Why are gastric cancer patients discovered late? Does being young have a lower risk of stomach cancer? After diagnosis, in addition to treating the tumor itself, what other issues need to be paid attention to? How does precision treatment really benefit patients?
From early screening, timely medical treatment, to standardized treatment and return to normal life after diagnosis, gastric cancer patients face different challenges at different stages. Many experts interviewed by reporters from China Youth Daily and China Youth Daily said that the early symptoms of gastric cancer are hidden, and some patients "put off the symptoms as long as they can." At the same time, early detection of young patients, their nutrition and psychological state after treatment, and how to better connect precise treatment with patients' actual needs are also worthy of attention.
The "White Paper on the Quality of Life of Chinese Gastric Cancer Patients" (hereinafter referred to as the "White Paper"), initiated by the Beijing Bethune Charity Foundation and guided by the Gastric Cancer Expert Committee of the Chinese Society of Clinical Oncology and the China Gastrointestinal Oncology Clinical Research Group (CGOG), was recently released during the 2026 Chinese Society of Clinical Oncology (CSCO) annual meeting. The "White Paper" is based on real data of 1,004 gastric cancer patients, providing an aspect to observe the above issues.
From "symptoms tolerated" to "timely screening"
Data from the "White Paper" shows that disease discovery among gastric cancer patients surveyed is still driven by symptoms: nearly 70% (69.0%) of patients were diagnosed with the disease after seeking medical treatment due to symptoms, and about 40% (39.8%) of patients who sought medical treatment due to symptoms delayed seeking medical treatment. Among them, 73.8% thought the symptoms were bearable and did not pay attention to them, while 73.5% attributed it to lack of disease awareness and misjudgment of severity. Busy work life, psychological burden and financial burden concerns accounted for 25.4%, 23.4% and 18.5% respectively. At the time of diagnosis, the proportion of patients in stages III and IV was as high as 55.2%.
The reason why gastric cancer is easily overlooked is that its early symptoms lack specificity. Data from the "White Paper" shows that 53.2% of the patients surveyed experienced upper abdominal fullness, discomfort or dull pain, 29.2% experienced loss of appetite, 28.0% experienced stomach pain, and 22.3% experienced weight loss. In addition, belching, acid reflux, fatigue, vomiting, etc. are also common, and 12.2% of the patients surveyed had no obvious specific symptoms.
"Gastric cancer often has no obvious symptoms in the early stages. By the time symptoms such as nausea, vomiting, and abdominal pain appear, the disease may have progressed to a later stage." Li Jin, director of Shanghai Gaobo Cancer Hospital affiliated to China Pharmaceutical University, said that compared with diseases that can detect abnormalities through self-observation, the early symptoms of gastric cancer are hidden, and it is more necessary to strengthen early screening and health science popularization.
Li Jin believes that screening should be further strengthened for people with risk factors such as family history of gastric cancer and Helicobacter pylori infection. At the same time, it is also necessary to change the concept of some patients of "putting it off when they are sick" in seeking medical treatment. "We must put health first. If you feel unwell, you should see a doctor as soon as possible." From the perspective of symptoms, upper abdominal discomfort, indigestion, loss of appetite, significant weight loss, belching, acid reflux, heartburn, etc. are worthy of attention.
“One of the more prominent problems is that the popularity of related concepts and technologies is still limited.” Chu Yuan, the attending physician at the Gastrointestinal Endoscopy Center of Shanghai Oriental Hospital, said that some people’s understanding of gastric cancer examinations still relies on traditional examination methods such as blood drawing and CT. However, for early gastric cancer, these examinations are difficult to make an accurate diagnosis. Gastroscopy and corresponding pathological diagnosis are the most direct and accurate diagnostic methods for gastric cancer, especially early gastric cancer.
Currently, different guidelines and expert consensus are not entirely consistent in defining the age of high-risk groups for gastric cancer screening. Chu Yuan said that the mainstream recommendation is that people over 40 years old and with related high-risk factors (such as Helicobacter pylori infection, atrophy, intestinal metaplasia, smoking, heavy drinking) undergo gastroscopy screening. For people with a history of gastric cancer in first-degree relatives, it is recommended to advance the age of first screening, generally about 10 years earlier than the earliest age of onset in the family, or starting from the age of 40.
Regarding the frequency of gastroscopy screening, Chu Yuan said that it is difficult to give a unified standard that applies to everyone, and it needs to be judged based on the results of the first examination and personal risk factors. "It depends on the circumstances of the first examination, including whether there are high-risk factors. If only superficial gastritis is found in the first gastroscopy, annual examinations are usually not required, and reexamination every 3 to 5 years is enough. Because the occurrence and development of most digestive tract tumors is a relatively slow process, it usually takes a long time to develop into advanced gastric cancer from no obvious abnormalities at first. But for subjects with severe atrophy or intestinal metaplasia, the interval between next gastroscopy should be shortened appropriately."
Youth does not equal low risk
Young people are also at risk for stomach cancer. Among the 1,004 gastric cancer patients surveyed in the "White Paper", 24.2% were 44 years old and younger, with the youngest patient only 20 years old; 54.2% were 45 to 64 years old, 17.2% were 65 to 74 years old, and 4.4% were 75 years old and above. It is worth noting that stage IV is more common when diagnosed in patients aged 44 and under.
Li Wen (pseudonym), 29, is a salesperson. Nearly a year before he was diagnosed with gastric cancer, he had recurring upper abdominal pain, fullness after meals, and occasionally acid reflux and loss of appetite. At first, he thought it was due to work stress or gastritis, so he bought stomach medicine and took it. Because his "symptoms were still tolerable," he did not seek medical treatment in time. It took about 8 months from the first onset of symptoms to the time he went to the hospital for examination. It was not until the pain worsened and his weight dropped significantly that Li Wen underwent a gastroscopy and discovered that he had stage IV gastric cancer with peritoneal metastasis.
After the diagnosis, Li Wen received chemotherapy combined with immunotherapy. During the treatment, he experienced adverse reactions such as low white blood cells, nausea, and fatigue, and the treatment plan once needed to be adjusted. The disease has also had a significant impact on his life: his income has dropped due to rest due to illness, and his wife's accompanying him for medical treatment has increased the family burden. In addition to treatment, he is also worried about recurrence, metastasis, treatment costs, and whether he can continue to work and realize his family plan in the future.
37-year-old Lin Li (pseudonym) discovered gastric lesions earlier due to a gastroscopy. She has occasionally experienced symptoms such as abdominal distension and belching in the past year. During the gastroscopy, the doctor found a depressed lesion of about 1 cm in the antrum of his stomach. Further pathological examination revealed that it was signet ring cell carcinoma.
Due to the timely discovery, Lin Li underwent endoscopic submucosal dissection (ESD). The postoperative pathological examination showed that the disease was in the early stage. According to relevant diagnosis and treatment standards, further subtotal gastrectomy and lymph node dissection were not needed, and regular review was enough. Doctors believe that Helicobacter pylori infection may be a clear risk factor.
After the treatment, Lin Li recovered well, but her cancer experience still changed her lifestyle. In the past, she often felt that she could "work a little harder" at work and put many things off later. After the surgery, she began to pay attention to her body and life. However, even if the doctor told her that she had reached the endoscopic cure criteria, she still worried about recurrence and metastasis, and sometimes had negative emotions.
The experiences of Li Wen and Lin Li illustrate the importance of early detection of gastric cancer from different aspects. Chu Yuan said that in recent years, the incidence of gastric cancer among people aged 19 to 35 in my country has been on the rise, and some patients are already in an advanced stage when diagnosed.
In terms of preventing gastric cancer, Chu Yuan suggested that the first step is to eradicate Helicobacter pylori, a clear carcinogen of gastric cancer. Secondly, we should start from the daily diet and lifestyle, maintain regular eating, reduce the intake of high-salt, pickled, smoked, barbecued, fried foods, etc., appropriately increase fresh fruits and vegetables, whole grains and other foods, quit smoking and limit alcohol. Regular work and rest, adequate sleep, appropriate exercise and weight control can also help maintain good physical condition.
Chu Yuan said that if you have persistent or recurring upper abdominal discomfort, indigestion, acid reflux, belching and other symptoms that have not been relieved after a period of time, or if you have alarm symptoms such as melena, hematemesis, weight loss, difficulty swallowing, etc., you should go to a gastroenterology specialist for evaluation in time; if you have high-risk factors such as a family history of gastric cancer, you should actively check according to relevant screening recommendations instead of waiting until obvious symptoms appear before seeking medical treatment.
What thresholds must be crossed for precision treatment?
Diagnosis is just the beginning. How to help patients not only "live longer" but also "live well" has also become the focus of this "White Paper". The "White Paper" shows that the overall quality of life of gastric cancer patients is at a medium level, and basic functions and daily activities can be maintained to a certain extent, but multiple burdens such as nutrition, psychosocial and economic are still prominent. 82.4% of the patients surveyed had mild or above malnutrition, of which more than half, 57.5%, were moderately or severely malnourished; 87.4% of the patients surveyed experienced varying degrees of social restriction after becoming ill. From the perspective of symptom burden, fatigue is the most prominent symptom among the patients interviewed, with a score of 32 points; followed by sleep disturbance and loss of appetite, both with 22 points; others are: pain (17 points), constipation (16 points), nausea and vomiting (15 points), shortness of breath (14 points) and diarrhea (13 points). In addition, economic hardship is also at a relatively high level.
Zhang Yanqiao, chief physician at Harbin Medical University Cancer Hospital, said that in clinical practice, doctors used to pay more attention to disease indicators such as tumor size and lesion changes, but paid relatively little attention to patients' sleep, nutrition, psychological conditions and other conditions. This is not only related to the number and workload of clinicians, but also reflects the need for further changes in diagnosis and treatment concepts.
"We should shift from focusing on tumors to focusing on people themselves." Zhang Yanqiao said that patients with gastric cancer not only need to "live longer" but also "live well." Problems such as pain, sleep disorders, loss of appetite, and malnutrition may interact with each other to form a vicious cycle, further reducing the patient's quality of life.
In terms of treatment methods, the "White Paper" data shows that surgery and chemotherapy are still the most important treatments for gastric cancer patients surveyed. 75.9% and 74.7% of the surveyed patients received surgical treatment and chemotherapy respectively, 35.2% of the surveyed patients received immunotherapy, 26.7% were treated with traditional Chinese medicine, 19.3% were treated with nutritional support, 18.9% were treated with targeted therapy, and 14.5% were treated with radiotherapy.
Patient demand for precise treatment is increasing. Bi Feng, director of the Department of Medical Oncology at West China Hospital of Sichuan University, said that many patients currently know that "there are targeted treatments for gastric cancer," but they have insufficient understanding of issues such as "why testing is needed and how the test results affect subsequent medication." Therefore, to improve the detection rate, we first need to strengthen patients' awareness. Doctors bear an important responsibility in this process. Only when patients truly understand the meaning of testing can they transform "knowledge" into "action." He also pointed out that targeted therapy is not suitable for all patients with gastric cancer, and its treatment has clear biomarker-driven characteristics. Only by clarifying whether the patient has corresponding targets through standardized testing can we further select an appropriate treatment plan.
Shen Lin, director of the Department of Gastrointestinal Oncology at Peking University Cancer Hospital, pointed out that gastric cancer is one of the common malignant tumors in my country. During the treatment process, patients often face multiple challenges brought about by the disease itself, treatment response, and life changes. The release of the "White Paper" will allow everyone to more systematically understand the real needs of patients in diagnosis, treatment and life. It will also promote clinical and social attention and support to them, allowing patients to build confidence in standardized diagnosis and treatment and full care, and have more strength to face and overcome challenges in the treatment process. *
China Youth Daily·China Youth Daily reporter Zhao Anqi
