Prepared by Aktif International Hospital Editorial Board .

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What you need to know about stomach cancer

Stomach cancer can be difficult to recognize because, especially in its early stages, it may mimic common digestive complaints. Symptoms such as indigestion, discomfort in the stomach area, or changes in appetite do not always indicate cancer. However, if these complaints persist, become more noticeable, or are accompanied by findings such as weight loss and anemia, it is appropriate to undergo a comprehensive medical evaluation under the supervision of a specialist physician.

For people diagnosed with stomach cancer and their relatives, the uncertainty surrounding the condition can be exhausting and emotionally challenging. During this process, the type of cancer, how it has spread, the person’s overall health, and the goals of treatment are considered together. The current approach is to plan the entire process, from diagnosis through post-treatment follow-up, through collaboration among gastroenterology, pathology, radiology, medical oncology, general surgery, and, when necessary, nutrition specialists.

What is stomach cancer?

Stomach cancer refers to the presence of malignant tumors that begin in the cells lining the inner surface of the stomach. The majority of cases belong to a group known as adenocarcinomas. These tumors can develop in different parts of the stomach and may have different biological behaviors. Less common types, including lymphomas, gastrointestinal stromal tumors, and neuroendocrine tumors, require different diagnostic and treatment approaches.

In addition to the location of the tumor within the stomach, several other factors can influence the course of the disease. Among the most important are how deeply the tumor has grown into the stomach wall, whether it has reached nearby lymph nodes, and whether it has spread to distant organs. Pathological examinations may also investigate biological characteristics such as HER2, PD-L1, and microsatellite instability. The information obtained from these assessments can help determine whether targeted therapies or immunotherapy may be appropriate for certain patients and guide the development of an individualized treatment plan.

Which symptoms require medical evaluation?

In patients with early-stage disease, stomach cancer may not cause noticeable symptoms. When symptoms do occur, they may resemble those associated with stomach ulcers, reflux, gastritis, or other digestive disorders. For this reason, it is not appropriate to draw conclusions based on a single symptom without medical evaluation. Information such as how long the symptoms have been present, their severity, and whether other findings accompany them should be assessed by a specialist physician.

It is particularly important to seek medical evaluation without delay if any of the following occur:

Unexplained weight loss, loss of appetite, or feeling full after eating only a small amount
Persistent stomach pain, indigestion, nausea, or difficulty swallowing
Black stools, blood in vomit, or iron deficiency anemia
Significant fatigue, recurrent vomiting, or abdominal bloating

Many of these symptoms may also occur for reasons unrelated to stomach cancer. Regardless of the cause, it is extremely important that people with persistent complaints, newly developed symptoms, or a family history of stomach cancer do not delay medical evaluation.

Risk factors and a realistic approach to prevention

Some of the factors that may contribute to an increased risk of developing stomach cancer include the following:

Helicobacter pylori infection: This infection is an important risk factor associated with long-term inflammation of the stomach lining and certain precancerous changes. In appropriate patients, identifying and treating the infection may form part of risk management.
Diet and lifestyle: Smoking, diets high in excessively salty or smoked foods, high consumption of processed meats, and certain occupational or environmental exposures may increase the risk.
Genetic predisposition and family history: Having stomach cancer in the family does not necessarily mean that every family member has a hereditary cancer syndrome. However, genetic counseling may need to be considered in situations such as:
- Stomach cancer occurring in more than one close relative
- Diagnosis at a young age
- The presence of other types of cancer in the family, such as breast, ovarian, or colorectal cancer

Preventing the disease cannot be reduced to a single measure that provides absolute protection. However, several meaningful steps can be taken to reduce risk:

Avoiding smoking
Following a balanced diet that includes fresh vegetables and fruits
Reducing unnecessary salt and processed food consumption
Not ignoring persistent stomach complaints and having them evaluated by a specialist
For people at higher risk, follow-up and screening plans should always be individualized.

How does the diagnosis of stomach cancer proceed?

One of the most valuable examinations when stomach cancer is suspected is upper gastrointestinal endoscopy. During this procedure, the physician directly examines the esophagus, stomach, and duodenum using a thin, flexible camera. If a suspicious area is identified during the examination, a biopsy can be taken. A definitive diagnosis is established when the biopsy sample is examined by a pathologist.

Once the diagnosis is confirmed, the next essential step is determining the stage of the disease. Computed tomography, and in some cases endoscopic ultrasonography, magnetic resonance imaging, or PET-CT, may be used. Not every patient requires all of these tests. The necessary examinations are determined according to the location of the tumor, the initial findings, and the specific clinical question that needs to be answered.

The pathology report is central to treatment planning. In addition to the type and grade of the tumor, molecular test results may also be evaluated when necessary. Accurate sampling and evaluation by an experienced pathology team play a critical role in determining the most appropriate treatment options.

What are the treatment options for stomach cancer?

The treatment plan varies according to the stage of the disease. In early-stage disease, very superficial tumors that meet specific criteria may be removed using endoscopic techniques. Whether this option is considered safe depends on factors such as the size and depth of the tumor, its cellular characteristics, and the risk of spread to the lymph nodes.

In localized disease, surgery is one of the main components of treatment. Depending on the location of the tumor, part or all of the stomach may be removed. Appropriate removal of the relevant lymph nodes during surgery is important both for controlling the disease and for accurate staging. The extent of the surgical procedure is planned individually, with the aim of achieving oncological safety while preserving the best possible functional outcome.

Some patients may receive chemotherapy before and after surgery. This approach aims to reduce the risk of microscopic disease that cannot be detected on imaging and to improve treatment outcomes. The decision regarding treatment after surgery is reassessed based on the pathology results and the person’s recovery. Radiotherapy may be included in the treatment plan in certain clinical situations, although it is not routinely required for every patient.

When the disease has spread beyond the stomach, treatment generally aims to control the cancer, prolong survival, and reduce symptoms. Chemotherapy, targeted therapies, and immunotherapy may be considered in patients with appropriate biomarkers. The expected benefits of these treatments, their possible side effects, and the person’s priorities should be discussed clearly.

How should follow-up and monitoring be managed after treatment?

Completing active treatment for stomach cancer, including surgery, chemotherapy, or radiotherapy, does not mean that the care process has ended. Follow-up after treatment is critically important both for detecting a possible recurrence of the disease at an early stage and for managing side effects that may develop as a result of treatment.

Follow-up appointments may generally be scheduled more frequently during the first two to three years, often every three to six months, and may later be reduced to once a year depending on the patient’s individual condition. Key evaluations during this period may include:

Clinical examination and physical assessment: Under a physician’s supervision, the patient’s overall health, weight changes, and any newly developed symptoms are evaluated.
Blood and biochemical tests: A complete blood count, liver and kidney function tests, and, when considered appropriate, tumor markers such as CEA and CA 19-9 may be monitored.
Imaging methods: Computed tomography or ultrasonography may be performed at intervals determined by the physician to evaluate the abdomen and lungs for possible recurrence.
Periodic endoscopy: Follow-up endoscopy may be planned at certain intervals to evaluate the remaining stomach tissue or surgical connection sites after surgery.

If new symptoms such as loss of appetite, rapid weight loss, difficulty swallowing, or abdominal pain develop between follow-up appointments, the patient should contact the physician responsible for their follow-up without waiting for the next scheduled appointment.

Nutrition, recovery and quality of life

A patient’s nutritional habits may change after stomach surgery or systemic treatments. Particularly when the stomach has been partially or completely removed, smaller and more frequent meals, adequate protein intake, and appropriate fluid consumption may be necessary. Levels of vitamin B12, iron, folate, vitamin D, and calcium should be monitored. When required, nutritional support is an integral part of treatment.

After surgery, rapid emptying of food from the stomach may cause palpitations, sweating, abdominal cramps, or diarrhea. This condition, known as dumping syndrome, can often be managed through changes in meal composition and eating habits. However, not every symptom experienced by the patient should automatically be considered part of the expected recovery process. New, worsening, or daily-life-limiting symptoms should be discussed with the physician.

Psychological support is another highly valuable part of the treatment process. A cancer diagnosis is not only a physical experience but also one with emotional and social effects. Active participation by the patient in treatment decisions, appropriate support from relatives, and assistance from mental health professionals when necessary may help improve quality of life.

If you have persistent stomach-related symptoms, the safest approach is to have them clarified through an evaluation by a specialist rather than trying to interpret them on your own, particularly through internet searches. Early and accurate diagnosis can make a significant difference by allowing treatment options to be planned without unnecessary delay.

Recommendations from our doctors at the Aktif International Hospital Oncology Unit

We asked our physicians what can be done both in the fight against stomach cancer and during the prevention process. We have summarized the key recommendations that our doctors particularly want to share with patients and their relatives:

Do not postpone evaluation of persistent stomach complaints: If stomach discomfort lasts for several weeks or longer, do not dismiss it as “just gastritis” or “ordinary indigestion.” Consult a gastroenterology or general surgery specialist. Diagnosis at an early stage can have a significant impact on treatment outcomes.
Avoid unproven treatments: Herbal supplements or so-called “cancer-fighting” remedies recommended on social media or by people around you without scientific evidence may interact with your ongoing medical treatments, particularly chemotherapy drugs, and may damage the liver or kidneys. Do not use any additional products without consulting your physician.
Do not hesitate to seek a second opinion: Cancer diagnosis and treatment planning are complex processes. As your treatment plan becomes clearer, openly discuss all of your questions with your physician and, when you consider it necessary, do not hesitate to seek a second opinion from centers that provide a multidisciplinary tumor board approach.
Maintain strong communication with your physician: Share even seemingly minor side effects experienced during or after treatment, such as nausea, loss of appetite, fatigue, or emotional distress, with your doctor. Modern medicine offers supportive treatments that can help manage many of these side effects and improve comfort during treatment.
Take a comprehensive approach to the process: Cancer treatment is not limited to surgery or medication. To support your overall treatment process, work with a nutrition specialist to help maintain an appropriate weight and consider psychological support to strengthen emotional resilience.