of gastric intrinsic factor or due to inadequate iron absorption or, possibly, blood loss. Therefore, lifelong B12 injections, iron, and calcium supplementation would be required depending on the health status.
Adapting to a new dietary routine can be challenging in the beginning, but working with a dietitian can help manage these changes and ensure adequate nutrition throughout treatment, promoting a long and fulfilling life.
Many people experience symptoms such as abdominal cramping, pain, diarrhoea, following short meals in the first few days after surgery. This occurs in a condition called Dumping Syndrome, caused by the rapid passage of food into the small intestine,15-30 minutes after eating. However, this can even occur 1-3 hours after eating foods rich in carbohydrates, which follow rapid sugar spikes and drops in the blood, resulting in symptoms such as sweating, confusion, hunger and weakness.8
However, with the relevant dietary modification and treatment, this condition will often subside over time.
Stomach cancer, or gastric cancer, is the fifth most diagnosed and fourth leading cause of cancer deaths globally, with adenocarcinoma being the most common type. It primarily affects older adults and is more common in men. The shift in cancer location from the lower to the upper stomach is partly due to the successful treatment of Helicobacter pylori (H. pylori), a major risk factor.
Other causes include chronic gastritis, pernicious anaemia, a diet low in fruits and vegetables, and genetic predisposition, particularly mutations in the CDH1 gene. Preventive strategies focus on reducing H. pylori infection, healthy dietary choices, avoiding smoking and alcohol, and early detection through endoscopy, especially in high-risk regions like Japan and Korea.
Stomach cancer symptoms can resemble common digestive issues but become more distinct as the disease advances. Surgery, particularly total gastrectomy, impacts eating habits, requiring small, nutrient-rich meals and lifelong supplements for nutrients like B12 and iron. Post-surgery challenges like Dumping Syndrome can occur but often improve with dietary adjustments. Early medical attention is crucial for persistent digestive symptoms.
