Skip to main contentLast updated: 23-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Stomach Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.89 from 216 reviews (Gota clinic) · 4.94 from 18 reviews (Apollo, Bhat)
In short
Most stomach cancers follow one well-worn plan. A few situations change it: where the cancer sits, the type of cells, an old operation, a family gene, or pregnancy.
In these situations the tests before surgery, the size of the operation and the order of chemotherapy and surgery are planned for that one situation.
Some of these cancers spread inside the belly early. A short keyhole look inside the belly, called staging laparoscopy, is often done before any big operation is decided.
How stomach cancer is usually tested, staged and treated is set out on the stomach cancer treatment in Ahmedabad page. This post covers the cases that need a different plan.
The usual plan is chemotherapy, then removal of the stomach or part of it with its glands, then more chemotherapy. Some cancers do not fit that pattern.
The reasons fall into a few groups:
None of this means the cancer cannot be treated. It means the plan is worked out for that person. A team of the surgeon, cancer physician, radiologist and pathologist often decides it together.
Cancer at the joint of the food pipe and the stomach is grouped by where its centre lies. It may be above the joint, at it, or just below.
Doctors call this the Siewert grouping, and you may see “Siewert I, II or III” on the endoscopy or CT report.
| Group | Where its centre lies | Usual operation |
|---|---|---|
| Siewert I | Above the joint, in the lower food pipe | Treated as food pipe cancer: most of the food pipe is removed through the belly and chest, and a new pipe is made from the stomach |
| Siewert II | Right at the joint | Either operation; the choice depends on how far it runs up the food pipe, where most of the growth is, the cell type and fitness |
| Siewert III | Just below the joint, in the top of the stomach | Treated as stomach cancer: the whole stomach and the lower end of the food pipe are removed through the belly |
For the joint cancers, the glands removed include those in the upper belly and those in the lower chest. Chemotherapy, and sometimes radiotherapy, is usually given before the operation. A trial comparing the two operations for Siewert II cancer is still running, so the choice remains a matter of judgement for each person.
In linitis plastica the cancer spreads through the whole wall of the stomach rather than forming a lump. The wall thickens and stiffens, and the stomach can no longer stretch to hold a meal.
Because of that spread, a staging laparoscopy with a wash of the belly for cancer cells is always done first. A positive wash changes the whole plan.
If surgery is planned, the whole stomach is removed with its glands. The surgeon cuts well clear of the cancer, often several centimetres beyond what can be seen, and the pathologist checks the cut edges during the operation. When the edge is not clear, more of the food pipe or the duodenum is taken. The spleen, part of the pancreas or part of the bowel are sometimes removed with it.
This is a large operation with a real chance of complications, and the outlook is guarded even after a complete removal. Chemotherapy is given first in most cases, and the decision to operate is made after it.
Signet ring cells are cancer cells so full of mucus that the nucleus is pushed to one side, like a stone on a ring. They are a diffuse cancer.
This type behaves differently from the usual, gland-forming stomach cancer:
What this changes in the plan:
Many people had part of the stomach removed for an ulcer long ago, before modern ulcer medicines. The part left behind is called the stomach remnant, or stump.
Bile flowing back into the remnant slowly damages its lining. After many years, cancer can start there. This is called stump cancer, or remnant gastric cancer.
Treatment is to remove the rest of the stomach with its glands, take down the old join, and connect the food pipe to the small bowel. The old operation leaves scar tissue, so this is a long and careful operation. Stage for stage, the outlook is close to that of a first stomach cancer, so finding it early matters.
Some families carry a change in the CDH1 gene. It causes diffuse stomach cancer at a young age, and lobular breast cancer in women. The cancer starts as tiny groups of cells hidden under a normal lining, which endoscopy often misses.
For a CDH1 carrier, removing the whole stomach before any cancer is found is usually offered between the ages of 20 and 30, after careful counselling.
Stomach cancer in pregnancy is rare. It is often found late, because nausea, vomiting, heartburn and tiredness are put down to the pregnancy itself.
An endoscopy with biopsy is safe in pregnancy. Persistent vomiting, weight loss, black stools or anaemia that does not respond to iron should lead to one.
For staging, MRI is used in place of CT where possible, to limit radiation to the baby. The plan then depends on how far the pregnancy has gone:
The surgeon, the cancer physician, the obstetrician and the newborn specialist plan this together, with the mother and her family.
After a gastric bypass, a large part of the stomach is left in place but shut off from food. Endoscopy cannot easily reach it, so a cancer there can grow unseen.
After a sleeve operation, the stomach is narrower but still reachable by endoscopy, so the usual tests apply.
The standard cancer operation removes a wide ring of glands around the stomach, called a D2 removal. It is longer and carries more strain on the body.
For someone very old, mostly in bed, or with serious heart or lung disease, a smaller gland removal can be safer. It is called D1. It may not control the cancer quite as well, but it lowers the chance of a serious complication. Chemotherapy is still considered afterwards if the person can manage it.
The choice is made after a full check of heart, lungs, kidneys and nutrition. It also follows an honest talk with the person and the family about what they want from treatment.
A stomach cancer can bleed, or grow across the outlet of the stomach so food cannot pass. These problems need attention even when the cancer cannot be removed.
Most bleeding from stomach cancer can be controlled without an operation. An emergency removal of the stomach is needed only now and then.
A stomach cancer can grow through its wall into the bowel, the pancreas, the spleen, the liver or the diaphragm. On the report this is called T4b.
This decision is made on scans and, often, a staging laparoscopy, by a team used to these operations.
It is a cancer centred right at the joint of the food pipe and the stomach. It can be treated with a food pipe operation or a total stomach removal, depending on how far it runs up the food pipe.
These types often spread over the lining of the belly in deposits too small for a CT scan to show. A short keyhole look, with a wash for cancer cells, finds them before a big operation is planned.
Yes. Bile flowing back into the remnant damages its lining over many years. Regular endoscopy from about ten years after the old operation helps find it early, when removal of the remnant works well.
Yes. An endoscopy with biopsy is safe in pregnancy and should not be delayed when vomiting, weight loss, black stools or anaemia keep going. MRI is used in place of CT where possible.
Often yes. A smaller gland removal, called D1, is safer for a frail person. Bleeding and blockage can be handled at endoscopy, with clips or a stent, without an operation.
If all of it can be removed with clear edges, the stomach and the involved part of the other organ are removed together in one piece. If not, chemotherapy and other treatment are preferred.
The full range of stomach cancer care is on the stomach cancer treatment page. For questions before you travel, call +91-63555-64601.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of endoscopy, biopsy and scan reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Bhat, Gandhinagar. Endoscopy and biopsy, CT scans, staging laparoscopy, stomach cancer surgery including total gastrectomy, and inpatient care.
Does the report say the cancer is at the food pipe joint, or of the signet ring type? Was it found in a stomach operated on years ago, or during a pregnancy? The reports can be sent ahead on WhatsApp, so the consultation starts with them already read. What you need is decided at the consultation, after examination. Call +91-63555-64601 Send your reports before the visit
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