Gastric Cancer
Basics
Description
- Malignant neoplasm occurring in the stomach
- Infiltration to lymph nodes, omentum, lungs, and liver is rapid.
- Uncommon in U.S. natives
- Synonym(s): linitis plastica (“leather bottle stomach”)
Pediatric Considerations
Rare
Pregnancy Considerations
- Rarely diagnosed during pregnancy
- Prognosis is poor.
Epidemiology
- Predominant age: >55 years (2/3 are >65 years)
- Predominant gender: male > female (1.7:1)
- Incidence is decreasing globally but remains the fifth most common malignancy and the third leading cause of cancer death worldwide.
Incidence
- 5.9/100,000 males (North America)
- 2.5/100,000 females (North America)
- 24,590 new cases per year (United States)
Etiology and Pathophysiology
Helicobacter pylori–associated gastric cancers are associated with interactions between bacterial virulence factors and host inflammatory responses.
Genetics
- More common in people with blood group A
- 2 to 4 times more common in first-degree relatives
- 1–3% of gastric cancers are associated with inherited gastric cancer predisposition syndromes (hereditary diffuse gastric cancer [CDH1] gene).
- Amplification or overexpression of the HER2 protein is associated with some gastric cancers.
Risk Factors
- H. pylori infection is primary risk in 65–80%.
- Smoking/tobacco abuse is second leading risk factor.
- Diet rich in additives (e.g., smoked, pickled, or salted foods; highly spiced foods), nitrates, and nitrites have been implicated.
- Atrophic gastritis/intestinal metaplasia
- Pernicious anemia
- Preexisting diabetes mellitus
- Overweight and obesity: Strength of association increases with increasing body mass index (BMI).
- Certain hereditary syndromes (familial adenomatous polyposis, hereditary nonpolyposis colon cancer, Peutz-Jeghers syndrome)
- Barrett esophagus
- Patients in lower socioeconomic status have higher risk of gastric cancer.
- Low consumption of fruits and vegetables
- Ethnicity: Hispanic, Japanese, Chilean, Costa Rican
- Migrants from high-incidence areas (e.g., Iceland, Chile, or Japan) to low-incidence areas maintain an increased risk, whereas their offspring have an occurrence rate that corresponds to that of the new location.
General Prevention
- Avoid tobacco, engage in regular exercise, maintain optimal body weight, and maintain a healthy diet.
- Diets that include 5 to 20 servings of both fruits and vegetables each week reduce the risk of gastric malignancy by ~50%.
- Insufficient data to recommend routine gastric cancer screening
- Screening to identify and eradicate H. pylori may reduce the risk. The impact may be greatest with increasing age and in high-prevalence areas.
Commonly Associated Conditions
- Giant hypertrophic gastritis (Ménétrier disease)
- Intestinal metaplasia
- Atrophic gastritis
- H. pylori infection
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Citation
Domino, Frank J., et al., editors. "Gastric Cancer." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer.
Gastric Cancer. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer. Accessed October 15, 2024.
Gastric Cancer. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer
Gastric Cancer [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 15]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer.
* Article titles in AMA citation format should be in sentence-case
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T1 - Gastric Cancer
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ED - Baldor,Robert A,
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BT - 5-Minute Clinical Consult, Updating
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