Gastric Cancer

– The information has been reviewed by Dr. Yang Pei Cheung, George


Gastric cancer is responsible for the sixth most deaths among common and fatal cancers in Hong Kong, accounting for about 4% of all new cancer cases. In 2018, 687 people died of gastric cancer. According to data from the Hospital Authority’s Hong Kong Cancer Registry, a total of 1,314 cases of gastric cancer were reported in 2017, accounting for 15.8% of all total cancer cases. The ratio of male to female patients was approximately 1.4:1.


What is Gastric Cancer? 

The stomach is a part of the digestive system, which is responsible for secreting gastric acid to digest food and transfer it into the intestine to continue the digestive process. Gastric cancer refers to abnormal changes in stomach cells and the development of malignant tumors.


Early stage gastric cancer may show no obvious symptoms, which are similar to general gastrointestinal discomfort and indigestion. Many patients who show obvious symptoms already have stage 2 or 3 gastric cancer when diagnosed. 

  • Indigestion
  • Loss of appetite
  • Nausea
  • Pain in upper abdomen 
  • Feeling bloated after eating
  • Vomit that includes blood
  • Bleeding or black stools
  • Weight loss
  • Fatigue
Causes & Risk Factors
Causes & Risk Factors

Gene mutations in gastric cells cause normal cells to develop into malignant tumors. In addition, studies have found that patients infected with Helicobacter pylori have an increased risk of gastric cancer.


Risk Factors

  • Men are at higher risk than women
  • Age
  • Helicobacter pylori infection
  • Smoking
  • Drinking
  • Genetics
  • Eating habits: long-term consumption of high-salt, pickled, and smoked foods
How is Gastric Cancer diagnosed & Treatment
How is Gastric Cancer diagnosed & Treatment

How is Gastric Cancer diagnosed? 

  • Gastroscopy: A doctor inserts a pipe-shaped endoscope into the stomach and duodenum through the mouth and esophagus of the patient to examine the stomach wall. Tissue samples will be taken for pathological examination.
  • Imaging Examination: Positron PET computer scanning can display cell metabolism, which may effectively tracks early cancer lesions. Some gastric cancer will not show up in pet scan. Computer scanning can also detect fine tumors and provide three-dimensional images of tumors. In addition, an MRI scan can show clear images of soft tissues such as the stomach wall, gastric cavity, etc. All can be used to diagnose the stage of gastric cancer and whether there is cancer metastasis.



Generally speaking, surgery is the most effective treatment for gastric cancer at the moment, as it has a better effect on cancer control or later digestive function. If the cancer is detected early, patients can have their stomach removed via surgery as an extreme measure. In addition to early gastric cancer, two therapies are combined to complement each other, increase treatment efficacy, and reduce the risk of recurrence and spread.


Removal of gastric tissues invaded by cancer cells. The scope of the surgery depends on the size and location of the tumor. As cancer cells may spread to lymph nodes near the stomach with lymph fluid, they must be removed as well. After removal, the stomach and small intestines will be connected and reorganized. In the past, gastric surgery was mostly performed in an open manner. Now, with assistance from da Vinci robotic arms, doctors can precisely  remove the tumor without damaging muscles, reduce risk of side effects, and improve recovery. Patients typically can leave their bed the next day, and can be discharged from the hospital within a week. 

Postoperative Diet: The patient must eat liquid and soft meals for one to two weeks after the operation. Normal eating may resume after this period, as both rice and meat can be eaten. Pay attention to cutting foods and avoid eating potatoes with skin and mushrooms.

Radiation Therapy

Uses high-energy rays to kill cancerous tissue. In addition, it can be done before surgery to reduce the size of the tumor.


Used against tumors that have spread, as the drug can travel throughout the body via blood, attacking and destroying remaining cancer cells in the body.

Adjuvant Therapy

Patients who undergo surgery from stage 2 to stage 4 will receive adjuvant therapy afterwards, according to the cancer stage and physical condition. This therapy includes chemotherapy, radiation therapy, or a combination of both to remove remaining cancer cells. Ideally, adjuvant therapy should begin four weeks after surgery.

Targeted Drug Therapy

If the patient tests positive for the HER2 receptor, they may consider adding targeted drugs that inhibit HER2 proteins during chemotherapy, which can effectively relieve the condition.