Stomach Cancer Screening

Stomach cancer is most treatable when it is found early, before it has grown through the stomach wall or spread to lymph nodes or other organs. Unlike colorectal or breast cancer, however, routine stomach cancer screening is not recommended for everyone in the United States. Because stomach cancer is relatively uncommon in the U.S., screening is generally focused on people who have a higher-than-average risk.

What is stomach cancer screening?

Screening means looking for cancer before you have signs or symptoms. The goal of stomach cancer screening is to find precancerous changes or cancer at an early stage, when treatment is more likely to be successful. In countries where stomach cancer is much more common, such as Japan and South Korea, population-wide screening programs are used to detect stomach cancer earlier. The original guide notes that the United States instead uses a more targeted approach for people at increased risk.

Who should consider stomach cancer screening?

Routine screening is not generally recommended for people at average risk in the United States. You may need to discuss screening or surveillance with your healthcare provider if you have a higher risk of developing stomach cancer, including if you have:

• A strong family history of stomach cancer

• Gastric intestinal metaplasia

• Gastric dysplasia or other precancerous stomach changes

• Hereditary diffuse gastric cancer syndrome or a CDH1 mutation

• Certain other inherited cancer syndromes

• A personal history of certain chronic stomach conditions

• A background associated with a country or region where stomach cancer is much more common

Your healthcare provider can help determine whether screening is appropriate based on your individual risk.

How is stomach cancer screening performed?

Upper endoscopy

Upper endoscopy, also called an esophagogastroduodenoscopy or EGD, is the primary method used to look for stomach cancer in people at increased risk. During an upper endoscopy, a doctor passes a thin, flexible tube with a light and camera through your mouth and into your esophagus and stomach. This allows the doctor to examine the stomach lining for abnormalities, including:

• Changes in the appearance or texture of the stomach lining

• Ulcers

• Polyps

• Precancerous changes

• Tumors

If an abnormal area is found, the doctor can take a small tissue sample called a biopsy. A pathologist then examines the tissue under a microscope.

What is surveillance endoscopy?

Some people who have an increased risk of stomach cancer may need regular endoscopies rather than a one-time screening test. This is called surveillance. Surveillance allows doctors to monitor changes in the stomach lining over time and potentially identify precancerous changes or cancer earlier.

People with precancerous stomach conditions

People with conditions such as intestinal metaplasia or gastric dysplasia may need periodic upper endoscopy. How often you need an endoscopy depends on the type and extent of the abnormal changes and your other risk factors.

People with hereditary diffuse gastric cancer

People with CDH1 mutations or other hereditary syndromes that substantially increase stomach cancer risk should be followed by a team experienced in hereditary stomach cancer. Diffuse stomach cancer can be especially difficult to detect through routine endoscopy. For people with hereditary diffuse gastric cancer who choose not to undergo preventive gastrectomy, specialized surveillance endoscopy may be recommended.

People with a strong family history

If you have one or more first-degree relatives, a parent, sibling, or child, with stomach cancer, talk with your healthcare provider about whether you should have H. pylori testing, genetic counseling, or endoscopic surveillance.

Screening vs. diagnosis

Screening is intended for people who do not have symptoms. If you are experiencing possible symptoms of stomach cancer, such as persistent abdominal pain, unexplained weight loss, difficulty swallowing, vomiting, blood in the stool, or feeling full after eating a small amount, your doctor may recommend an endoscopy or other tests to determine what is causing your symptoms. This is considered diagnostic testing, not screening.

Talk with your healthcare provider about your risk

There is no single stomach cancer screening schedule that is right for everyone. If you have a family history of stomach cancer, a precancerous stomach condition, an inherited genetic mutation, or another factor that increases your risk, talk with your healthcare provider about whether screening or ongoing surveillance is appropriate for you.