Stomach cancer, the leading cancer killer in America a century ago, has dropped precipitously in the national rankings since then. A decline in overall stomach cancer cases and deaths has continued even in recent decades.
But the disease, also called gastric cancer, still has a low survival rate nationally — and an increasing number of cases are being seen in young adults.
“Gastric cancer is very difficult to diagnose. Most of the patients don't have any symptoms in its early development. And when the symptoms arise, they could be mistaken for some other diagnoses like reflux,” Yanghee Woo, M.D., director of the Gastroenterology Minimally Invasive Therapy Program at City of Hope® Orange County Lennar Foundation Cancer Center, says on the Talking Hope podcast. “And then, by the time that the gastric cancer is actually detected … in most of our patients in the United States, it's in advanced stages.”
While stomach cancer is no longer among the most prevalent cancers in the United States — it ranked 17th in estimated cancer deaths last year — the global situation is very different. It is the fifth most common cancer worldwide and fourth in terms of deaths annually.
Stomach cancer hotspots include East Asia, Eastern Europe and South and Central America, the National Cancer Institute reports. In the United States, the disease is more common among African Americans, Hispanics, Asian/Pacific Islanders and Native Americans than it is among non-Hispanic whites.
“The incidence rate among Asian Americans can be 10 to 12 times higher than for non-Hispanic whites, making it among the top five cancers in that population”, Dr. Woo says in the podcast. The Hispanic and African-American communities also see a higher death rate from stomach cancer, she says.
The relative five-year survival rate for Americans diagnosed with stomach cancer was 36.4% in 2024. However, for those diagnosed during the earliest stage, before the cancer had a chance to spread, the survival rate was 75.4%.
Because stomach cancer is not one of the leading cancers in the country — it accounts for about 1.3% of new cancer cases annually and 1.8% of cancer deaths — Dr. Woo says “not that much awareness exists about gastric cancer and what it's doing within our communities.”
In this article, we will examine:
- Stomach Cancer in Young People
- What Causes Stomach Cancer in Young Adults?
- Is Screening an Option?
- Gastric Cancer Symptoms: What to Look for
If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.
Stomach Cancer in Young People
Doctors don’t usually suspect stomach cancer when a younger person comes in with underlying symptoms, because the cancer is still considered an older person’s disease. Also, many more likely possibilities may account for the pain a person is experiencing, whether the symptom is acid reflux, heartburn, indigestion or nausea.
A 2018 study found that cases of non-cardia gastric cancer — a cancer that attacks the lower portion of the stomach — were decreasing at an annual rate of 2.6% for individuals over 50 years old, but increasing by 1.3% a year for those under 50.
“Unfortunately, a large percentage of our patients that come to see us are very young, in their 20s, 30s, 40s, with young children. They're supposed to be at the height of their lives, their careers, their family building — and they get hit with stomach cancer,” Dr. Woo says.
“At City of Hope, we see a lot of very advanced patients, advanced stage gastric cancer. We also see a lot of patients that have had long delays with months and months of upper GI, stomach related symptoms that have been misdiagnosed in some way, or even though they have stomach cancer diagnosis, they have found difficulty finding experts.”
Men are twice as likely as women to be diagnosed with the disease, but a study out of Cedars-Sinai Medical Center, published in 2023, found a rising incidence nationally of non-cardia gastric cancer in younger, non-Hispanic white women over the previous two decades, outpacing the increase in younger men. Unfortunately, the study concluded that “the reasons for these alarming trends remain elusive.”
There are ways of reducing your risk of getting stomach cancer. They include quitting smoking, maintaining a healthy weight and avoiding smoked, pickled, preserved, salted and processed foods. Making sure you eat plenty of fruits and vegetables and are physically active may also help reduce the risk.
What Causes Stomach Cancer in Young Adults?
Stomach cancer has certain causes, regardless of age. Dr. Woo says the ethnic connections to stomach cancer may be linked to other risk factors, such as:
- A Helicobacter pylori (H. pylori) infection
- A family history of stomach cancer
- Immigration from a country with a high incidence of stomach cancer
- Perhaps higher rates of smoking and drinking than in the general population
A 2018 National Cancer Institute report examined the possibility of the disease’s link to non-cardia gastric cancer.
“Two of the main causes of non-cardia gastric cancer are infection by the bacterium Helicobacter pylori and autoimmune gastritis, which occurs when a person’s immune system attacks the lining of the stomach,” the NCI report said. “The prevalence of H. pylori infection has clearly decreased in the United States over the past century, whereas autoimmune gastritis may have become more common in recent decades.”
That includes, according to some research, being seen more frequently in adults at younger ages — a possible connection to the rise in stomach cancer seen nationally among younger adults.
The NCI report was based on a study that also indicated it’s possible that a new form of stomach cancer may be emerging. And it suggested another possible cancer cause is the rise in the use of antibiotics over the past half-century, which if proven in new research, might partly explain the increase in stomach cancer in young adults.
“We are seeing an increasing risk of this cancer in people born after 1950, and that coincides with the introduction of antibiotics,” said M. Constanza Camargo, Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics, in the report. “The increase in non-cardia gastric cancer rates is more pronounced in females than males, and we know that females take more antibiotics than males.”
Is Screening an Option?
Unlike for some cancers, a routine screening test isn’t available in the United States for detecting stomach cancer. For people at greater risk for developing stomach cancer, an upper endoscopy may be performed that looks at the esophagus, stomach and duodenum (part of the small intestine) to search for any abnormalities.
Dr. Woo says at City of Hope, the first part of screening is not a medical procedure, but a determination of a person’s risk for developing the disease.
“We have developed a study, a two-tier assessment, two-tier screening program where we want to identify persons at risk of developing stomach cancer,” Dr. Woo says. “I call it two tier because the first tier is the risk assessment.”
The assessments look to see if the person is a smoker, is from an ethnic background in which the disease is more prevalent, if he or she has had H. pylori and examine other known risk factors.
“Second tier is to offer the gold standard of stomach cancer diagnosis, which is upper endoscopy,” Dr. Woo says. “The upper endoscopy is like a colonoscopy, but in the other direction, and it's performed by gastroenterologists. A simple method of looking down directly into our stomach and also to biopsy the stomach wall to find any abnormal cells, whether they're premalignant or cancer.”
City of Hope doctors may also order blood chemistry studies to see if a patient is anemic, which may be a result of bleeding, liver problems or malnutrition related to cancer.
Gastric Cancer Symptoms: What to Look for
Stomach cancer often isn’t diagnosed because its symptoms are frequently signs of more common conditions. That’s why it’s important for people experiencing symptoms to know if they are at higher risk for the disease.
“Knowing that we are at a higher risk of developing gastric cancer will help us be more aware of our symptoms and that when symptoms come and go, it's very different from having symptoms that last a long time,” Dr Woo says. “Abdominal pain, nausea, inability to digest food, weight loss. We try so hard to lose weight. And when all of a sudden we lose weight without even wanting to do so, then that's kind of concerning. There's something wrong.”
The National Cancer Institute lists the following symptoms that may occur during early-stage stomach cancer:
- Indigestion and stomach discomfort
- Bloating after eating
- Mild nausea
- Loss of appetite
- Heartburn
In addition to these symptoms, the NCI says advanced-stage stomach cancer symptoms may also include:
- Blood in the stool
- Vomiting
- Weight loss for no known reason
- Stomach pain
- Jaundice (yellowing of eyes and skin)
- Ascites (buildup of fluid in the abdomen)
- Trouble swallowing
City of Hope has a team of internationally trained gastric specialists available for consultation. If you are experiencing persistent and troubling gastrointestinal symptoms, if you have a family history of stomach cancer, or if you are at genetic risk of the disease, City of Hope has professional expertise to diagnose stomach cancer and — if cancer is found — to formulate a personal treatment plan that also provides you with the support services you need.
If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.