Stomach Cancer: Early Symptoms, Stage 4 Signs and Risk Factors

By Anjela Jeganathan – Medical Herbalist | Herba Naturalle

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Stomach cancer — also known as gastric cancer — is the fifth most common cancer worldwide and one of the most important to catch early, as prognosis differs dramatically between early and advanced stages. In the UK, approximately 6,000 people are diagnosed with stomach cancer each year. Understanding the symptoms — particularly the early, easy-to-overlook signs — can make a meaningful difference.

The Challenge of Early Detection

One of the greatest clinical challenges with stomach cancer is that early-stage disease is frequently asymptomatic — or produces symptoms so common and non-specific (mild indigestion, occasional nausea) that they are attributed to normal digestive variation. By the time definitive symptoms develop, the cancer has often progressed.

This is why alarm symptoms — symptoms that cross the threshold from common digestive complaints to potential serious pathology — must be taken seriously and investigated promptly.

The distinction between common gastric symptoms (gastritis, indigestion) and alarming ones is relevant to our post on gastritis, sickness bugs and recovery.

Early Symptoms of Stomach Cancer

Early stomach cancer may produce:

• Persistent indigestion — particularly if newly developed or worsening in someone over 55
• Feeling full quickly (early satiety) when eating smaller portions than usual
• Upper abdominal discomfort — a nagging ache in the area below the sternum
• Nausea — particularly after eating
• Loss of appetite — new and progressive
• Heartburn — that does not resolve with standard antacids

These symptoms are non-specific — they are far more commonly caused by benign conditions (gastritis, peptic ulcer, reflux) than cancer. However, when they are new, persistent, worsening, or occur in a person over 55, they require GP assessment.

Red Flag Symptoms Requiring Urgent Referral

The NHS 2-week wait referral pathway for suspected upper GI cancer is triggered by:

• Dysphagia (difficulty swallowing) at any age
• Upper abdominal mass on examination
• Haematemesis (vomiting blood) at any age
• Unexplained weight loss with upper abdominal symptoms
• Anaemia (iron deficiency) with upper GI symptoms over 55

Stage 4 Stomach Cancer Symptoms

By stage 4, the cancer has spread beyond the stomach to distant organs — liver, lungs, lymph nodes, or peritoneum (the abdominal cavity lining). Symptoms at this stage may include:

• Jaundice — yellowing of the skin and whites of the eyes (liver metastasis)
• Ascites — fluid accumulation in the abdomen, causing significant distension and discomfort (peritoneal spread)
• Progressive, marked weight loss
• Severe fatigue — often related to anaemia, nutritional depletion, and the metabolic demands of advanced disease
• Bone pain — if skeletal metastases are present
• Generalised abdominal pain — spreading from the stomach region

Stage 4 stomach cancer has a significantly reduced prognosis compared to stage 1 or 2 disease — highlighting the importance of investigating alarm symptoms promptly rather than waiting.

Risk Factors for Stomach Cancer

• Helicobacter pylori infection — the most significant modifiable risk factor; a bacterial infection of the stomach lining that causes chronic gastritis and significantly raises the risk of both peptic ulcer and gastric cancer
• Age — risk increases significantly over 55
• Sex — more common in men
• Diet — high intake of salted, smoked, and preserved foods; low intake of fresh fruit and vegetables
• Smoking
• Excessive alcohol consumption
• Family history — first-degree relatives with gastric cancer increase risk
• Previous stomach surgery

When to See Your GP

Do not wait and watch for stomach cancer symptoms — book a GP appointment promptly for any of the following:

• New, persistent indigestion over 55
• Difficulty swallowing
• Unexplained weight loss
• Persistent nausea or vomiting
• Vomiting blood or passing very dark/tarry stools

The broader context of digestive health and abdominal symptoms is explored in our posts on abdominal pain and its causes and IBS, IBD and bowel cancer symptoms.

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This article is for educational purposes only. Please see your GP urgently for any alarm symptoms listed above.