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Most gastric cancers are adenocarcinomas.\nEarly gastric cancer may cause few or no symptoms. Some patients develop upper abdominal discomfort, loss of appetite, early satiety, nausea, unexplained weight loss, or anemia.\nTreatment depends on tumor location, TNM stage, resectability, and biomarkers such as HER2, PD-L1, MMR\u002FMSI, and CLDN18.2.",[68,74,78,82,86],{"key":69,"title":70,"html":71,"icon":72,"updatedAt":73},"","Overview","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">The stomach lies between the esophagus and small intestine and helps store, mix, and begin the digestion of food.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Most stomach cancers are adenocarcinomas arising from glandular cells in the stomach lining. This page focuses on gastric adenocarcinoma rather than other stomach tumors such as lymphoma or gastrointestinal stromal tumor, which require different treatment approaches.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Gastric cancer can arise in different parts of the stomach. Tumors near the gastroesophageal junction may sometimes require treatment planning that incorporates principles used for gastroesophageal junction cancer.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">A diagnosis of gastric cancer does not automatically mean that the entire stomach must be removed. The extent of treatment depends on tumor location, depth of invasion, lymph node involvement, and whether the cancer has spread.\u003C\u002Fspan>\u003C\u002Fp>","⚕️","2026-09-19",{"key":69,"title":75,"html":76,"icon":77,"updatedAt":73},"Causes and Risk Factors","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Gastric cancer usually results from a combination of infection, genetic susceptibility, long-term changes in the stomach lining, and lifestyle factors.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Helicobacter pylori infection is one of the most important modifiable risk factors. Long-term infection can lead to chronic gastritis, gastric atrophy, intestinal metaplasia, and eventually gastric cancer in some people. Treating H. pylori infection can reduce future gastric cancer risk in selected populations.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Other risk factors include increasing age, smoking, diets high in salted or smoked foods, chronic atrophic gastritis, intestinal metaplasia, pernicious anemia, some Epstein-Barr virus–associated gastric cancers, a family history of gastric cancer, and certain inherited cancer syndromes.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Hereditary diffuse gastric cancer is associated with inherited alterations in genes such as CDH1 and CTNNA1. Lynch syndrome, familial adenomatous polyposis, and several other inherited syndromes can also increase gastric cancer risk.\u003C\u002Fspan>\u003C\u002Fp>","🧬",{"key":69,"title":79,"html":80,"icon":81,"updatedAt":73},"Signs and Symptoms","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Early gastric cancer may cause no noticeable symptoms, and when symptoms occur they can resemble common digestive problems.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Possible symptoms include upper abdominal discomfort or pain, indigestion, early satiety, loss of appetite, nausea or vomiting, bloating, unexplained weight loss, fatigue or anemia, black stools, or vomiting blood.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Tumors near the upper stomach or gastroesophageal junction may also cause difficulty swallowing.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">These symptoms are often caused by conditions other than cancer, but persistent or worsening symptoms—particularly when accompanied by weight loss, anemia, bleeding, or difficulty swallowing—should be medically evaluated.\u003C\u002Fspan>\u003C\u002Fp>","📋",{"key":69,"title":83,"html":84,"icon":85,"updatedAt":73},"Diagnosis","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Upper endoscopy with biopsy is the cornerstone of gastric cancer diagnosis.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Endoscopy allows doctors to directly inspect the stomach lining and collect tissue from suspicious areas. Pathologic examination confirms the diagnosis and provides information about tumor type and biologic features.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">After diagnosis, additional tests are used for staging.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Contrast-enhanced CT is commonly used to evaluate local disease, lymph nodes, and distant metastases.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Endoscopic ultrasound can help determine the depth of invasion and regional lymph node involvement in selected localized tumors.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">PET\u002FCT is not required for every patient but may be useful in selected staging situations.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Staging laparoscopy may be recommended for some potentially resectable, locally advanced cancers to identify small peritoneal metastases that may not be visible on imaging.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 16px;\">\u003Cstrong>Biomarker Testing\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 18px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 18px;\">\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">Biomarker testing has become an important part of treatment planning, particularly for unresectable, recurrent, or metastatic gastric adenocarcinoma.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">Key biomarkers include HER2, PD-L1, mismatch repair deficiency or microsatellite instability, and CLDN18.2.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">HER2 can identify patients who may benefit from HER2-targeted therapy. PD-L1, commonly reported as a combined positive score, can help guide immunotherapy decisions. dMMR\u002FMSI-H tumors are particularly sensitive to immune checkpoint inhibition, while CLDN18.2 has become an important therapeutic target in advanced gastric cancer.\u003C\u002Fspan>\u003C\u002Fp>","🩺",{"key":69,"title":87,"html":88,"icon":89,"updatedAt":73},"Treatment","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">Treatment for gastric cancer depends on the tumor stage, location, whether complete resection is possible, pathological type, biomarkers, and the patient's overall physical condition.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"color: rgb(15, 17, 21); background-color: rgb(255, 255, 255); font-size: 16px;\">\u003Cstrong>Early Gastric Cancer\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Some very early gastric cancers confined to the mucosa or superficial submucosa and associated with a low risk of lymph node spread can be treated endoscopically.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Common procedures include endoscopic submucosal dissection and, in selected situations, endoscopic mucosal resection.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Pathology after endoscopic treatment determines whether removal is considered curative or whether additional surgery is needed.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(15, 17, 21);  background-color: rgb(255, 255, 255);\">\u003Cstrong>\u003Cspan class=\"\">Resectable Gastric Cancer\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(15, 17, 21);  background-color: rgb(255, 255, 255);\">\u003Cstrong>\u003Cspan class=\"\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For resectable gastric cancer requiring surgery, the goal is complete removal of the tumor together with appropriate regional lymph node dissection.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Depending on tumor location and extent, surgery may involve distal, proximal, or total gastrectomy. Removal of the entire stomach is not necessary for every patient.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For locally advanced resectable disease, surgery alone is generally not sufficient. Perioperative chemotherapy—treatment given both before and after surgery—is an important strategy, with FLOT representing a major modern regimen.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">In East Asian practice, postoperative chemotherapy following adequate D2 gastrectomy is also an established strategy for appropriate stage II or III disease, with regimens such as CAPOX or S-1 supported by clinical trials.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cstrong>Radiation Therapy\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Radiation therapy is not routinely required before or after surgery for every patient with gastric cancer.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Chemoradiation may be considered in selected situations, such as inadequate surgical resection or lymph node dissection, concern about local residual disease, unresectable local disease, or relief of symptoms such as bleeding or pain.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Modern treatment more commonly relies on surgery combined with perioperative or postoperative systemic chemotherapy for appropriately resectable disease.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(15, 17, 21);  background-color: rgb(255, 255, 255);\">\u003Cstrong>\u003Cspan class=\"\">Advanced or Metastatic Gastric Cancer\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(15, 17, 21);  background-color: rgb(255, 255, 255);\">\u003Cstrong>\u003Cspan class=\"\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Treatment of advanced gastric cancer is now strongly influenced by biomarker results rather than chemotherapy alone.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Before first-line therapy, testing for HER2, PD-L1, MMR\u002FMSI, and CLDN18.2 can directly affect treatment selection.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For HER2-negative advanced disease, fluoropyrimidine- and platinum-based chemotherapy remains an important backbone and may be combined with immune checkpoint inhibition in appropriate patients. Pembrolizumab plus chemotherapy is FDA-approved for HER2-negative locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For HER2-positive disease, trastuzumab remains an important targeted therapy. For tumors with PD-L1 CPS of at least 1, pembrolizumab combined with trastuzumab and chemotherapy is FDA-approved as first-line treatment.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For HER2-negative, CLDN18.2-positive locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma, zolbetuximab combined with fluoropyrimidine- and platinum-containing chemotherapy is another first-line option.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cstrong>\u003Cspan style=\"font-size: 16px;\">Supportive Care\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">Supportive care is important throughout gastric cancer treatment, not only at the end of life.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">Patients may experience poor appetite, weight loss, malnutrition, anemia, nausea, or difficulty eating because of the cancer, surgery, or systemic treatment.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">After partial or total gastrectomy, patients may need dietary adjustments and monitoring for deficiencies such as iron or vitamin B12.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">When advanced disease causes bleeding, gastric outlet obstruction, or pain, treatments such as endoscopic stenting, surgical bypass, radiation therapy, or other supportive procedures may be used.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0px;\">\u003Cspan style=\"font-size: 15px;\">Palliative care can be provided together with active anticancer treatment and focuses on symptom relief, nutrition, function, and quality of life.\u003C\u002Fspan>\u003C\u002Fp>","💊",{"author":69,"reviewedBy":69,"lastReviewed":69,"datePublished":69,"citations":91,"disclaimer":69},[],false,1792294354742]