by Nicole Evans M.D.

Created on: May 26, 2009   Last Updated: January 03, 2010

Ulcers in the stomach are most commonly benign gastric ulcers. However, these ulcers have similar symptoms and a similar appearance on endoscopy to ulcerating stomach cancers. If you have been recently diagnosed with a gastric ulcer your doctor should ensure that a biopsy is done to rule out gastric malignancy.

Until the biopsy has proven you are free of stomach cancer, you can arm yourself with the following information to determine your level of risk for this malignant condition and whether you may be displaying some of the symptoms seen with gastric carcinomas.

Gastric cancer is more common in men than in women and has a peak incidence at 60 years old. Well-defined risk factors for stomach cancer have been identified. These risk factors include:

1. Pernicious anemia

2. Achlorhydria (lack of hydrochloric acid in the stomach)

3. Blood group Type A

4. Previous partial gastrectomy (resection of stomach)

5. Positive family history of gastric carcinoma

6. Smoking

7. Smoked and/or spicy foods

8. History of gastric adenomatous polyps

Keep in mind that while smoking is a risk factor for stomach cancer, it is also a risk factor for gastric ulcers (also called peptic ulcer disease or PUD). Other risk factors for gastric ulcers include:

1. Alcohol consumption

2. Helicobacter pylori (H. pylori) infection

3. High gastric acid output

4. NSAIDs (ex. ibuprofen), steroids (ex. prednisone), and salicylates (ex. aspirin)

5. Duodenogastric bile reflux

While gastric ulcers have an excellent prognosis, unfortunately the same is not true for gastric malignancy. Stomach cancer has a very poor prognosis. Only 10% of individuals with gastric cancer are living 5 years after diagnosis. This statistic holds true whether they have had apparently successful resection of their stomach tumor or not.

Part of the reason that gastric carcinoma has such a poor survival rate is that it is relatively asymptomatic in the early stages. This means that many people with stomach cancer don't realize that they have this condition until the cancer is at an advanced, more difficult to treat, stage.

The signs and symptoms of stomach cancer can be caused by the primary malignancy itself or by the areas that have been seeded with metastatic cancer. The signs and symptoms of stomach cancer include:

1. Dyspepsia (stomach upset)

2. Vomiting

3. Epigastric mass with or without gnawing, unremitting pain

4. Left supraclavicular lymphadenopathy due to cancer spread from the thoracic duct

5. Systemic symptoms such as weight loss and decreased appetite

6. Anemia from iron deficiency and/or Vitamin B12 deficiency from B12 malabsorption

There is quite a bit of overlap between the symptoms listed above and the symptoms of completely benign gastric ulcers. Signs and symptoms commonly seen with non-cancerous stomach ulcers include:

1. Epigastric pain (pain below the ribs and above the belly button)

2. Vomiting

3. Weight loss

4. Anemia

Stomach ulcers are usually easily treated by lifestyle changes, eradication of H. pylori and/or suppressing gastric acid secretion with medications such as H2 receptor blockers or proton pump inhibitors. A recurring gastric ulcer or one that is resistant to medical therapy is suspicious for gastric malignancy.

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