Stomach Cancer

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with stomach cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with stomach cancer?

In 2023, an estimated 26,500 (15,930 men and 10,570 women) in the United States will be diagnosed with stomach cancer. Worldwide, an estimated 1,089,103 people were diagnosed with the disease in 2020. Stomach cancer is the fifth most commonly diagnosed cancer in the world.

It is estimated that 11,130 deaths (6,690 men and 4,440 women) from this disease will occur in the United States in 2023. In 2020, an estimated 768,793 people died from stomach cancer worldwide. Globally, it is the fourth leading cause of cancer deaths.

About 60% of people who are diagnosed with stomach cancer in the United States are older than age 64. The average age of diagnosis is 68.

The incidence of stomach cancer varies in different parts of the world. In the United States, incidence rates dropped by 1.5% annually in the last decade. Part of this decline may be due to the use of infection-treating antibiotics. These medicines can kill H. pylori (see Risk Factors ). However, stomach cancer is still one of the most common cancer types and one of the top causes of cancer deaths worldwide.

What is the survival rate for stomach cancer?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from stomach cancer. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with stomach cancer are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with stomach cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative U.S. survival rate for people with stomach cancer is 33%. This statistic reflects the fact that 62% of people with stomach cancer are diagnosed after the cancer has already spread, either regionally or distantly, beyond the location it began.

If stomach cancer is found before it has spread, the 5-year relative survival rate is generally higher but depends on the stage of the cancer found during surgery. The survival rates for stomach cancer also vary based on a person’s age and general health, and how well the treatment plan works.

If the cancer is diagnosed and treated before it has spread outside the stomach, the 5-year relative survival rate is 72%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year relative survival rate is 33%. If the cancer has spread to a distant part of the body, the 5-year relative survival rate is 6%.

Experts measure relative survival rate statistics for stomach cancer every 5 years. This means the estimate may not reflect the results of advancements in how stomach cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics .

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2023, the ACS website, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program (All sources accessed March 2023.)

The next section in this guide is Medical Illustrations . It offers drawings of the body parts often affected by stomach cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about the factors that increase the chance of developing stomach cancer. Use the menu to see other pages.

What are the risk factors for stomach cancer?

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing stomach cancer:

• Age. Stomach cancer occurs most commonly in people older than 55. Most people diagnosed with stomach cancer are in their 60s and 70s.

• Sex. Men are twice as likely to develop stomach cancer as women.

• Bacteria. A common bacterium called Helicobacter pylori , also called H. pylori, causes stomach inflammation and ulcers. It is also considered one of the main causes of stomach cancer. Testing for H. pylori is available and an infection can be treated with antibiotics. Testing for H. pylori is recommended if you have had a first-degree relative, such as a parent, sibling, or child, who has been diagnosed with stomach cancer or an H. pylori infection. Other family members could have it as well, and the infection should be treated if found.

• Family history/genetics. People who have a parent, child, or sibling who has had stomach cancer have a higher risk of the disease. In addition, certain inherited genetic disorders, such as hereditary diffuse gastric cancer , Lynch syndrome , hereditary breast and ovarian cancer (HBOC) , and familial adenomatous polyposis (FAP) may increase the risk of stomach cancer. Learn more about genetics and cancer .

• Race/ethnicity. Stomach cancer is more common in Black, Hispanic, and Asian people than in White people.

• Diet. Eating a diet high in salt has been linked to an increased risk of stomach cancer. This includes foods preserved by drying, smoking, salting, or pickling and foods high in added salt. Eating fresh fruits and vegetables may help lower the risk.

• Previous surgery or health conditions. People who have had stomach surgery, pernicious anemia, or achlorhydria have a higher risk of stomach cancer. Pernicious anemia happens when the stomach cannot take in enough vitamin B12. This causes a severe decrease in red blood cells. Achlorhydria is when there there is no hydrochloric acid in the gastric juices, which help digest food.

• Occupational exposure. Exposure to certain dusts and fumes may increase the risk of developing stomach cancer.

• Tobacco and alcohol. Tobacco use and drinking a lot of alcohol may increase the risk of developing stomach cancer.

• Obesity. Excess body weight increases a man’s risk of developing stomach cancer. It is not clear whether obesity increases a woman’s risk of stomach cancer.

The next section in this guide is Symptoms and Signs . It explains the body changes or medical problems that stomach cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How stomach cancer is diagnosed

There are different tests used for diagnosing stomach cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose stomach cancer:

• Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

• Biomarker testing of the tumor . Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options.

  For stomach cancer, testing may be done for PD-L1 and high microsatellite instability (MSI-H), which may also be called a mismatch repair deficiency. Testing can also be done to determine if the tumor is making too much of a protein called human epidermal growth factor receptor 2 (HER2), particularly if the cancer is more advanced. The results of these tests help doctors find out if immunotherapy is a treatment option (see Types of Treatment ).

• Endoscopy. An endoscopy allows the doctor to see the inside of the body with a thin, lighted, flexible tube called a gastroscope or endoscope. The person may be sedated as the tube is inserted through the mouth, down the esophagus, and into the stomach and small bowel. Sedation is giving medication to become more relaxed, calm, or sleepy. The doctor can remove a sample of tissue as a biopsy during an endoscopy and check it for signs of cancer.

• Endoscopic ultrasound. This test is similar to an endoscopy, but the gastroscope has a small ultrasound probe on the end. An ultrasound uses sound waves to create a picture of the internal organs. An ultrasound image of the stomach wall helps doctors determine how far the cancer has spread into the stomach and nearby lymph nodes, tissue, and organs, such as the liver or adrenal glands.

• X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

• Barium swallow. In a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is usually given both as a liquid to swallow and an injection into a patient's vein.

• Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein.

• Positron emission tomography (PET) or PET-CT scan. A PET scan creates pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the patient’s vein. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

• Laparoscopy. A laparoscopy is a minor surgery in which the surgeon inserts a thin, lighted, flexible tube called a laparoscope into the abdominal cavity. It is used to find out if the cancer has spread to the lining of the abdominal cavity or liver. A CT or PET scan cannot often find cancer that has spread to these areas.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with stomach cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for stomach cancer. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for stomach cancer in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How stomach cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include other health care professionals, including physicians, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists and others. Learn more about the clinicians who provide cancer care.

People with stomach cancer may work with doctors in different specialties. This team can include the following specialists.

• Gastroenterologist: a doctor who specializes in the gastrointestinal tract including the stomach and intestines

• Surgeon or surgical oncologist: a doctor who specializes in treating cancer using surgery

• Medical oncologist: a doctor who specializes in treating cancer with medication

• Radiation oncologist: a doctor who specializes in giving radiation therapy to treat cancer

• Pathologist: a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease

• Radiologist: a medical doctor who specializes in using imaging tests to diagnose disease

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Often, a combination of treatments is used to treat stomach cancer.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. It can be difficult to cure stomach cancer because it is often not found until it is at an advanced stage. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for stomach cancer because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for stomach cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

READ MORE BELOW:

• Surgery

• Radiation therapy

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Physical, social, and emotional effects of cancer

• Metastatic stomach cancer

• Remission and the chance of recovery

• If treatment does not work

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. The type of surgery used depends on the stage of the cancer (see Stages ).

For a very early stage (T1a) cancer, some doctors may recommend a non-surgical treatment called an endoscopic mucosal resection. This is the removal of the tumor with an endoscope (see Diagnosis ).

In early stages (stages 0 or I), when the cancer is still only in the stomach, surgery is used to remove the part of the stomach with cancer and nearby lymph nodes. This is called a subtotal or partial gastrectomy. In a partial gastrectomy, the surgeon connects the remaining part of the stomach to the esophagus or small intestine.

If the cancer has spread to the outer stomach wall with or without having spread to the lymph nodes, surgery plus chemotherapy or chemotherapy and radiation therapy may be used (see below). The surgeon can perform a subtotal gastrectomy or a total gastrectomy, which is the removal of all of the stomach. During a total gastrectomy, the surgeon attaches the esophagus directly to the small intestine.

Gastrectomy is a major surgery and can have serious side effects. After this surgery, the patient will only be able to eat a small amount of food at a time. A common side effect is a group of symptoms called "dumping syndrome," which includes cramps, nausea, diarrhea, and dizziness after eating. This happens when food enters the small intestine too fast. The doctor can suggest ways to avoid this and can prescribe medication to help control these symptoms. The symptoms usually lessen or disappear in a few months, but they may be permanent for some people.

Patients who have had their entire stomach removed may need regular supplements of vitamin B12 because they may have trouble absorbing this essential vitamin through their stomach. B12 can be given as an injection or it is available as a lozenge that can be absorbed under the tongue, called sublingual B12.

Regional lymph nodes are often removed during surgery because the cancer may have spread to those lymph nodes. This is called a lymphadenectomy.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Also be sure to ask what to expect during your recovery. Learn more about the basics of cancer surgery .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. People with stomach cancer usually receive external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.

Side effects from radiation therapy include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Talk with your radiation oncologist about the possible side effects you may experience and your recovery period.

Learn more about the basics of radiation therapy .

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for stomach cancer include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce cancer-related symptoms. It also may be combined with radiation therapy. Currently, there is no single standard chemotherapy treatment regimen that is used worldwide. However, most chemotherapy treatments for stomach cancer are based on combinations of the following drugs:

• Cisplatin (available as a generic drug)

• Oxaliplatin (Eloxatin)

• Fluorouracil (5-FU, Efudex)

Other drugs used include:

• Capecitabine (Xeloda)

• Docetaxel (Taxotere)

• Irinotecan (Camptosar)

• Paclitaxel (Taxol)

• Ramucirumab (Cyramza)

• Trastuzumab deruxtecan (Enhertu)

• Trifluridine/tipiracil (Lonsurf)

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy .

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments .

Targeted therapy for stomach cancer includes:

• HER2-targeted therapy. Some cancers may make too much of a protein called human epidermal growth factor receptor 2 (HER2). This type of cancer is called "HER2-positive cancer." Trastuzumab (Herceptin, Herzuma, Ogivri, Ontruzant) plus chemotherapy may be an option for people with later-stage HER2-positive stomach cancer. The U.S. Food and Drug Administration (FDA) has also approved a drug called fam-trastuzumab deruxtecan-nxki (Enhertu, Daiichi Sankyo) for use if trastuzumab is no longer effective. For previously untreated stomach cancer that is HER2 positive and is either metastatic or cannot be removed with surgery, the American Society of Clinical Oncology (ASCO) recommends trastuzumab combined with pembrolizumab (see below) and chemotherapy. Trastuzumab deruxtecan is recommended for people with HER2-positive stomach cancer if first-line therapy, or the first treatment given, has not worked.

• Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. For patients whose tumor has grown while receiving initial chemotherapy, the drug ramucirumab (Cyramza) may be an additional option and may be given either in combination with paclitaxel or by itself. Learn more about anti-angiogenesis therapy .

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells.

For people with advanced HER2-negative, PD-L1-positive stomach cancer, ASCO recommends treatment with the immunotherapy nivolumab (Opdivo) in combination with chemotherapy. Nivolumab is a type of immunotherapy called an immune checkpoint inhibitor that helps the body’s immune system target and destroy cancer cells.

For patients with advanced stomach cancer, that is high microsatellite instability (MSI-H) (see Diagnosis ), pembrolizumab (Keytruda), nivolumab, and dostarlimab (Jemperli) are options when chemotherapy does not work.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, hypothyroidism, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns .

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Metastatic stomach cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer (also called "stage IV", described in the Stages section). If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

The goal of treatment at this stage is typically to lengthen a patient’s life and care for the symptoms of the cancer since metastatic stomach cancer is not considered curable. Any treatment, including chemotherapy or radiation therapy, is considered palliative therapy . Surgery is rarely used, and the main treatment is usually chemotherapy. It is important to note that studies show that the use of palliative chemotherapy for stomach cancer can improve both the length and quality of life.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recovery

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, immunotherapy, targeted therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent stomach cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about stomach cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials . Always talk with your doctor about the best diagnostic and treatment options for you.

• Chemoprevention. Chemoprevention is the use of drugs or nutrients to lower a person’s risk of developing cancer. Early research suggests that using antibiotics to treat H. pylori infections (see Risk Factors ) can prevent changes to stomach cells that may lead to cancer.

• Combination therapy. The combination of chemotherapy, radiation therapy, and surgery may reduce the chance that stomach cancer will return. Doctors may give chemotherapy before surgery, called neoadjuvant therapy, or after surgery, called adjuvant therapy. In addition, doctors may also combine radiation therapy and chemotherapy after surgery. Doctors are also looking at giving both radiation therapy and chemotherapy before surgery.

• Newer chemotherapy treatments. Chemotherapy with multiple combinations of drugs is being increasingly used for people with stomach cancer. Drug combinations work slightly better than single drugs. As outlined in the Types of Treatment section, drugs such as 5-FU, paclitaxel, docetaxel, irinotecan, oxaliplatin, as well as oral medications such as capecitabine are being studied in combination with other types of chemotherapy.

• Molecular testing of the tumor . Researchers are looking at the genetic changes in tumor cells to identify specific genes, proteins, and other factors unique to the tumor. Patients with different types of tumors with the same genetic change are able to participate in clinical trials, called “basket trials” , with the goal of finding treatments that target that genetic change.

• Targeted therapy. Previous research has shown that several types of targeted therapy do not work well for stomach cancer. These include drugs that target the gene c-MET , bevacizumab (Avastin, Mvasi), and drugs that block epidermal growth factor receptor (EGFR). However, research continues on this type of treatment approach (see Molecular testing of the tumor, above).

• Immunotherapy. Immunotherapy is an expanding area of research for stomach cancer. Researchers are looking at different types of immunotherapy that block the CTLA4 and/or PD-1 pathways. A tumor can use these pathways to hide from the body’s immune system. Immunotherapy that blocks these pathways allow the immune system to identify and destroy the cancer.

• Palliative and supportive care . Clinical trials are underway to find better ways of reducing symptoms and side effects of current stomach cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in stomach cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Visit the Cancer.Net Blog to read about research announced in ASCO's Clinical Cancer Advances report from 2021 .

• Listen to a podcast from ASCO experts discussing highlights from 2022 Congress of the European Society for Medical Oncology (ESMO).

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. People who have had their entire stomach removed can feed themselves, but it is important for them to re-learn how to eat after this major surgery. Learn more about cancer rehabilitation .

Learn more about the importance of follow-up care .

Watching for recurrence

A goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What is my diagnosis? What does this mean?

• What stage is the cancer?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What types of research are being done for stomach cancer in clinical trials? Do clinical trials offer additional treatment options for me?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• What are the possible side effects of this treatment, both in the short term and the long term?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities? Will my eating habits need to change?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• What type of surgery will I have? Will lymph nodes be removed?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy, chemotherapy, targeted therapy, or immunotherapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term effects of having this treatment?

• What can be done to relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• When should I return to my primary care doctor for regular medical care?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.