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Gastric cancer
Other Resources UpToDate PubMed

Gastric cancer

Contributors: Michael W. Winter MD, Christine Osborne MD
Other Resources UpToDate PubMed


Gastric cancer arises from malignant transformation of gastric cells. Eighty-five percent of gastric cancers are gastric adenocarcinomas; there are other subtypes of gastric cancer that more rarely occur (eg, mucosa-associated lymphoid tissue lymphoma, leiomyosarcoma, gastrointestinal stromal tumors, linitis plastica). Histologically, gastric cancers are defined as either intestinal or diffuse. Although gastric cancers can occur anywhere in the stomach, there are epidemiologic differences between tumors that originated in the cardia and tumors with noncardia origins. The rates of gastric cancer have been declining since the identification and treatment of Helicobacter pylori.

Risk factors for development of noncardia gastric cancers include long-term ingestion of foods with high concentration of nitrites, such as dried, smoked, and salted foods, infection with H pylori, lower socioeconomic status, and migration from nations with high incidence of gastric cancer including nations in East Asia, Eastern Europe, and South America. The risk of cardia gastric cancer is increased in patients with gastroesophageal reflux disease (GERD) and those who are obese. Age, male sex, tobacco use, family history, sedentary lifestyle, and radiation are risk factors for all types of gastric cancer. Approximately 15%-20% of patients with advanced disease have overexpression of human epidermal growth factor receptor 2 (HER2). Germline pathogenic variants in several homologous-recombination genes have also been associated with increased risk of gastric cancer.

Many patients with early, superficial disease are asymptomatic. As the disease progresses, patients may present with vague upper abdominal discomfort, postprandial fullness, severe pain, anorexia, nausea, weight loss, early satiety, progressive food intolerance, heartburn, melena, or symptomatic anemia. There may be delayed gastric emptying (gastroparesis), which can progress to gastric outlet obstruction. Other unusual clinical features associated with gastric cancer include migratory thrombophlebitis, microangiopathic hemolytic anemia, diffuse seborrheic keratoses, and acanthosis nigricans. Patients with linitis plastica often present with advanced disease. The liver is the most common site of metastases, and malignant ascites may occur.


C16.9 – Malignant neoplasm of stomach, unspecified

363349007 – Malignant tumor of stomach

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Differential Diagnosis & Pitfalls

  • Gastritis
  • Peptic ulcer disease
  • Pancreatitis (Acute pancreatitis, Chronic pancreatitis)
  • Pancreatic carcinoma
  • Gastroparesis
  • Small bowel obstruction
  • Gastroesophageal reflux disease
  • Acute cholecystitis
  • Biliary calculus
  • Esophageal motility disorder
  • Esophageal carcinoma

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Last Reviewed:11/01/2017
Last Updated:05/03/2023
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Gastric cancer
A medical illustration showing key findings of Gastric cancer : Abdominal pain, Nausea, Vomiting, Iron deficiency anemia, Anorexia, Dysphagia, Heme+ stool
Imaging Studies image of Gastric cancer - imageId=6846464. Click to open in gallery.  caption: '<span>Axial CT image demonstrates  thickening and irregularity of the gastric antrum. Endoscopy findings  and biopsy were consistent with gastric carcinoma. </span>'
Axial CT image demonstrates thickening and irregularity of the gastric antrum. Endoscopy findings and biopsy were consistent with gastric carcinoma.
Copyright © 2024 VisualDx®. All rights reserved.