When Should I Worry About...

Stomach Cancer: Early Warning Signs, Symptoms & Prevention Strategies

Feb. 9, 2024

The rate of new stomach cancer diagnoses in the U.S. has declined by about 1.5% each year over the past decade. But at the same time, there's been a steady increase among younger patients. In fact, stomach cancer has the fastest-growing incidence rate among all early-onset cancers.

"Though 68 is the average age of diagnosis, we're diagnosing patients with advanced stomach cancer in their early 60s, 50s and even 40s," says Dr. Anaum Maqsood, a gastrointestinal medical oncologist at Houston Methodist.

About 27,000 new cases of stomach cancer are diagnosed each year, and approximately 11,000 people die from the disease annually. Among the most recent deaths is country music star Toby Keith, who was diagnosed with stomach cancer at age 60 in 2021 and died of the disease in early 2024 at age 62.

"When you hear about celebrities that have a poor outcome after terminal illness, patients start to question their own symptoms," says Dr. Maqsood. "While everyone has gastrointestinal symptoms from time to time, we need to be mindful when symptoms don't go away with over-the-counter treatment."

In Texas, particularly in Harris County, rates of stomach cancer are slightly higher than average. Research suggests the increase in cases could be associated with societal trends, such as eating more processed foods, limited exercise and poor access to fruits and vegetables.

While some cases of stomach cancer are genetic, many risk factors can be controlled in partnership with your doctor. Follow these four tips to reduce your risk of stomach cancer and catch it early if it develops.

1. Know the symptoms

Early stomach cancer rarely causes symptoms — inflammation and digestive acids that enter the throat cause changes to cells that can result in gastrointestinal (GI) cancer over several years.

"Stomach acids are very important for digestion, but as chronic acidic damage initiates more cell repair processes and new cell growth, the chances increase that some of those cells will go haywire and become cancer," Dr. Maqsood says.

Noticing the subtle signs of stomach cancer and talking with a doctor about your symptoms can help catch the disease early when it is more treatable.

Here are stomach cancer symptoms you should never ignore:

  • Bloating after eating
  • Blood in the stool, which may look dark brown or black
  • Diarrhea or constipation
  • Indigestion, heartburn or gastroesophageal reflux disease (GERD)
  • Loss of appetite
  • Nausea or vomiting
  • Pain or discomfort in the abdomen
  • Sensation of food stuck in the throat
  • Swelling or fluid buildup in the abdomen
  • Unexplained weight loss
  • Weakness and fatigue


These symptoms can indicate conditions other than stomach cancer. Knowing the facts can make the difference between getting a potential cure or developing a life-threatening illness.

"Talk with a doctor right away if GI symptoms don't resolve with over-the-counter treatment," Dr. Maqsood says. "Our guideline is that if symptoms are not improving within eight weeks, you should get an endoscopy to make sure there's no underlying disease."

(Related reading: 7 Signs It's Time to See a Gastroenterologist)

2. Know your risk factors

Many risk factors for stomach cancer are within your control, in partnership with your doctor, including:


Some forms of stomach cancer are genetic, meaning DNA changes associated with some cancers are passed down through generations of families. For example, CDH+1 mutations are associated with gastric cancer. Lynch syndrome is associated with various cancers, including breast, colon and stomach cancer.

Infection with Helicobacter pylori (H. pylori) bacteria can also cause stomach cancer. H. pylori spreads through contaminated food and water or contact with infected blood, vomit or stool. Research shows that Hispanic patients are twice as likely to develop infection-related stomach cancer and three-times as likely to die from them.

"Treatment for H. pylori infection is a four-week course of antibiotics," Dr. Maqsood says. "Unfortunately, if people don't get proper treatment or follow through with their medication, H. pylori infection can cause stomach cancer."

Certain conditions also increase the risk, including:

  • Barrett's esophagus, a condition where the esophageal lining is damaged by GERD
  • Chronic heartburn, indigestion or GERD that lasts longer than eight weeks
  • Family history of stomach cancer
  • Pernicious anemia, when the immune system destroys cells in the stomach lining
  • Type A blood, which some studies have shown to increase the risk of stomach cancer for reasons that are still under investigation
  • History of stomach surgery or stomach polyps
  • Environmental exposure, such as working in the coal or rubber industries


If you have any of these factors, talk with your doctor about whether you could be at high risk for stomach cancer.

3. Get screened if you are at high risk

Colonoscopy starting at age 45 or sooner is the gold-standard screening to detect colon cancer or prevent it by removing suspicious polyps. While there is no stomach screening for stomach cancer for the general population, patients with risk factors have screening options (more below) that are covered by insurance.

Houston Methodist Cancer Center features a High Risk Program to identify and help patients reduce their chances of getting stomach cancer. The program offers:

  • Risk assessments, including medical and family history review
  • Nutrition and lifestyle modification and education
  • Genetic screening, counseling and testing
  • Cancer surveillance
  • Connection to clinical studies


"In gastric cancer, it's all about early diagnosis," Dr. Maqsood says. "If the cancer spreads beyond the stomach, it's more difficult to treat — so evaluation is crucial for patients at high risk."

A primary care provider or gastroenterologist may recommend that you have one of a number of exams or minimally invasive procedures to identify your risk or diagnose stomach cancer. Most are covered by insurance, regardless of your age.

The exams or procedures:

Endoscopy is an in-office procedure to test a sample of cells from your stomach while you are under light sedation. You won't have to drink a prep solution like with a colonoscopy, and you won't need intubation or a hospital stay.

The provider will give you sedative anesthesia and insert a thin, flexible, lighted tube into your mouth and guide it down your throat to view your stomach. They'll take a small sample of stomach tissue to view under a microscope for abnormalities.

"The procedure takes about 30 minutes," Dr. Maqsood says, "Then you recover for an hour and go home. It's as easy, if not easier, than getting a colonoscopy, and in some cases, it can spare patients from suffering with advanced stomach cancer."

Barium swallow, or upper gastrointestinal series, is an exam in which you drink a beverage with an imaging agent inside that illuminates under X-ray. The agent coats the GI organs so doctors can look for abnormalities in the stomach and esophagus.

Stool blood tests can measure the level of pepsinogen in your stool. Pepsinogen is a substance that aids in digestion, and low levels can indicate a chronic GI problem such as cancer.

Talk with a doctor about your risk whether stomach cancer screening is right for you.

4. Build a healthy lifestyle

"Patients who have symptoms of indigestion, heartburn and acid reflux disease have become very common in the general population owing to our diets, lack of exercise, lifestyles and increasing body mass indexes (BMI)," Dr. Maqsood says.

Your healthcare provider is your partner in lifelong health. We can help you make a personalized plan to reduce your risk of stomach cancer. Here are some guidelines we all should follow:

  • Eat more fruits and vegetables. If you have trouble getting healthy food, your healthcare team can connect you with community resources to help.
  • Eat less processed food. Packaged foods with long ingredient lists are generally less healthy than whole grains, fruits and vegetables and lean proteins. (Related: How Ultra-Processed Foods Harm Your Health & Examples of What Counts)
  • Exercise regularly. Walk, jog, bike, swim or even kickbox. Find a form of cardiovascular exercise that you can enjoy for 30 minutes a day, at least five days a week.


(Related reading: Are You Exercising Enough?)

Houston Methodist providers are your partners in lifelong health. From prevention strategies through diagnosis, treatment and beyond, our team of specialists will give you the personalized care you need.

We are on the leading edge of stomach cancer research. Our doctors host clinical trials that give patients access to the most advanced treatments before they are widely available elsewhere.

"We are preparing to open a few clinical trials to learn more about how new medications work to target biomarkers on tumors," Dr. Maqsood says. "One of these is to target HER-2, a gene mutation that is also associated with breast cancer."

Preventing stomach cancer starts with acknowledging your personal risk and listening to your body. Talk with your doctor about your family medical history and lifestyle to understand your chances of developing stomach cancer — and to catch it early if it happens.

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