Stomach and esophageal cancers

Food travels down the esophagus and into the stomach, where it is mixed with stomach juices that help to digest it. Stomach cancer develops when cells in the lining of the stomach change and grow out of control. If it is not found and treated early, it can spread to other parts of the body.

Men are almost twice as likely as women to be diagnosed with stomach cancer. It is more common in people over 60, but it can occur at any age.

Esophageal cancer begins when abnormal cells develop in the innermost layer of the esophagus. There are two main types: esophageal adenocarcinoma and esophageal squamous cell carcinoma. If it is not found and treated early, esophageal cancer can spread to other parts of the body, most commonly the liver. Men are much more likely than women to be diagnosed.

Signs and symptoms#

Stomach and esophageal cancers may cause no symptoms in the early stages, and when symptoms do appear they are often the same as those of other, more common conditions.

Common symptoms of stomach cancer include:

• unexplained weight loss or loss of appetite
• difficulty swallowing
• indigestion (pain or a burning sensation in the abdomen, frequent burping, reflux)
• persistent nausea or vomiting with no apparent cause
• abdominal pain
• a sense of fullness, even after a small meal
• swelling of the abdomen or feeling bloated
• unexplained tiredness
• vomit containing blood
• black or bloody stools

Common symptoms of esophageal cancer include:

• difficulty or pain when swallowing
• new heartburn or reflux, or reflux that does not go away
• food or fluids “catching” in the throat, or regurgitation when swallowing
• unexplained weight loss or loss of appetite
• discomfort in the upper abdomen, especially when eating
• unexplained tiredness that won’t go away
• vomit that contains blood

Not everyone with these symptoms has stomach or esophageal cancer#

If you have any of these symptoms or are worried, always see your doctor.

Risk factors#

Some things make it more likely that a person will develop stomach or esophageal cancer. Having one or more risk factors does not mean you will develop cancer, and often there is no clear reason why it occurs.

Risk factors for stomach cancer include:

• older age (being over 60)
• infection with the bacteria Helicobacter pylori
• having had part of the stomach removed to treat non-cancerous conditions
• smoking tobacco
• low red blood cell levels (pernicious anemia)
• a family history of stomach cancer
• chronic inflammation of the stomach (chronic gastritis)
• being overweight or obese
• drinking alcohol
• eating foods preserved by salt

Some inherited conditions, such as Lynch syndrome, gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS), and hereditary diffuse gastric cancer (HDGC), can also increase risk.

Risk factors for esophageal adenocarcinoma include being overweight or obese, gastro-esophageal reflux disease and Barrett’s esophagus, smoking tobacco, and older age. Risk factors for squamous cell carcinoma include drinking alcohol, smoking tobacco, older age, and damage to the esophagus from hot or corrosive liquids.

If you are worried about your risk factors, ask your doctor for advice#

Tests and diagnosis#

Your doctor may do some tests to check for stomach or esophageal cancer.

• Endoscopy allows the doctor to look inside your digestive tract and examine the lining.
• Biopsy – during an endoscopy, if the doctor sees any suspicious-looking areas, they may remove a small amount of tissue. A pathologist then examines it under a microscope to check for signs of disease.
• Endoscopic ultrasound – a doctor passes an endoscope with an ultrasound probe down your throat and esophagus and into your stomach and small bowel. The probe uses sound waves that echo off solid structures, helping to show whether the cancer has spread.
• Blood tests may be used if other tests suggest cancer.
• CT scan and PET-CT scan provide detailed images and can show whether the cancer has spread to other parts of the body.
• Laparoscopy – a surgical procedure that lets your doctor look inside your abdomen and examine the outer layer of the stomach and the lining of the abdominal wall for signs that the cancer has spread.

Types#

The most common type of stomach cancer is adenocarcinoma, which starts in the glandular tissue on the stomach’s inner surface. Other, less common types include small cell carcinomas, lymphomas, neuroendocrine tumors, and gastrointestinal stromal tumors. Your doctor can explain more about these types.

The two main types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. Adenocarcinoma often starts near the gastro-esophageal junction and is linked with Barrett’s esophagus. Squamous cell carcinoma starts in the thin, flat squamous cells of the mucosa and often begins in the middle and upper part of the esophagus.

Stages, prognosis and survival#

The stage of a cancer describes how far it has grown in the body. Doctors commonly use the TNM (tumor, nodes, metastasis) staging system, which is based on the size of the tumor, whether lymph nodes are affected, and whether the cancer has spread. Early-stage cancer is found only in the stomach or esophagus; later stages describe cancer that has spread.

A prognosis is the doctor’s opinion of how likely the cancer is to spread and the chances of recovery. It depends on the type and stage of cancer, as well as the person’s age and general health. Generally, the earlier these cancers are diagnosed, the better the chances of successful treatment. Your doctor will talk to you about your individual situation.

Every person’s experience is different, and there is support available to you#

Treatment#

Treatment depends on the stage of the cancer, your age, medical history, nutritional needs, and general health.

You might feel confused or unsure about your treatment options and decisions#

It’s okay to ask your treatment team to explain information more than once, and it’s often okay to take some time to think about your decisions.

• Endoscopic resection – very early-stage tumors that have not spread from the stomach or esophageal walls may be removed using a long, flexible tube (endoscope) passed down the throat. For some people this may be the only treatment they need.
• Surgery is the main treatment for stomach cancer that has not spread elsewhere. It aims to remove all of the cancer while keeping as much normal tissue as possible. A gastrectomy removes all or part of the stomach, and a lymphadenectomy removes nearby lymph nodes to reduce the risk of the cancer returning and to help with staging.
• Esophagectomy is surgery to remove part or all of the esophagus, along with nearby affected lymph nodes. Depending on where the cancer is, the surgeon may also remove part of the upper stomach. Esophageal surgery is complex, and surgeons who perform it regularly have better outcomes, so you may need to travel to a specialist center.
• Chemotherapy uses drugs to kill or slow the growth of cancer cells. It may be given before surgery to shrink tumors, after surgery to reduce the chance of the cancer returning, or as palliative treatment.
• Targeted therapy attacks specific parts of cancer cells to stop them growing and spreading. It is only available for certain types of stomach cancer.
• Radiation therapy uses a controlled dose of radiation to kill or damage cancer cells. For stomach cancer it is often used to control bleeding, and sometimes before or after surgery. It is the main treatment for esophageal cancer that has not spread and cannot be removed surgically.
• Immunotherapy with checkpoint inhibitors uses the body’s own immune system to fight cancer, and has shown advances in treating advanced stomach or esophageal cancer.

Speak to your doctor about whether immunotherapy is the right treatment for you#

Side effects and support#

All cancer treatments can have side effects. Your treatment team will discuss these with you before you start, and you should tell your doctor or nurse about any side effects you experience.

Some people will have a feeding tube before or during treatment to help maintain their weight and build strength. Many find it makes eating easier and more comfortable. A feeding tube can be placed into the small bowel either through a nostril or through the skin of the abdomen. Your treatment team will show you how to care for the tube, and it will be removed when it is no longer needed. For information, talk to a dietitian or nurse.

A counselor or psychologist can provide emotional support and coping strategies#

Before you start treatment, it is recommended that you:

• Improve diet and nutrition – people with stomach cancer often lose a lot of weight and can become malnourished. Your doctor may refer you to a dietitian to help slow weight loss, improve strength, and reduce side effects.
• Stop smoking – if you smoke, aim to quit before treatment, as continuing may mean you respond less well.
• Begin or continue exercise – exercise helps build strength for recovery. Talk to your doctor or physiotherapist about the right type for you.
• Limit alcohol – alcohol can affect how the body works and increase the risk of complications after surgery, including bleeding, infection, and the cancer returning.
• Talk to someone – you may find it helpful to talk to a counselor or psychologist about how you are feeling.

This can help you deal with any anxiety about diagnosis and treatment#

Having stomach or esophageal cancer and treatment can change how you feel about yourself and other people. These changes can be upsetting and hard to talk about.

Doctors and nurses are very understanding and can give you support#

You can ask for a referral to a counselor or therapist who specializes in body image, sex, and relationships.

Living with advanced cancer#

Advanced cancer usually means cancer that is unlikely to be cured, but some people live for many months or years with it. Palliative care can help during this time. Most people continue to have treatment for advanced cancer as part of palliative care, because it helps manage the cancer and improve day-to-day life.

Many people think palliative care is only for those who are dying, but it is for any stage of advanced cancer. Treatment may include chemotherapy, radiation therapy, or another type of treatment. It can help by:

• slowing how fast the cancer is growing
• shrinking the cancer
• managing symptoms such as pain so you can live more comfortably

Treatment depends on where the cancer started, how far it has spread, your general health, and your preferences.

Support for carers, family and friends#

Caring for someone with cancer can be difficult at times. If you are caring for someone with stomach or esophageal cancer, support services for carers, families, and friends are available to help you find the information, resources, and support you may need.

Key points#

• Stomach cancer is more common in people over 60, but it can occur at any age.
• Not everyone with these symptoms has stomach or esophageal cancer.
• If you have any of these symptoms or are worried, always see your doctor.
• Some things, called risk factors, make these cancers more likely.
• If you are worried about your risk factors, ask your doctor for advice.

Where to get help#