The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body. Food moves from the throat to the stomach through a hollow, muscular tube called the esophagus. After leaving the stomach, partly-digested food passes into the small intestine and then into the large intestine.
In stomach cancer (also called gastric cancer), cancer cells usually begin on the inner lining of stomach walls and then penetrate deeper into the stomach walls as the cancer develops. The tumor may grow to involve nearby organs like the liver and pancreas.
Stomach cancer is one of the most common cancers worldwide. The number of stomach cancer cases has been steadily declining over the last few decades, possibly because of widespread use of refrigeration that increased access to fresh food without preservatives and bacterial contamination.

Signs and symptoms of stomach cancer may include:
1) Difficulty swallowing
2) Feeling bloated after eating
3) Feeling full after eating small amounts of food
4) Heartburn
5) Indigestion
6) Nausea
7) Stomach pain
8) Unintentional weight loss
9) Vomiting

The following factors may raise a person’s risk of developing stomach cancer:
1) Age. Stomach cancer occurs most commonly in people older than 55. Most people diagnosed with stomach cancer are in their 60s and 70s.
2) Gender. Men are twice as likely to develop stomach cancer as women.
3) 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.
4) 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.
5) Race/ethnicity. Stomach cancer is more common in Black, Hispanic, and Asian people than in white people.
6) 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.
7) 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.
8) Occupational exposure. Exposure to certain dusts and fumes may increase the risk of developing stomach cancer.
9) Tobacco and alcohol. Tobacco use and drinking a lot of alcohol may increase the risk of developing stomach cancer.
10) 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.

Types of stomach cancer:
Adenocarcinoma
Adenocarcinomas are cancers that develop in gland cells. These cells make mucus and stomach juices. This is the most common type of stomach cancer. Linitis plastica is a rare type of adenocarcinoma. It spreads to the muscles of the stomach wall and thickens the stomach wall, affecting digestion.
Staging for rare types of stomach cancer varies, depending on what type of cell the cancer starts in:
Squamous cell cancer
These cancers develop in squamous cells. These are the flat, surface covering cells found in the lining of the stomach. Squamous cell cancer is treated in the same way as adenocarcinoma.
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma is a cancer of the lymphatic system. The treatment is different to other stomach cancers.
Gastrointestinal stromal tumour (GIST)
This is a rare type of sarcoma found in the digestive system, most often in the wall of the stoma
Neuroendocrine tumours
Stomach neuroendocrine tumours (NETs) are rare stomach tumours that start in the neuroendocrine cells of the stomach. You might hear some stomach NETs called carcinoid

Grades of stomach cancer:
The grade means how abnormal the cells look under a microscope. Knowing the grade gives your doctor an idea of how the cancer might behave and what treatment you need. The grades of cancer cells are from 1 to 3:
1) grade 1 (low grade) look like normal stomach cells
2) grade 2 look a bit like normal cells
3) grade 3 (high grade) look very abnormal and not like normal cells

The following tests are commonly used to rule out or diagnose stomach cancer:
1) Health history and physical exam
Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. A physical exam allows your doctor to look for any signs of stomach cancer. During a physical exam, your doctor may:
a) feel the abdomen for enlarged organs, lumps or fluid
b) check the lymph nodes in the armpits and above the collar bones
c) do a digital rectal exam to check for a lump in the pelvis
2) Complete blood count (CBC)
A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for anemia from long-term (chronic) bleeding into the stomach.
Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests used to diagnose and stage stomach cancer include:
a) Blood urea nitrogen (BUN) and creatinine may be measured to check kidney function. Increased levels could indicate that cancer has spread to the ureters or kidneys.
b) Lactate acid dehydrogenase, alkaline phosphatase, transaminase and bilirubin may be measured to check liver function. Increased levels could indicate that cancer has spread to the liver.
Upper gastrointestinal (GI) endoscopy
An upper gastrointestinal endoscopy is an examination of the upper GI tract, including the esophagus, stomach and upper part of the small intestine (duodenum). It allows the doctor to look inside these organs using a flexible tube with a light and lens on the end (an endoscope).This is the most common test used to diagnose stomach cancer. An upper GI endoscopy is done to:
a) examine the stomach for bleeding, ulcers, polyps, tumours and inflammation (gastritis)
b) take samples of tissue to be tested in the lab (biopsy)
Endoscopic ultrasound
Endoscopic ultrasound (EUS) uses an endoscope with an ultrasound probe at the end. Ultrasound uses high-frequency sound waves to make images of structures in the body. It can provide detailed information about the location, size and depth of the tumour.
Biopsy
During a biopsy, tissues or cells are removed from the body so they can be tested in the lab. The report from the lab will confirm whether or not cancer cells are present in the sample and what type of cancer cells (such as adenocarcinoma) are present.
a) Endoscopic biopsy – Tissue is removed using a special tool on an endoscope during an upper GI endoscopy.
b) EUS-guided needle biopsy – Tissue is removed by a needle that is guided with an endoscopic ultrasound. An EUS-guided needle biopsy can check for cancer deep within the stomach wall, outside the stomach or in surrounding lymph nodes.
c) Laparoscopic biopsy – A laparoscopic biopsy is usually done after a diagnosis of stomach cancer. It is used during a laparoscopy to look for cancer that may have spread outside of the stomach such as to the peritoneum or lymph nodes. A laparoscopic biopsy removes tissue using a special tool on a thin, flexible lighted tube called a laparoscope.
Upper gastrointestinal (GI) series
An upper gastrointestinal series uses x-rays to look for tumours in the esophagus, stomach and first part of the small intestine (duodenum). This test is not used often because it has been replaced by the upper gastrointestinal endoscopy.
Tumour marker tests
Tumour markers are substances in the blood that may mean stomach cancer is present. Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose stomach cancer.
HER2 (human epidermal growth factor receptor 2) is a gene that can change (mutate). If it changes, it may help a tumour grow (oncogene). HER2 status testing is done to find out the amount of HER2 made by a tumour. Stomach tumours that contain HER2 are called HER2-positive. This information will help doctors plan your treatment.
Higher than normal levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) or cancer antigen 125 (CA 125) may indicate stomach cancer.
CT scan
A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is the most common test used to stage stomach cancer
Chest x-ray
An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is used to look for cancer that has spread to the lungs. You likely won’t have a chest x-ray if you had a CT scan of the chest.
Laparoscopy
A laparoscopy is surgery that uses a laparoscope (a type of endoscope) to examine or remove internal organs through several small incisions (surgical cuts) in the skin.
PET scan
A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues
MRI
Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures. An MRI is used to look for cancer in the stomach or cancer that has spread outside of the stomach.
Ultrasound
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used:
1) with an endoscopy to look at how far cancer has spread into the wall of the stomach and if cancer has spread to lymph nodes or surrounding tissues
2) to guide a needle for a biopsy
3) to look for cancer that has spread to the liver (liver ultrasound)

1) Treating early-stage stomach cancer
1) Endoscopic mucosal resection (EMR)
If you have a very early-stage stomach cancer, you may be offered a treatment to remove the cancer using an endoscope. This is called an endoscopic mucosal resection (EMR), or an endoscopic sub-mucosal dissection (ESD). Your surgeon may offer you this treatment if the tumour is very small and is only affecting the inner lining of the stomach.
2) Surgery
If you have stomach cancer that has not spread, you may be offered surgery to remove the cancer. This is a major operation to remove part, or all, of the stomach and nearby lymph nodes. You need to be well enough to have this operation.
3) Chemotherapy
Chemotherapy is also used to treat stomach cancer. You may have chemotherapy before and after surgery to reduce the risk of the cancer coming back. Sometimes you might have chemotherapy with radiotherapy (chemoradiation) after surgery.
2) Treating stomach cancer that has spread
1) Surgery
Sometimes, surgery is used to relieve the symptoms of stomach cancer that has spread. For example, it may be used if the cancer is causing a blockage (obstruction).
2) Chemotherapy
Chemotherapy may be used to treat stomach cancer that has spread. It may be given on its own when an operation is not possible. Radiotherapy
You may have radiotherapy or targeted therapy to relieve symptoms if the cancer is advanced.
3) Targeted therapy
Sometimes, a targeted therapy drug called trastuzumab is given with chemotherapy to treat stomach cancer that has spread. Trastuzumab is not suitable for everyone. Your cancer doctor or specialist nurse can explain whether trastuzumab may help you.
4) Immunotherapy
Immunotherapy treatment has been shown to be helpful for treating a few different cancers. An immunotherapy drug such as nivolumab or pembrolizumab may be used. Currently immunotherapy is not commonly used to treat stomach cancer. But you may be offered it as part of a clinical trial.

5-year relative survival rates for small intestine cancer:
1) Localized:70% The cancer is limited to the wall of the small intestine.
2) Regional: 32% The cancer has spread outside the wall of the small intestine into nearby structures or lymph nodes.
3) Distant: 6% The cancer has spread to distant parts of the body such as the liver or peritoneum (the inner lining of the abdomen).

Cancer is a life threatening disease that can affect anyone regardless of race, age, and gender. Traditional cancer treatments like radiotherapy and chemotherapy often result in undesirable and uncomfortable side effects such as vomiting, numbness, nausea, and diarrhea to name a few. Herbal medicine is a complementary therapy that some people with cancer use to ease cancer symptoms. Herbal remedies for cancer such as those commonly found in traditional medicine contains antimutagenic, anti-inflammatory, and apoptosis inducing compounds that help in slowing the development of cancer and relieve treatment side effects for patients.

Herbal medicine has a wide variety of applications but all of them rely on the sustainable use of various plant parts such as flowers, leaves, bark, and roots. Each part of a plant features different medicinal properties and uses. Although herbal medicine has countless use cases, cancer care is one of the most practical applications because of how harsh traditional oncology treatments can be on patients.

Herbal remedies are a part of a growing field of medicine called integrative oncology. Research conducted on the use of herbal medicine for cancer complementary therapy has proven herbs can:
• Slows the spread of cancer
• Reduces the side effects of cancer treatment
• Boosts immune system strength and functionality
• Minimizes the symptoms of cancer
• Attacks cancer cells

Several herbs may help control the side effects of conventional cancer treatment. However, doctors do not recommend that cancer patients take herbal medicine while undergoing normal traditional cancer treatment. Herbal medicines may be likely less to cause side effects than traditional drugs. But patients may can still experience complications. Some herbs may can cause negative interactions with chemotherapy drugs. Closely monitor how you feel before and after taking herbal remedies. Patients should always consult with their doctor before trying herbs as a complementary therapy or the supplements to avoid complications.