Stomach (Gastric) Cancer

The dominant cause is long-standing H. pylori infection — about 90% of non-cardia gastric cancers. Other factors: high salt and smoked food intake, smoking, family history (particularly E-cadherin gene mutations), pernicious anemia, prior partial gastrectomy.

Gastric cancer is the 5th most common cancer worldwide and is more common in some Saudi regions than others. Major risk factors: H. pylori infection, smoking, family history, atrophic gastritis, intestinal metaplasia, salty/smoked diets.

Several Saudi tertiary centers (KFSH, KFMC, KAMC) perform ESD for early gastric cancer. Multidisciplinary tumor boards are standard. Insurance covers all standard treatments; some immunotherapy and targeted therapy may require pre-authorization.

**Upper endoscopy with biopsy** is the standard. Modern techniques (narrow-band imaging, magnified endoscopy) can detect very early cancers. After diagnosis: CT or PET to stage the cancer; endoscopic ultrasound (EUS) for depth; sometimes laparoscopy.

Prevention focuses on H. pylori treatment, lifestyle, and screening in high-risk groups.

• Eradicate H. pylori if positive — reduces cancer risk by 30–40%.

• Stop smoking.

• Limit smoked, salted, and pickled foods.

• If you have family history or early gastric polyps, ask about screening endoscopy.

A Mediterranean-style diet is associated with lower risk.

• Plenty of fresh fruit and vegetables — protective.

• Reduce red and processed meat, especially smoked or salted.

• Avoid very hot beverages (links to esophageal/gastric cancer in some studies).

Treatment depends on stage and biomarkers — and is rapidly evolving.

• H. pylori eradication for prevention if positive.

• Chemotherapy (typically FLOT or FOLFOX combinations) before AND after surgery for resectable disease.

• Trastuzumab (Herceptin) added if HER2-positive.

• Immunotherapy (nivolumab, pembrolizumab) for advanced disease.

• Zolbetuximab for CLDN18.2-positive advanced cancers.

Procedural options range from endoscopic cure to major surgery.

• Endoscopic submucosal dissection (ESD) — for very early cancers; cure without surgery.

• Partial or total gastrectomy with lymph node dissection — standard for invasive cancers.

• Palliative procedures (stents, surgical bypasses) for obstruction in advanced disease.

Immunotherapy combined with chemotherapy has improved survival for advanced gastric cancer. Targeted therapies for HER2-positive (~15% of cases) and CLDN18.2-positive cancers are changing outcomes. Endoscopic submucosal dissection (ESD) cures very early cancers without surgery.

Stage matters enormously. Stage I (limited to mucosa or submucosa): >90% 5-year survival, often cured by endoscopy alone. Stage II–III: surgery + chemotherapy, 30–60% 5-year survival. Stage IV: median survival ~12 months but improving with immunotherapy.

• What stage is my cancer?

• Should my tumor be tested for HER2 and CLDN18.2?

• Am I a candidate for ESD instead of surgery?

• Should my family members be screened?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Patient Education Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.