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Types of stomach cancer

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Stomach cancer happens when cells start behaving abnormally, growing and proliferating uncontrollably. The stomach, a hollow organ that collects food and breaks it down, has five different parts—from the top of the stomach, which connects to the esophagus, to the bottom of the stomach, which connects to the small intestine:

  • Cardia, the area nearest to the esophagus
  • Fundus, the upper stomach
  • Corpus, the main body of the stomach
  • Antrum, where food gets broken down by stomach acid
  • Pylorus, which connects to the small intestine

There are also five layers of tissue and muscle that surround the stomach and make up the stomach wall. Going from inner to outer, the layers are:

  • Mucosa
  • Submucosa
  • Muscularis propria
  • Subserosa
  • Serosa

Stomach cancer progressively spreads through these different layers. Establishing how far within the stomach wall the cancer has spread is a part of the staging process, which determines how serious the cancer is and how best to treat it.

The mucosa layer, which produces stomach acid, is where most stomach cancers begin.

A less common type of stomach cancer is caused by gastrointestinal stromal tumors (GISTs), which start in immature cells called interstitial cells of Cajal.

Other rare stomach cancer types, such as lymphoma and neuroendocrine tumors, start in different cell types in the stomach.

Different types of stomach cancer include:

Adenocarcinomas

Adenocarcinomas of the stomach develop in the cells of the innermost lining. Most stomach cancer cases, about 90 percent to 95 percent, are adenocarcinomas, according to the American Cancer Society (ACS).

Adenocarcinomas are broken down into two categories:

  • Intestinal adenocarcinomas are usually slow-growing and more treatable. Oftentimes, these cancers may be treated with therapy drugs that are designed to target specific mutations in cancer cells. This type most often occurs in men and older adults.
  • Diffuse adenocarcinomas are less common than intestinal adnocarciomas and usually more aggressive. They tend to be faster-growing, often spreading (metastasizing) to other parts of the body quickly. This type is more common at a younger age than intestinal adenocarcinomas.

Linitis plastica is a rare subtype of adenocarcinoma of the stomach, accounting for 7 percent to 14 percent of cases, according to a study in the Annals of Surgical Oncology. In this type, the cancer cells spread throughout the stomach, causing tissues to stiffen. By the time it’s diagnosed, linitis plastica cancer has usually spread to lymph nodes. Compared with other types of adenocarcinomas, it tends to be difficult to treat.

Early-stage adenocarcinomas may come with symptoms such as:

  • Indigestion
  • Bloating
  • Nausea
  • Poor appetite
  • Heartburn

As these cancers advance, they may cause:

  • Bloody stool
  • Vomiting
  • Unexplained weight loss
  • Belly pain
  • Jaundice (yellowing of the skin and eyes)
  • Difficulty swallowing

Various tests may be used to diagnose these cancers, including:

  • Blood tests
  • Endoscopy (a procedure to look inside the stomach and surrounding areas with an instrument that is inserted through the mouth)
  • X-rays and other scans
  • Biopsy (a procedure to remove a small sample of abnormal tissue/cells to check for cancer)

Treatment options include:

Rare types of stomach cancer

Lymphomas are cancers of the immune system tissue that may start anywhere lymph tissues are found, including in the stomach. However, lymphomas in the stomach are rare, accounting for about 4 percent of all stomach cancers.

MALT (mucosa-associated lymphoid tissue) lymphoma is a type of non-Hodgkin lymphoma that typically occurs in the stomach. The cancer starts in lymph tissue that lines the stomach.

Most people who develop MALT lymphoma of the stomach have had a bacterial infection, especially one caused by helicobacter pylori (H. pylori), or a viral infection. This cancer tends to be slow-growing (though it’s been known to change to a fast-growing type), and is usually detected in the early stages. If it’s caused by an H. pylori infection, the cancer is often treated with antibiotics.

If the cancer doesn’t respond to antibiotics, other treatment options include:

  • Radiation therapy
  • Chemotherapy
  • Targeted therapy
  • Surgery

Gastrointestinal stromal tumors, or GISTs, are a rare type of stomach cancer that forms in a special cell found in the lining of the stomach called interstitial cells of Cajal (ICCs). Under a microscope, GIST cells look similar to muscle or nerve cells. These tumors may develop throughout the digestive tract, but 60 percent to 70 percent occur in the stomach. In the United States, 4,000 to 6,000 new GIST cases throughout the GI tract are diagnosed per year, according to the ACS.

GISTs in the stomach may cause:

  • Abdominal pain
  • Mass or swelling in the stomach
  • Vomiting
  • Poor appetite
  • Unexplained weight loss

These tumors may also bleed, which causes blood to show up in vomit and bowel movements. Large tumors may cause a blockage between the stomach and intestine, leading to stomach pain and vomiting. These symptoms often lead people to see their doctor.

Diagnosis may involve:

Surgery and targeted therapy are the most commonly used treatment options for GISTs, but chemotherapy and radiation therapy may also be used.

Carcinoid tumors typically start in the hormone-producing cells of the stomach. These tumors usually don’t spread to different organs and account for about 3 percent of stomach cancer incidence.

The three types of gastric carcinoid tumors are:

  • Type I and II ECL-cell carcinoids rarely spread to other parts of the body and may produce no symptoms. They’re most often discovered during an endoscopy for another health issue, such as acid reflux.
  • Type III ECL-cell carcinoids are more aggressive. The excess hormone secretion of carcinoid tumors may lead to a condition called carcinoid syndrome, marked by flushing, abdominal pain, diarrhea, constriction of the bronchial tubes in the lungs and, in some cases, heart troubles like valve dysfunction. Carcinoid syndrome is a sign that more aggressive treatment may be required.

About 8,000 gastrointestinal carcinoid tumors are diagnosed in the United States each year, according to the ACS. Not all of these cancers start in the stomach—they may also occur in the intestines, appendix, colon and rectum.

Carcinoid tumors of the stomach and digestive system may be diagnosed using imaging tests (such as X-rays, CT scans and MRI scans) and a biopsy. Gastrointestinal tumors may be biopsied during an endoscopy or by needle biopsy (a procedure using a needle to remove a small sample of the suspicious tissue, which is analyzed to see whether it contains cancer and determine the type of tumor).

Treatment options include:

  • Surgery
  • Chemotherapy
  • Radiation therapy

Hereditary (familial) diffuse gastric cancer: About 1 percent to 3 percent of all stomach cancers are a rare type called hereditary diffuse gastric cancer (HDGC), according to the National Cancer Institute. This type of stomach cancer, which is caused by a genetic condition passed down from parents to children, tends to grow in multiple parts of the stomach and quickly spread to other areas of the body. Genetic testing reveals whether someone has a mutation associated with HDGC. These tests are recommended for people with two or more close relatives who developed stomach cancer at an early age or who were diagnosed with this particular type of stomach cancer.

Symptoms of this stomach cancer type may include:

  • Stomach pain
  • Nausea
  • Vomiting
  • Poor appetite
  • Unexplained weight loss
  • Difficulty swallowing

It’s usually diagnosed using a needle biopsy. Imaging tests such as ultrasounds, CT scans and positron emission tomography (PET) scans may also be used to assess the tumor's size, location and spread in the body.

Treatment options include:

  • Surgery
  • Chemotherapy

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