The final stages of stomach cancer, also known as advanced or metastatic gastric cancer (Stage IV), occur when the disease has spread beyond the stomach to distant organs. Curative treatment is no longer the primary goal at this stage. Care shifts toward managing symptoms and maintaining quality of life. Understanding the symptoms that arise during this phase helps prepare for a focus on comfort and dignity.
Localized Symptoms of Tumor Progression
The primary tumor growing within the stomach causes mechanical disruptions leading to distressing localized symptoms. Tumor growth can physically obstruct the passage of food and liquids (gastrointestinal obstruction). This obstruction often results in persistent nausea, vomiting, and a premature feeling of fullness after eating small amounts of food.
If the tumor is near the junction of the esophagus and stomach, difficulty swallowing (dysphagia) becomes prominent. The stomach lining is prone to ulceration and bleeding as the tumor erodes the tissue. Internal bleeding can manifest as black, tarry stools (melena), or cause chronic blood loss leading to anemia and fatigue.
Severe and constant abdominal pain is frequent, often requiring strong medication as the tumor invades nearby tissues or nerves. This localized pain signifies the physical burden of the mass on surrounding abdominal structures. Palliative interventions like gastrectomy or stenting can sometimes alleviate this immediate distress.
Systemic Indicators of Advanced Disease
Once stomach cancer metastasizes, its systemic impact causes symptoms far beyond the digestive tract. The liver is a common site for spread, leading to dysfunction. Signs of liver involvement include jaundice (yellowing of the skin and eyes) and pain in the upper right abdomen.
Cancer cells can also spread to the peritoneum, resulting in a buildup of fluid called ascites. This fluid accumulation causes abdominal swelling, bloating, and pressure, making movement uncomfortable. Metastasis to the bones causes widespread bone pain, while spread to the lungs may trigger a persistent cough or shortness of breath.
A profound, persistent exhaustion, known as cancer-related fatigue, is a nearly universal systemic indicator not relieved by rest. This tiredness is caused by the body’s inflammatory response to the widespread disease burden. These symptoms indicate that the disease is consuming significant bodily resources and affecting multiple organ systems.
Severe Physical Decline and Metabolic Changes
A distinct syndrome called cancer cachexia marks the severe physical decline in the final stages of gastric cancer. Cachexia is a complex metabolic disorder that causes involuntary wasting of muscle and fat mass, not simply weight loss from poor nutrition. Up to 80% of patients with advanced cancer develop some degree of cachexia.
This wasting is driven by inflammatory chemicals released by the tumor, which alter the body’s use of proteins, fats, and carbohydrates. The body breaks down muscle tissue at an accelerated rate, and this loss of lean body mass cannot be reversed by increasing food intake. This profound muscle wasting results in extreme weakness and a decreasing ability to perform basic daily activities, leading to immobility.
Low food intake combined with the tumor’s high metabolic demands leads to dehydration and electrolyte imbalances. As the body becomes frailer, the skin can become fragile and susceptible to breakdown due to nutritional deficits and prolonged pressure. This state of severe physical decline indicates that the body’s systems are failing to sustain themselves despite supportive measures.
Focus of Care in the Final Stages
At this advanced stage, the focus of medical intervention shifts entirely from disease-modifying treatment to comfort-focused care. Palliative care is an interdisciplinary approach aimed at relieving suffering and improving the quality of life for the patient and their family. This specialized care includes aggressive management of symptoms like pain, nausea, and shortness of breath using concentrated medications.
When a patient’s life expectancy is measured in months, the care model typically transitions to hospice care, which is a specific type of palliative care. Hospice emphasizes holistic support, addressing the patient’s physical symptoms alongside their emotional, social, and spiritual needs. This often means discontinuing aggressive treatments like chemotherapy that are no longer effective and may cause unnecessary suffering. The goal is to ensure the patient lives the remainder of their life with peace and dignity.