Stomach Cancer
NIH Publication No. 94-1554 Originally Posted: 9/28/1998 Last Modified: 12/12/2000

Introduction

Each year, about 24,000 people in the United States learn that they have cancer of the stomach. This National Cancer Institute (NCI) booklet will give you important information about the symptoms, diagnosis, and treatment of stomach cancer. This booklet also has information to help you deal with this disease if it affects you or someone you know.

Words that may be new to readers appear in italics. Definitions of these words and other terms related to stomach cancer can be found in the Dictionary. For some words, a "sounds-like" spelling is also given.

Other NCI booklets are listed in the Other Booklets section. Our materials cannot answer every question you may have about stomach cancer. They cannot take the place of talks with doctors, nurses, and other members of the health care team. We hope our information will help with those talks.

Researchers continue to look for better ways to diagnose and treat cancer of the stomach, and our knowledge is growing. For up-to-date information or to order this publication, call the NCI-supported Cancer Information Service (CIS) toll free at 1-800-4-CANCER (1-800-422-6237).

The Stomach

The stomach is part of the digestive system. It is located in the upper abdomen, under the ribs. The upper part of the stomach connects to the esophagus, and the lower part leads into the small intestine.

When food enters the stomach, muscles in the stomach wall create a rippling motion that mixes and mashes the food. At the same time, juices made by glands in the lining of the stomach help digest the food. After about 3 hours, the food becomes a liquid and moves into the small intestine, where digestion continues.

What Is Cancer?

Cancer is a group of more than 100 different diseases. They affect the body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control or order.

Like all other organs of the body, the stomach is made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy.

If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be benign or malignant.

• Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Most important, cells from benign tumors do not spread to other parts of the body. Benign tumors are rarely a threat to life.

• Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.

Stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs. It may grow along the stomach wall into the esophagus or small intestine.

It also may extend through the stomach wall and spread to nearby lymph nodes and to organs such as the liver, pancreas, and colon. Stomach cancer also may spread to distant organs, such as the lungs, the lymph nodes above the collar bone, and the ovaries.

When cancer spreads to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if stomach cancer spreads to the liver, the cancer cells in the liver are stomach cancer cells. The disease is metastatic stomach cancer (it is not liver cancer). However, when stomach cancer spreads to an ovary, the tumor in the ovary is called a Krukenberg tumor. (This tumor, named for a doctor, is not a different disease; it is metastatic stomach cancer. The cancer cells in a Krukenberg tumor are stomach cancer cells, the same as the cancer cells in the primary tumor.)

Symptoms

Stomach cancer can be hard to find early. Often there are no symptoms in the early stages and, in many cases, the cancer has spread before it is found. When symptoms do occur, they are often so vague that the person ignores them. Stomach cancer can cause the following:

• Indigestion or a burning sensation (heartburn);
• Discomfort or pain in the abdomen;
• Nausea and vomiting;
• Diarrhea or constipation;
• Bloating of the stomach after meals;
• Loss of appetite;
• Weakness and fatigue; and
• Bleeding (vomiting blood or having blood in the stool).

Any of these symptoms may be caused by cancer or by other, less serious health problems, such as a stomach virus or an ulcer. Only a doctor can tell the cause. People who have any of these symptoms should see their doctor. They may be referred to a gastroenterologist, a doctor who specializes in diagnosing and treating digestive problems. These doctors are sometimes called gastrointestinal (or GI) specialists.

Diagnosis

To find the cause of symptoms, the doctor asks about the patient's medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:

Fecal occult blood test--a check for hidden (occult) blood in the stool. This test is done by placing a small amount of stool on a plastic slide or on special paper. It may be tested in the doctor's office or sent to a laboratory. This test is done because stomach cancer sometimes causes bleeding that cannot be seen. However, noncancerous conditions also may cause bleeding, so having blood in the stool does not necessarily mean that a person has cancer.

Upper GI series--x-rays of the esophagus and stomach (the upper gastrointestinal, or GI, tract. The x-rays are taken after the patient drinks a barium solution, a thick, chalky liquid. (This test is sometimes called a barium swallow.) The barium outlines the stomach on the x-rays, helping the doctor find tumors or other abnormal areas. During the test, the doctor may pump air into the stomach to make small tumors easier to see.

Endoscopy --an exam of the esophagus and stomach using a thin, lighted tube called a gastroscope, which is passed through the mouth and esophagus to the stomach. The patient's throat is sprayed with a local anesthetic to reduce discomfort and gagging. Patients also may receive medicine to relax them. Through the gastroscope, the doctor can look directly at the inside of the stomach. If an abnormal area is found, the doctor can remove some tissue through the gastroscope. Another doctor, a pathologist, examines the tissue under a microscope to check for cancer cells. This procedure--removing tissue and examining it under a microscope--is called a biopsy. A biopsy is the only sure way to know whether cancer cells are present.

A patient who needs a biopsy may want to ask the doctor some of these questions:

• How long will the procedure take? Will I be awake? Will it hurt?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?

Staging

If the pathologist finds cancer cells in the tissue sample, the patient's doctor needs to know the stage, or extent, of the disease. Staging exams and tests help the doctor find out whether the cancer has spread and, if so, what parts of the body are affected. Because stomach cancer can spread to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may order a CT (or CAT) scan, an ultrasound exam, or other tests to check these areas.

Staging may not be complete until after surgery. The surgeon removes nearby lymph nodes and may take samples of tissue from other areas in the abdomen. All of these samples are examined by a pathologist to check for cancer cells. Decisions about treatment after surgery depend on these findings.

Treatment

The doctor develops a treatment plan to fit each patient's needs. Treatment for stomach cancer depends on the size, location, and extent of the tumor; the stage of the disease; the patient's general health; and other factors.

Many people who have cancer want to learn all they can about the disease and their treatment choices so they can take an active part in decisions about their medical care. The doctor is the best person to answer questions about their diagnosis and treatment plan.

When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for people to think of everything they want to ask the doctor. Often, it helps to make a list of questions. Also, to help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor--to take part in the discussion, to take notes, or just to listen. Patients should not feel the need to ask all their questions or remember all the answers at one time. They will have other chances to ask the doctor to explain things and to get more information.

When talking about treatment choices, the patient may want to ask about taking part in a research study. Such studies, called clinical trials, are designed to improve cancer treatment. More information about clinical trials is in the Clinical Trials section.

These are some questions a patient may want to ask the doctor before treatment begins:

• What is the stage of the disease?
• What are my treatment options? Which do you suggest for me? Why?
• Would a clinical trial be appropriate for me?
• What are the expected benefits of the treatment?
• What are the risks and possible side effects of the treatment?
• What can be done about side effects?
• What can I do to take care of myself during therapy?
• How long will my treatment last?

Patients and their loved ones are naturally concerned about the effectiveness of the treatment. Sometimes they use statistics to try to figure out whether the patient will be cured, or how long he or she will live. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a particular person because no two cancer patients are alike; treatments and responses vary greatly. Patients may want to talk with the doctor about the chance of recovery (prognosis). When doctors talk about surviving cancer, they may use the term remission rather than cure. Even though many patients recover completely, doctors use this term because the disease can return. (The return of cancer is called a recurrence.)

Getting a Second Opinion

Treatment decisions are complex. Sometimes it is helpful for patients to have a second opinion about the diagnosis and the treatment plan. (Some insurance companies require a second opinion; others may pay for a second opinion if the patient requests it.) There are several ways to find another doctor to consult:

• The patient's doctor may be able to suggest a specialist. Specialists who treat this disease include gastroenterologists, surgeons, medical oncologists and radiation oncologists.

• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.

• Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.

Methods of Treatment

Cancer of the stomach is difficult to cure unless it is found in an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. However, advanced stomach cancer can be treated and the symptoms can be relieved. Treatment for stomach cancer may include surgery, chemotherapy, and/or radiation therapy. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials. A patient may have one form of treatment or a combination of treatments.

Surgery is the most common treatment for stomach cancer. The operation is called gastrectomy. The surgeon removes part (subtotal or partial gastrectomy) or all (total gastrectomy) of the stomach, as well as some of the tissue around the stomach. After a subtotal gastrectomy, the doctor connects the remaining part of the stomach to the esophagus or the small intestine. After a total gastrectomy, the doctor connects the esophagus directly to the small intestine. Because cancer can spread through the lymphatic system, lymph nodes near the tumor are often removed during surgery so that the pathologist can check them for cancer cells. If cancer cells are in the lymph nodes, the disease may have spread to other parts of the body.

These are some questions a patient may want to ask the doctor before surgery:

• What kind of operation will I have?
• What are the risks of this operation?
• How will I feel afterwards? If I have pain, how will you help me?
• Will I need a special diet? Who will teach me about my diet?

Chemotherapy is the use of drugs to kill cancer cells. This type of treatment is called systemic therapy because the drugs enter the bloodstream and travel through the body.

Clinical trials are in progress to find the best ways to use chemotherapy to treat stomach cancer. Scientists are exploring the benefits of giving chemotherapy before surgery to shrink the tumor, or as adjuvant therapy after surgery to destroy remaining cancer cells. Combination treatment with chemotherapy and radiation therapy is also under study. Doctors are testing a treatment in which anticancer drugs are put directly into the abdomen (intraperitoneal chemotherapy). Chemotherapy also is being studied as a treatment for cancer that has spread, and as a way to relieve symptoms of the disease.

Most anticancer drugs are given by injection; some are taken by mouth. The doctor may use one drug or a combination of drugs. Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment, and so on. Usually a person receives chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.

These are some questions patients may want to ask about chemotherapy:

• What is the goal of this treatment?
• What drugs will I be taking?
• Will the drugs cause side effects? What can I do about them?
• How long will I need to take this treatment?
• How will we know if the treatment is working?

Radiation therapy (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing. Like surgery, it is local therapy; the radiation can affect cancer cells only in the treated area. Radiation therapy is sometimes given after surgery to destroy cancer cells that may remain in the area. Researchers are conducting clinical trials to find out whether it is helpful to give radiation therapy during surgery (intraoperative radiation therapy). Radiation therapy may also be used to relieve pain or blockage.

The patient goes to the hospital or clinic each day for radiation therapy. Usually treatments are given 5 days a week for 5 to 6 weeks.

These are some questions a patient may want ask the doctor before receiving radiation therapy:

• What is the goal of this treatment?
• How will the radiation be given?
• When will the treatment begin? When will it end?
• Will I have side effects? What can I do about them?
• How will we know if the radiation therapy is working?

Biological therapy (also called immunotherapy) is a form of treatment that helps the body's immune system attack and destroy cancer cells; it may also help the body recover from some of the side effects of treatment. In clinical trials, doctors are studying biological therapy in combination with other treatments to try to prevent a recurrence of stomach cancer. In another use of biological therapy, patients who have low blood cell counts during or after chemotherapy may receive colony-stimulating factors to help restore the blood cell levels. Patients may need to stay in the hospital while receiving some types of biological therapy.

Clinical Trials

Many patients with stomach cancer are treated in clinical trials (treatment studies). Doctors conduct clinical trials to find out whether a new approach is both safe and effective and to answer scientific questions. Patients who take part in these studies are often the first to receive treatments that have shown promise in laboratory research. In clinical trials, some patients may receive the new treatment while others receive the standard approach. In this way, doctors can compare different therapies. Patients who take part in a trial make an important contribution to medical science and may have the first chance to benefit from improved treatment methods. Researchers also use clinical trials to look for ways to reduce the side effects of treatment and to improve the quality of patients' lives.

Many clinical trials for people with stomach cancer are under way. Patients who are interested in taking part in a trial should talk with their doctor. The booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know explains the possible benefits and risks of treatment studies.

One way to learn about clinical trials is through PDQ, a computer database developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials. The Cancer Information Service can provide PDQ information to doctors, patients, and the public.

Side Effects of Treatment

It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because healthy cells and tissues also may be damaged, treatment can cause unpleasant side effects.

The side effects of cancer treatment are different for each person, and they may even be different from one treatment to the next. Doctors try to plan treatment in ways that keep side effects to a minimum; they can help with any problems that occur. For this reason, it is very important to let the doctor know about any problems during or after treatment.

The National Cancer Institute booklets Radiation Therapy and You and Chemotherapy and You have helpful information about cancer treatment and coping with side effects.

Surgery

Gastrectomy is major surgery. For a period of time after the surgery, the person's activities are limited to allow healing to take place. For the first few days after surgery, the patient is fed intravenously (through a vein). Within several days, most patients are ready for liquids, followed by soft, then solid, foods. Those who have had their entire stomach removed cannot absorb vitamin B₁₂, which is necessary for healthy blood and nerves, so they need regular injections of this vitamin. Patients may have temporary or permanent difficulty digesting certain foods, and they may need to change their diet. Some gastrectomy patients will need to follow a special diet for a few weeks or months, while others will need to do so permanently. The doctor or a dietitian (a nutrition specialist) will explain any necessary dietary changes.

Some gastrectomy patients have cramps, nausea, diarrhea, and dizziness shortly after eating because food and liquid enter the small intestine too quickly. This group of symptoms is called the dumping syndrome. Foods containing high amounts of sugar often make the symptoms worse. The dumping syndrome can be treated by changing the patient's diet. Doctors often advise patients to eat several small meals throughout the day, to avoid foods that contain sugar, and to eat foods high in protein. To reduce the amount of fluid that enters the small intestine, patients are usually encouraged not to drink at mealtimes. Medicine also can help control the dumping syndrome. The symptoms usually disappear in 3 to 12 months, but they may be permanent.

Following gastrectomy, bile in the small intestine may back up into the remaining part of the stomach or into the esophagus, causing the symptoms of an upset stomach. The patient's doctor may prescribe medicine or suggest over-the-counter products to control such symptoms.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs the patient receives. As with any other type of treatment, side effects also vary from person to person. In general, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may have side effects such as loss of appetite, nausea, vomiting, hair loss, or mouth sores. For some patients, the doctor may prescribe medicine to help with side effects, especially with nausea and vomiting. These effects usually go away gradually during the recovery period between treatments or after the treatments stop.

Radiation Therapy

Patients who receive radiation to the abdomen may have nausea, vomiting, and diarrhea. The doctor can prescribe medicine or suggest dietary changes to relieve these problems. The skin in the treated area may become red, dry, tender, and itchy. Patients should avoid wearing clothes that rub; loose-fitting cotton clothes are usually best. It is important for patients to take good care of their skin during treatment, but they should not use lotions or creams without the doctor's advice.

Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Biological Therapy

The side effects of biological therapy vary with the type of treatment. Some cause flu-like symptoms, such as chills, fever, weakness, nausea, vomiting, and diarrhea. Patients sometimes get a rash, and they may bruise or bleed easily. These problems may be severe, and patients may need to stay in the hospital during treatment.

Nutrition for Cancer Patients

It is sometimes difficult for patients who have been treated for stomach cancer to eat well. Cancer often causes loss of appetite, and people may not feel like eating when they are uncomfortable or tired. It is hard for patients to eat when they have nausea, vomiting, mouth sores, or the dumping syndrome. Patients who have had stomach surgery are likely to feel full after eating only a small amount of food. For some patients, the taste of food changes. Still, good nutrition is important. Eating well means getting enough calories and protein to help prevent weight loss, regain strength, and rebuild normal tissues.

Doctors, nurses, and dietitians can offer advice for healthy eating during and after cancer treatment. Patients and their families also may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful suggestions.

Support for Cancer Patients

Living with a serious disease is not easy. Cancer patients and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services. Several useful booklets, including Taking Time, are available from the Cancer Information Service.

Cancer patients may worry about holding their job, caring for their family, or keeping up with their daily activities. Concerns about tests, treatments, hospital stays, and medical bills are common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy also can be helpful for patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.

Friends and relatives can be very supportive. Also, it helps many patients to discuss their concerns with others who have cancer. Cancer patients often get together in support groups, where they can share what they have learned about coping with cancer and the effects of treatment. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another--even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.

Often, a social worker at the hospital or clinic can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care. For example, the American Cancer Society has many services for cancer patients and their families. Local offices of the American Cancer Society are listed in the white pages of the telephone directory. The Cancer Information Service also has information on local resources.

Causes of Stomach Cancer

The stomach cancer rate in the United States and the number of deaths from this disease have gone down dramatically over the past 60 years. Still, stomach cancer is a serious disease, and scientists all over the world are trying to learn more about what causes this disease and how to prevent it. At this time, doctors cannot explain why one person gets stomach cancer and another does not. They do know, however, that stomach cancer is not contagious; no one can "catch" cancer from another person.

Researchers have learned that some people are more likely than others to develop stomach cancer. The disease is found most often in people over age 55. It affects men twice as often as women, and is more common in black people than in white people. Also, stomach cancer is more common in some parts of the world--such as Japan, Korea, parts of Eastern Europe, and Latin America--than in the United States. People in these areas eat many foods that are preserved by drying, smoking, salting, or pickling. Scientists believe that eating foods preserved in these ways may play a role in the development of stomach cancer. On the other hand, fresh foods (especially fresh fruits and vegetables and properly frozen or refrigerated fresh foods) may protect against this disease.

Stomach ulcers do not appear to increase a person's risk (chance) of getting stomach cancer. However, some studies suggest that a type of bacteria, Helicobacter pylori, which may cause stomach inflammation and ulcers, may be an important risk factor for this disease. Also, research shows that people who have had stomach surgery or have pernicious anemia, achlorhydria, or gastric atrophy (which generally result in lower than normal amounts of digestive juices) have an increased risk of stomach cancer.

Exposure to certain dusts and fumes in the workplace has been linked to a higher than average risk of stomach cancer. Also, some scientists believe smoking may increase stomach cancer risk.

People who think they might be at risk for stomach cancer should discuss this concern with their doctor. The doctor can suggest an appropriate schedule of checkups so that, if cancer appears, it can be detected as early as possible.

Other Booklets

National Cancer Institute printed materials, including the booklets listed below, are available from the Cancer Information Service free of charge by calling 1-800-4-CANCER.

Booklets About Cancer Treatment

• Chemotherapy and You: A Guide to Self-Help During Treatment
• Radiation Therapy and You: A Guide to Self-Help During Treatment
• Taking Part in Clinical Trials: What Cancer Patients Need To Know
• Eating Hints for Cancer Patients
• Pain Control: A Guide for People with Cancer and Their Families

• Taking Time: Support for People With Cancer and the People Who Care About Them
• Facing Forward: A Guide for Cancer Survivors
• When Cancer Recurs: Meeting the Challenge Again
• Advanced Cancer: Living Each Day

National Cancer Institute Information Resources

You may want more information for yourself, your family, and your health care provider. The following National Cancer Institute (NCI) services are available to help you.

Telephone
Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-800-422-6237)

TTY (for deaf and hard of hearing callers): 1-800-332-8615

Internet

These Web sites may be useful:

http://cancer.gov		NCI's primary Web site; contains information about the Institute and its programs.
http://cancertrials.nci.nih.gov		cancerTrials™; NCI's comprehensive clinical trials information center for patients, health professionals, and the public. Includes information on understanding trials, deciding whether to participate in trials, finding specific trials, plus research news and other resources.
http://cancernet.nci.nih.gov		CancerNet™; contains material for health professionals, patients, and the public, including information from PDQ® about cancer treatment, screening, prevention, supportive care, genetics, and clinical trials; CANCERLIT®, a bibliographic database; and a dictionary with medical terms related to cancer.

E-mail
CancerMail
Includes NCI information about cancer treatment, screening, prevention, and supportive care. To obtain a contents list, send e-mail to cancermail@icicc.nci.nih.gov with the word "help" in the body of the message.

Fax
CancerFax^®
Includes NCI information about cancer treatment, screening, prevention, and supportive care. To obtain a contents list, dial 1-800-624-2511 or 301-402-5874 from your touch tone phone or fax machine hand set and follow the recorded instructions.

Dictionary

abdomen (AB-do-men): The part of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

achlorhydria (a-klor-HY-dree-a): A lack of hydrochloric acid in the digestive juices in the stomach. Hydrochloric acid helps digest food.

adjuvant therapy (AD-joo-vant): Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy.

anesthetics (an-es-THET-iks): Substances that cause loss of feeling or awareness. Local anesthetics cause loss of feeling in a part of the body. General anesthetics put the person to sleep.

benign (beh-NINE): Not cancerous; does not invade nearby tissue or spread to other parts of the body.

biological therapy (by-o-LAHJ-i-kul): Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy.

biopsy (BY-ahp-see): The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

cancer: A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body.

chemotherapy (kee-mo-THER-a-pee): Treatment with anticancer drugs.

clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease.

colon (KO-lun): The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

colony-stimulating factors: Substances that stimulate the production of blood cells. Colony-stimulating factors include granulocyte colony-stimulating factors (also called G-CSF and filgrastim), granulocyte-macrophage colony-stimulating factors (also called GM-CSF and sargramostim), and promegapoietin.

CT scan: Computed tomography scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan.

digestive system (dye-JES-tiv): The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum.

dumping syndrome: A group of symptoms that occur when food or liquid enters the small intestine too rapidly. These symptoms include cramps, nausea, diarrhea, and dizziness. Dumping syndrome sometimes occurs in people who have had a portion of their stomach removed.

endoscopy (en-DAHS-ko-pee): The use of a thin, lighted tube (called an endoscope) to examine the inside of the body.

esophagus (eh-SOF-a-gus): The muscular tube through which food passes from the throat to the stomach.

fecal occult blood test (FEE-kul o-KULT): A test to check for blood in stool. (Fecal refers to stool; occult means hidden.)

gastrectomy (gas-TREK-toe-mee): An operation to remove all or part of the stomach.

gastric (GAS-trik): Having to do with the stomach.

gastric atrophy (GAS-trik AT-ro-fee): A condition in which the stomach muscles shrink and become weak. The digestive (peptic) glands may also shrink, resulting in a lack of digestive juices.

gastroenterologist (GAS-tro-en-ter-AHL-o-jist): A doctor who specializes in diagnosing and treating disorders of the digestive system.

gastroscope (GAS-tro-skope): A thin, lighted tube used to view the inside of the stomach.

gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production.

Helicobacter pylori (HEEL-ih-ko-BAK-ter pye-LOR-ee): Bacteria that cause inflammation and ulcers in the stomach.

intraoperative radiation therapy: IORT. Radiation treatment aimed directly at a tumor during surgery.

intraperitoneal chemotherapy (IN-tra-per-ih-toe-NEE-al KEE-mo-THER-a-pee): Treatment in which anticancer drugs are put directly into the abdominal cavity through a thin tube.

Krukenberg tumor (KROO-ken-berg TOO-mer): A tumor in the ovary caused by the spread of stomach cancer.

liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

local therapy: Treatment that affects cells in the tumor and the area close to it.

lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph).

lymphatic system (lim-FAT-ik): The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, and lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body.

malignant (ma-LIG-nant): Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body.

medical oncologist (on-KOL-o-jist): A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often serves as the main caretaker of someone who has cancer and coordinates treatment provided by other specialists.

metastasis (meh-TAS-ta-sis): The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases.

ovaries (O-va-reez): The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus.

pancreas: A glandular organ located in the abdomen. It makes pancreatic juices, which contain enzymes that aid in digestion, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach, intestines, and other organs.

pathologist (pa-THOL-o-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.

pernicious anemia (per-NISH-us a-NEE- mee-a): A type of anemia (low red blood cell count) caused by the body's inability to absorb vitamin B12.

prognosis (prog-NO-sis): The likely outcome or course of a disease; the chance of recovery or recurrence.

radiation oncologist (ray-dee-AY-shun on-KOL-o-jist): A doctor who specializes in using radiation to treat cancer.

radiation therapy (ray-dee-AY-shun): The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy.

remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body.

risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease.

side effects: Problems that occur when treatment affects healthy cells. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

small intestine: The part of the digestive tract that is located between the stomach and the large intestine.

staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the o>