Keep Stomach Cancer Away®

H. pylori — the part you can actually act on

Helicobacter pylori is a bacterium that lives in the stomach lining, infects a large share of the world's population, usually causes no symptoms, and is the leading modifiable cause of stomach cancer. Chronic infection causes inflammation that, over decades, can progress toward cancer.

It can be detected with a breath test, stool test or biopsy, and eradicated with one to two weeks of antibiotics plus acid suppression. Treating it reduces stomach cancer risk — and the benefit is greatest when it is treated before advanced changes have developed.

Who should consider testing: people with persistent indigestion or ulcers, those with a first-degree relative who had stomach cancer, people who have had a stomach lesion removed, and those from regions where both infection and stomach cancer are common — including many Asian, Hispanic, Eastern European and Central American communities. If a parent or sibling had stomach cancer, ask about being tested.

Universal population testing is not standard in the U.S., but targeted testing of higher-risk groups is a genuine prevention opportunity that is often missed.

Who is at risk

• H. pylori infection — the single most important modifiable cause.
• Diet — heavy in salted, smoked, pickled or processed foods; low in fresh fruit and vegetables.
• Smoking, which roughly doubles risk, and heavy alcohol.
• Age and sex — most common after 60 and more common in men.
• Race, ethnicity and geography — incidence is substantially higher among American Indian/Alaska Native, Black, Asian/Pacific Islander and Hispanic Americans than among non-Hispanic White Americans. This is a real and under-discussed disparity.
• Prior stomach conditions — chronic atrophic gastritis, intestinal metaplasia, pernicious anaemia, stomach polyps, or previous stomach surgery.
• Family history, and inherited syndromes — hereditary diffuse gastric cancer (CDH1 mutation), Lynch syndrome, and familial adenomatous polyposis.
• Obesity, particularly for cancers near the junction with the oesophagus.

Finding it early

The United States has no population screening programme for stomach cancer, because it is relatively uncommon here. Japan and South Korea, where it is far more common, do screen with endoscopy — and they detect it far earlier as a result. That contrast is worth knowing if your family comes from a high-incidence region.

Symptoms are notoriously vague and easily attributed to indigestion: persistent indigestion or burning, feeling full after small amounts, nausea, unintentional weight loss, vague upper abdominal discomfort, tiredness from anaemia, and later vomiting or difficulty swallowing. Black tarry stools or vomiting blood need immediate assessment.

The practical rule: new, persistent upper abdominal symptoms in an adult over 50 — or at any age with weight loss, anaemia, difficulty swallowing or vomiting — warrant endoscopy rather than an indefinite trial of acid-suppressing tablets. Those tablets can mask symptoms while the underlying problem progresses.

People with CDH1 mutations (hereditary diffuse gastric cancer) are managed very differently, with surveillance and often preventive removal of the stomach — a drastic-sounding step that is genuinely life-saving in that specific group.

How it’s diagnosed

Upper endoscopy with biopsy is the definitive test. Staging then uses CT of the chest, abdomen and pelvis, often PET/CT, and endoscopic ultrasound to judge depth of invasion.

Staging laparoscopy — a keyhole look inside the abdomen — is often done before major surgery, because small deposits on the abdominal lining are frequently invisible on scans and would change the plan entirely.

Molecular testing is essential and sometimes skipped: HER2, PD-L1, mismatch repair/MSI and CLDN18.2 status all determine which drugs can be used. Ask for these results.

Staging explained simply

The stomach wall is layered, so depth of invasion and the number of lymph nodes involved drive stage. A thorough lymph node dissection at surgery (D2 lymphadenectomy) both stages accurately and improves outcomes — another reason surgical experience matters here.

Grading and biology

Graded by how abnormal the cells appear, but the more useful division is intestinal type (often related to H. pylori and diet, forms a discrete mass, more common in older patients) versus diffuse type (spreads through the wall without forming a clear mass, occurs in younger patients, includes signet-ring cell cancer, and carries a worse outlook). Diffuse type is the one associated with CDH1 mutations.

Linitis plastica — diffuse infiltration making the whole stomach rigid — is a particularly difficult form.

Molecular subgroups now guide treatment: HER2-positive cancers receive HER2-targeted therapy; MSI-high cancers respond well to immunotherapy and may need less chemotherapy; CLDN18.2-positive cancers have a newer targeted option.

How it’s treated

Very early cancers confined to the lining can sometimes be removed endoscopically, preserving the stomach.

Surgery — partial or total removal of the stomach with a thorough lymph node dissection — is the main curative treatment. Outcomes are better at centres that perform this operation regularly.

Chemotherapy before and after surgery (perioperative) is now standard for most locally advanced disease, and improves cure rates over surgery alone.

Radiation has a defined but secondary role in stomach cancer, and we would rather be precise about that than overstate it. It is used with chemotherapy after surgery when lymph node dissection was limited or margins were positive, sometimes before surgery for cancers at the junction with the oesophagus, and for symptom control — particularly bleeding, which radiation stops effectively, and pain or obstruction.

Advanced disease is treated with chemotherapy plus immunotherapy or targeted therapy chosen by molecular profile.

Where CureRays fits: selective — adjuvant chemoradiation in specific situations, junction tumours, and symptom control. Your surgeon and medical oncologist lead this one.

What the guidelines say

In broad strokes: test and treat H. pylori in appropriate groups; diagnose by endoscopy with biopsy; stage with CT, PET/CT, endoscopic ultrasound and often staging laparoscopy; treat early lesions endoscopically; give perioperative chemotherapy around gastrectomy with adequate lymph node dissection; use chemoradiation selectively after inadequate nodal dissection or positive margins; and test every tumour for HER2, PD-L1, mismatch repair and CLDN18.2 to guide therapy in advanced disease.

Your team will follow national guidelines such as those from the National Comprehensive Cancer Network (NCCN). The above is a plain-language overview of the general approach, not the guideline itself. NCCN publishes free NCCN Guidelines for Patients®.

Outcomes and odds of cure

Source: NCI SEER Cancer Stat Facts: Stomach Cancer, SEER 21 (excluding IL), 2016–2022. Overall 5-year relative survival is 39.8%. In 2026 an estimated 31,510 people will be diagnosed and about 10,740 will die of it.

These are population statistics from the National Cancer Institute's SEER program. They describe large groups of people, not any one person, and lag current treatment by several years. They cannot predict what will happen to you.

The spread between 78.1% for localized disease and 8.1% once it has spread is the whole argument for taking persistent upper abdominal symptoms seriously — and for H. pylori testing in higher-risk groups.

Two trends, pointing different ways: overall survival has improved substantially (roughly 15% in the 1970s to about 40% now) and death rates are falling about 2.0% a year, but new cases have been rising about 1.1% a year (SEER, through 2024). The disparities are stark too — incidence among American Indian/Alaska Native men (15.9 per 100,000) is roughly double that among non-Hispanic White men (7.6).

Side effects and how we watch for them

After gastrectomy, eating changes permanently. Expect small frequent meals, early fullness, and often dumping syndrome — cramping, sweating, palpitations and diarrhoea after eating, particularly sugary foods. It is manageable with dietary changes, and it is far easier to handle if you were warned it was coming.

Long-term nutritional deficiencies are expected, not exceptional: vitamin B12 (usually requiring lifelong injections after total gastrectomy), iron, calcium and vitamin D. These should be monitored on a schedule — ask who is checking them.

Chemotherapy: nausea, fatigue, low counts, and neuropathy with platinum drugs — report tingling early. Radiation to the upper abdomen causes nausea and fatigue, with the kidneys, liver and small bowel deliberately protected in planning.

How it is assessed: graded at each visit on a standard scale, with weight and nutritional bloods tracked. Report black stools, vomiting blood, inability to keep fluids down or new severe pain urgently.

Follow-up, remission and survivorship

Remission means no detectable cancer. Most recurrences occur within two to three years, so follow-up is closest then — clinical review, imaging, endoscopy where appropriate, and nutritional bloods.

Survivorship after stomach surgery is mostly about nutrition, and it needs active management rather than endurance: dietitian input, B12 and iron monitoring, bone density, and managing dumping syndrome. Weight loss is common and should prompt help rather than resignation.

If your cancer was diffuse type or you have a family history, ask about genetic counselling — CDH1 mutations have major implications for relatives, who may be offered surveillance or preventive surgery.

Questions people actually ask

Informational only, not medical advice — confirm with your care team.

Go deeper on stomach cancer

Read the full plain-language guide, or ask us where radiation fits in your treatment.

Full stomach cancer guide