Gastric (Stomach) Cancer
Gastric cancer is more common in our part of the world than in the West — and unfortunately is often diagnosed late, when symptoms have been mistaken for ordinary acidity. Catching it earlier, treating it with a combined plan, and supporting nutrition throughout makes a real difference.
What gastric cancer is — in plain words
Gastric cancer begins in the cells lining the stomach. The most common type, adenocarcinoma, accounts for over 90% of cases. Risk is increased by chronic infection with Helicobacter pylori (a treatable bacterium that lives in the stomach), by a diet high in salt-preserved and smoked foods, by smoking, and by a family history. In South Asia, untreated H. pylori is a major driver.
Signs and symptoms to take seriously
Persistent indigestion
Heartburn or epigastric discomfort that doesn't respond to a few weeks of standard treatment, especially in anyone over 45.
Early satiety
Feeling full after just a few bites of food, when previously you could eat a full meal.
Unintended weight loss
Losing weight without trying, in combination with any digestive symptom, is a red flag.
Vomiting or anaemia
Vomiting blood, dark or black stools, or unexplained iron-deficiency anaemia. Any of these warrants prompt endoscopy.
"If a patient over 45 has had 'gastric trouble' for more than six weeks despite a course of acid suppression, that patient needs an endoscopy. Not another month of tablets — an endoscopy."
How gastric cancer is diagnosed
- Upper GI endoscopy — a flexible camera examines the stomach lining. Biopsies of any suspicious area are taken at the same time.
- CT scan of chest, abdomen and pelvis — for staging and to look for spread.
- Endoscopic ultrasound (EUS) — to assess how deeply the tumour invades the stomach wall and the nearby lymph nodes.
- PET-CT — sometimes used in selected cases to clarify staging.
- Diagnostic laparoscopy — a small operation to look inside the abdomen for tiny peritoneal deposits invisible on scans, often done before deciding on major surgery.
- HER2, PD-L1 and MSI testing — on the biopsy. These results decide whether targeted therapy and immunotherapy are options.
Stages — what the numbers mean
Stage I
Tumour confined to the inner layers of the stomach wall. Surgery alone may cure. Five-year survival can exceed 80%.
Stage II–III
Deeper invasion or lymph node spread. Treated with perioperative chemotherapy plus surgery — curative intent, with five-year survival in the 30–60% range.
Stage IV (metastatic)
Spread to liver, lungs, peritoneum or distant nodes. Not curable, but a combination of chemotherapy with targeted therapy and immunotherapy can give meaningful additional time and symptom control.
Peritoneal disease
A common pattern in our region — small deposits on the peritoneal lining. Needs careful, individualised management.
How we treat gastric cancer
Perioperative chemotherapy
For stage II and III disease, the modern standard is the FLOT regimen (a combination of 5-FU, leucovorin, oxaliplatin and docetaxel) given as four cycles before surgery and four cycles after. This sandwich approach improves survival over surgery alone. Read more about chemotherapy →
Surgery
Either a partial gastrectomy (removing part of the stomach) or a total gastrectomy, depending on the tumour's location and size. The lymph nodes around the stomach are also removed (a D2 lymphadenectomy). This is major surgery and recovery takes time, but most patients return to a normal diet within a few months — eating smaller, more frequent meals.
Targeted therapy
About 15–20% of gastric cancers over-express HER2. For these patients, trastuzumab added to chemotherapy in advanced disease significantly improves outcomes. Newer agents (trastuzumab-deruxtecan, zolbetuximab for CLDN18.2-positive tumours) are expanding the targeted options.
Immunotherapy
Checkpoint inhibitors (pembrolizumab, nivolumab) combined with chemotherapy have become standard first-line treatment for many advanced gastric cancers, especially those with high PD-L1 expression or MSI-high status. Read more about immunotherapy →
Radiation therapy
Used in selected cases, particularly for gastro-oesophageal junction tumours or for palliating bleeding or pain.
Nutritional support
Often the most undervalued part of gastric cancer care. A dietitian's input from day one — through chemotherapy, after surgery, and into long-term follow-up — keeps weight and strength up so that treatment can continue at full dose.
What the outlook honestly looks like
Outcomes depend heavily on the stage at diagnosis. Stage I gastric cancer is highly curable; stage IV is not currently curable but is increasingly controllable for longer than was once possible. The honest message is this: catch it early through prompt endoscopy of persistent symptoms, treat it with a full combined plan, and outcomes are far better than the old reputation suggests.
Screening and prevention
- Test and treat H. pylori in anyone with chronic dyspepsia or a family history of gastric cancer.
- Limit smoked, salted and pickled foods; eat fresh fruits and vegetables regularly.
- Stop smoking — it is a clear and modifiable risk factor.
- Surveillance endoscopy for patients with strong family history or known precursor conditions (intestinal metaplasia, dysplasia).
Life during treatment
Eating well becomes a focused project. After surgery, smaller and more frequent meals work better than three large ones. Iron, vitamin B12 and calcium need long-term supplementation after total gastrectomy. Energy may take six months or more to return after the combined chemotherapy and surgery — that is normal, not a setback.
After treatment — survivorship
Follow-up includes clinic visits, CT scans and attention to nutritional status. Vitamin and mineral monitoring continues for life after gastrectomy. Read about survivorship care →
Endoscopy showed a gastric cancer? Let's plan the next steps.
Bring the biopsy report, the CT scan and your recent blood tests. We will explain the staging, the HER2 and PD-L1 results, and lay out the plan in plain words.
Medically reviewed by
Dr. Rehan Abdullah
Dr. Rehan Abdullah is a dual-trained clinical and radiation oncologist with over a decade of experience treating both solid tumours and hematologic malignancies. He serves as Consultant Oncologist at INMOL Hospital and sees patients at Farooq Hospital and Healthnox Medical Center, Lahore. Read full profile →
This page is patient education, not a substitute for an in-person consultation. Cancer care must be individualised. Read our medical disclaimer →