Stomach cancer is a malignant growth that begins in the lining of the stomach and can invade deeper layers or spread to nearby organs and lymph nodes.

Early symptoms include indigestion, mild upperabdominal discomfort, early satiety, loss of appetite, nausea, or heartburn. Late symptoms may include persistent stomach pain, unexplained weight loss, vomiting (sometimes with blood), black or tarry stools, palpable lump or fullness in the upper abdomen, and persistent fatigue from anemia. In very early stages, patients can be asymptomatic too.

The major risk factors are chronic Helicobacter pylori infection, longstanding atrophic gastritis, smoking, highsalt or smoked foods, family history of gastric cancer, certain hereditary syndromes, and prior gastric surgery.

While initial evaluation requires detailed clinical history, physical exam, basic blood tests & tests for H. pylori, endoscopic biopsy for tissue diagnosis is needed. Staging the cancer requires further imaging like CT scan, endoscopic ultrasound or staging laparoscopy depending on clinical picture.

For very early, small & well selected lesions, endoscopic mucosal resection or submucosal dissection are feasible. For other localized diseases, surgery with curative intent [partial or total gastrectomy] with appropriate lymph node removal [as per oncologic principles], often combined with perioperative or adjuvant chemotherapy or chemoradiation [based on stage and pathology] is required. However, if the disease is locally advanced or highrisk, multimodal therapy with neoadjuvant (preoperative) chemotherapy to shrink tumor followed by surgery followed by adjuvant therapy is needed. Non-operative treatment with systemic chemotherapy, targeted therapy, immunotherapy and supportive/palliative therapies are the only options in Stage IV disease.

Surgery is recommended when imaging and biopsy indicate the tumor can be removed completely and the patient’s fitness for operation is adequate.

Not always; small very early tumors may be treated endoscopically, and advanced metastatic disease is usually treated with systemic therapy and symptom control.

Prompt evaluation is important to plan staging and treatment without unnecessary delay.