Stomach cancer is one of the few types of cancer for which scientists have strong evidence that diet is a primary cause, yet an estimated 22,000 Americans develop the illness each year and half of them die from it. Why does this occur?

A diet rich in salted, smoked or pickled foods and/or processed meats, such as salami and corned beef, has been identified as a risk factor for stomach cancer. Infection with Helicobacter pylori (H. pylori)—the bacterium that causes most ulcers-also increases risk for the disease. It's estimated that half of Americans age 60 and older are infected with H. pylori, but most of them don't know it.

In addition, smokers are twice as likely as nonsmokers to develop stomach cancer. In former smokers, risk for the disease is 50% higher than in someone who never smoked. How to protect yourself…

Hidden Symptoms

Most patients with stomach cancer have few or no symptoms in the early stages. Even when symptoms such as abdominal pain, nausea and/or heartburn-are present, they're often mistaken for other, less serious problems.

Result: The cancer usually isn't detected until it reaches an advanced stage, in which it has spread to other organs and/or distant lymph nodes.

Symptoms to watch for…

  • Dull, achy pain in the upper abdomen that isn't relieved with antacids, such as famotidine (Pepcid) or ranitidine (Zantac).
  • Abdominal pain and/or cramping that's worse after eating.
  • An unusual feeling of fullness after eating, even when you're eating less than usual.
  • Vomiting after meals.
  • Sudden weight loss.

Important: If you have any of these symptoms, talk to your doctor.

Steps To Protect Yourself

With the exception of not smoking, there is no definitive evidence that preventive strategies can reduce stomach cancer risk. However, cancer experts agree on the following approaches as prudent and reasonable precautions…

  • Treat ulcers promptly. Ulcers were once believed to be caused mainly by lifestyle factors, such as chronic stress and eating spicy foods. It's now known that the vast majority of duodenal ulcers (which develop in the part of the small intestine that connects to the stomach) are caused by H. pylori, an organism that burrows into the protective layer (mucosal lining) of the stomach Ulcers don't necessarily increase the risk for stomach cancer, but H. pylori does-by 200% to 600%.

Reason: Infection with H. pylori causes chronic inflammation in the stomach lining and increases the risk for cell changes that can lead to cancer. In patients with duodenal ulcers, antibiotic therapy is the standard approach to eradicate the bacteria.

Self-defense: If you have ulcers or gastritis inflammation of the stomach lining), ask your doctor for an H. pylori blood test, and consider antibiotic therapy (usually for two weeks) if an infection is present.

  • Avoid foods with certain preservatives. Certain types of preserved foods, such as smoked or salted meat or fish...pickled veg. etables and processed or cured meats, including bologna, salami, hot dogs, bacon or ham, usually contain high levels of nitrates and nitrites, chemicals that combine with other compounds in the stomach to form carcinogens. People who eat these foods regularly have at least double the risk for stomach cancer as those who don't—and the risk rises with increased consumption.

Recent finding: A diet rich in red meat—particularly meat that's well-done and/or barbecued—also may increase risk for stomach cancer.

Self-defense: Do not exceed one or two weekly servings of foods that contain nitrates and/or nitrites. (Check the ingredients list on the label) The evidence isn't strong enough to recommend giving up these foods altogether.

  • Eat more fresh produce. Studies suggest that people who eat many fruits and vegetables—particularly brightly colored produce, such as spinach, cantaloupe, broccoli and winter squash—have lower rates of stomach cancer.

Self-defense: Eat five to nine one-half cup servings of non-pickled fruits and vegetables daily.

Best Detection Techniques

Most cases of stomach cancer can be diagnosed with endoscopy, in which a lighted tube is inserted through the mouth into the stomach. If an area looks abnormal (for example, discoloration or masses are present), a biopsy will be taken and analyzed in a laboratory. Although stomach cancer is relatively easy to diagnose with endoscopy, most people with the disease don't receive this test until the malignancy is advanced.

For earlier detection: A fecal occult blood test (FOBT) detects trace amounts of blood in stool samples. This test is mainly used as part of colon-cancer screening, but it also can detect bleeding that may be present with early-stage stomach cancer.

Self-defense: Ask your doctor if you should have an FOBT annually. The FOBT doesn't identify the source of bleeding—a positive test needs to be followed by other screenings, such as colonoscopy (for colon cancer) or endoscopy (for stomach cancer).

Treatment Options

Surgery is the main treatment for stomach cancer. If the cancer involves a small area, a subtotal gastrectomy (only part of the stomach is removed) is usually performed. More advanced cancers may require a total gastrectomy (removal of the entire stomach). After a total gastrectomy, food is digested in the small intestine.

Most patients with locally advanced stomach cancer (which occurs when the tumor affects only the stomach and nearby tissues) are also treated with chemotherapy and radiation. The combination of surgery, chemotherapy and radiation is more effective for this stage of stomach cancer than surgery alone.

With very early-stage, localized cancers, about two-thirds of patients recover completely. Once the cancer has spread through the stomach wall to nearby lymph nodes and/or organs, treatment is less successful and the survival rate ranges from less than 10% to 40%.

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