Stomach cancer

Also called Gastric cancer

Symptoms that look exactly like indigestion, which is why it is usually found late. Persistent indigestion over 55 is a referral, not a prescription.

What it is

Cancer of the stomach lining. Rates in the UK have fallen substantially over decades, largely because of less Helicobacter pylori infection and better food preservation, but it remains a cancer that is usually diagnosed late.

The reason is the symptoms. Indigestion, feeling full quickly, and mild upper abdominal discomfort are extremely common and almost always benign, so both patients and clinicians treat them as such. Persistent acid suppression relieves the symptom and can mask the disease.

The main risk factors are H. pylori infection, smoking, a diet high in salted and processed foods, pernicious anaemia, previous stomach surgery, and family history. A small proportion are hereditary, linked to the CDH1 gene, where relatives may be offered preventive surgery.

The referral rule worth knowing is straightforward: new dyspepsia in anyone over 55 that persists despite treatment warrants endoscopy, and any age with alarm features warrants urgent endoscopy.

Treatment is usually surgery with chemotherapy, and eating changes permanently afterwards, which is why nutrition support is central rather than optional.

Signs you might notice

Persistent indigestion, heartburn or upper abdominal discomfort that does not settle.

Feeling full very quickly when eating.

Loss of appetite and unintentional weight loss.

Nausea and vomiting, sometimes vomiting blood or material like coffee grounds.

Black tarry stools.

Difficulty swallowing. See oesophageal cancer.

Tiredness and breathlessness from anaemia, often the first thing found on a blood test.

Urgent: difficulty swallowing, vomiting blood, black stools, a lump in the upper abdomen, or weight loss with indigestion.

Over 55 with persistent indigestion despite treatment: ask for endoscopy.

How it can affect day-to-day life

After stomach surgery, eating changes for good: small frequent meals, and often dumping syndrome, where food passes too quickly and causes sweating, palpitations, cramps and diarrhoea after eating. It is manageable with dietary changes and is rarely explained well.

Vitamin B12 injections are needed for life after total gastrectomy, because the stomach makes the factor required to absorb it. Missing this causes B12 deficiency with neurological damage, and it is a known gap after discharge.

Weight loss is common and consequential; a dietitian should be involved from diagnosis.

The speed from vague symptom to major diagnosis is disorienting for families and rarely paced to what they can absorb.

Supporting someone well

For persistent indigestion over 55, ask for endoscopy rather than another prescription.

Ask to be tested for H. pylori; it is a simple test and treating it reduces risk.

Do not take acid-suppressing tablets indefinitely without review.

Ask for a dietitian at diagnosis, not after weight is lost.

After total stomach removal, make sure lifelong B12 injections are set up and recorded on the GP record before discharge.

Ask about dumping syndrome and how to manage it, before it happens.

Ask about family history and about genetic testing where several relatives have had stomach or lobular breast cancer.

Stop smoking.

Where to get help

A GP practice, asking directly for endoscopy where the rules above apply.

The upper gastrointestinal clinical nurse specialist once under a team.

Guts UK for information on stomach conditions.

Macmillan Cancer Support on 0808 808 00 00.