Stomach cancer, also known as gastric cancer, involves the uncontrolled growth of abnormal cells in the stomach lining. The stomach, located in the upper abdomen, plays a role in digestion by breaking down food. While stomach cancer is generally more prevalent in older individuals, it can, in rare instances, affect younger people.
Understanding Stomach Cancer in Younger Adults
Stomach cancer is relatively uncommon in individuals under 40, with approximately 2% to 8% of diagnoses occurring in this age group. The average age for diagnosis is around 68 years. Despite the overall decline in stomach cancer rates in the United States over the past century, the proportion of cases in younger adults has been increasing, now accounting for more than 30% of all stomach cancers in the U.S.. This rising trend in younger populations, particularly in non-Hispanic white women, remains largely unexplained.
Low awareness of stomach cancer in younger adults, coupled with the assumption that it is an older person’s disease, can lead to delayed diagnosis. Such delays allow the cancer to advance, making treatment more challenging and potentially affecting long-term outcomes.
Key Symptoms to Watch For
Stomach cancer often develops slowly, and early-stage symptoms can be vague or absent, making detection challenging. When symptoms do appear, they frequently mimic less serious digestive issues like indigestion or heartburn.
Common symptoms to observe include persistent indigestion or heartburn, a feeling of fullness after eating only a small amount of food, and unexplained weight loss. Other signs may involve a loss of appetite, nausea, and vomiting, sometimes with blood. Abdominal pain or discomfort, often described as a vague sensation above the navel, can also be present. Fatigue or weakness, potentially due to anemia from internal bleeding, may also occur.
It is important to seek medical evaluation for any persistent or worsening digestive symptoms, especially if they do not improve with typical remedies or if new symptoms arise. While these symptoms can be caused by many conditions, a medical professional can determine the underlying cause and recommend appropriate action.
Potential Risk Factors and Underlying Causes
Several factors can increase an individual’s risk of developing stomach cancer. A major cause, particularly for cancers in the lower part of the stomach, is long-term infection with the bacterium Helicobacter pylori (H. pylori). This infection can lead to chronic inflammation and precancerous changes in the stomach lining. While H. pylori prevalence has decreased overall in the U.S., it remains a factor, and some studies suggest a higher incidence of H. pylori infection in younger gastric cancer patients.
Genetic predispositions play a role, with 1% to 3% of stomach cancer cases linked to inherited cancer predisposition syndromes. These include hereditary diffuse gastric cancer (HDGC), often associated with mutations in the CDH1 gene, and Lynch syndrome, which can also increase the risk of colorectal cancer. A family history of stomach cancer, especially in first- or second-degree relatives diagnosed at a younger age, also elevates risk. Lifestyle factors such as a diet high in smoked, pickled, or salted foods, along with smoking and heavy alcohol consumption, are also associated with an increased risk. Obesity has been linked to an increased risk of gastric cardia cancer, which forms where the stomach meets the esophagus.
Diagnosis and Treatment Options
Diagnosing stomach cancer typically begins with a medical history review and a physical examination. Blood tests may be conducted to check for anemia, a potential sign of bleeding in the stomach, and sometimes for tumor markers like CA-125 and CEA. Stool samples can also be checked for hidden blood. The most common diagnostic procedure is an upper endoscopy, also known as esophagogastroduodenoscopy (EGD). During this procedure, a thin, lighted tube with a camera is passed through the mouth to examine the esophagus, stomach, and the first part of the small intestine.
If suspicious areas are found, a biopsy is performed to collect tissue samples for laboratory analysis to confirm the presence of cancer cells and determine the cancer type. Imaging tests, such as CT scans, PET scans, and endoscopic ultrasound (EUS), are used to assess the extent of the cancer and determine if it has spread to nearby lymph nodes or other organs.
Treatment plans for stomach cancer are highly individualized and depend on the cancer’s stage, location, and the patient’s overall health. Common treatment approaches include surgery, which aims to remove all or part of the stomach and nearby lymph nodes. Chemotherapy may be administered before surgery to shrink tumors (neoadjuvant therapy) or after surgery to eliminate remaining cancer cells (adjuvant therapy). Radiation therapy can be used alone or in combination with chemotherapy. Targeted therapy and immunotherapy are newer approaches.