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 cancer is not inherited. It grows after years of damage to the stomach lining, mostly caused by the germ H. pylori, with salt and tobacco adding to it.
A small share of stomach cancer runs in families. The clearest example is the CDH1 gene, which causes diffuse stomach cancer young and lobular breast cancer in women.
Treating H. pylori lowers the risk. A family with a strong pattern of stomach cancer should see a genetic counsellor, because a blood test can show who needs closer care.
How stomach cancer is tested, staged and treated, from the first endoscopy to the operation, is set out on the stomach cancer treatment in Ahmedabad page.
Most risk factors are things around us that build up over many years. A few are genes passed down in a family. Having one does not mean cancer will come.
Many people with stomach cancer had no risk factor that they knew of.
Doctors think of the lower stomach and the upper stomach as two slightly different diseases. Cancer of the lower and middle stomach is linked mainly to H. pylori and diet. Cancer at the top, where the food pipe joins the stomach, is linked more to acid reflux and to being overweight.
Helicobacter pylori is a germ that lives in the stomach lining. It is usually caught in childhood, from food, water or close contact, and it stays for life unless it is treated. Many adults in India carry it without knowing.
Over decades, H. pylori keeps the lining inflamed. The lining thins, then changes to look like bowel lining. In a few people, abnormal cells and then cancer follow.
Doctors call these steps atrophic gastritis, intestinal metaplasia and dysplasia. You may see these words on a biopsy report.
A breath test, a stool test or a biopsy during endoscopy can show the germ. After treatment, a second test is done to make sure it has gone, because it does not always clear the first time.
Food preserved with a lot of salt, or by smoking or drying, forms chemicals that can harm the stomach lining. Salt also makes it easier for H. pylori to do damage.
A pickle with a meal now and then is not the problem. What matters is a diet high in salt and preserved food, day after day, for decades. A refrigerator in the house, which replaced salting as the way to keep food, is one reason stomach cancer has become less frequent across the world.
Tobacco raises the risk of stomach cancer, whether it is smoked or chewed. It also adds to the harm done by H. pylori. Stopping lowers the risk over time.
Heavy drinking adds a little risk. The link is weaker than for cancer of the food pipe. Being overweight, and long-standing acid reflux, raise the risk of cancer at the top of the stomach and the joint with the food pipe, more than in the rest of the stomach.
A few medical conditions raise the risk enough that doctors suggest regular endoscopy.
Most families with one case of stomach cancer do not carry a cancer gene. They often share the same germ, kitchen and habits. An unusual pattern points to a gene.
These are the signs that point to a gene:
A family tree drawn at the consultation, going back two or three generations, is often the most useful single test. Write down who had which cancer, and at what age, before you come.
The CDH1 gene makes E-cadherin, a protein that holds stomach cells together. When one copy of the gene is faulty from birth, the condition is called hereditary diffuse gastric cancer.
CDH1 cancer starts as tiny groups of cells hidden under a normal-looking lining, and endoscopy often misses them. That is why an operation before cancer starts is offered.
A second gene, CTNNA1, causes a milder form of the same condition. Its carriers are usually offered regular endoscopy rather than an operation.
For a CDH1 carrier, removing the whole stomach before cancer starts is called a prophylactic total gastrectomy. It is usually offered between the ages of 20 and 30.
It may be advised a few years younger than the youngest relative who had stomach cancer.
It is a big decision, and it is never rushed. The person meets the surgeon, a genetic counsellor and a dietitian, often more than once.
Women who carry CDH1 also need breast checks with yearly MRI from about the age of 30, organised with a breast specialist.
Several other inherited conditions raise the risk of stomach cancer, though less than CDH1. In each of them, the stomach is only part of the picture.
| Condition | Gene | What it means for the stomach |
|---|---|---|
| Lynch syndrome | MLH1, MSH2, MSH6, PMS2 | Mainly bowel and womb cancer; stomach cancer risk rises too, so endoscopy every few years from the 30s is advised in many families |
| Familial adenomatous polyposis (FAP) | APC | Many stomach polyps, mostly harmless; the ones with abnormal cells are removed at regular endoscopy |
| Peutz-Jeghers syndrome | STK11 | Polyps through the gut and dark spots on the lips; endoscopy starts in childhood |
| Juvenile polyposis | SMAD4, BMPR1A | Can fill the stomach with polyps; removal of the stomach is sometimes needed when they cannot be controlled |
| Li-Fraumeni syndrome, BRCA2 | TP53, BRCA2 | A smaller rise in stomach cancer risk; other cancers matter more |
Some families have several cases of the intestinal type of stomach cancer, with no gene found. Their relatives are watched based on the family history alone.
A genetic test is a blood or saliva test for a faulty gene passed down in the family. It should start with the person who has, or had, the cancer.
If a change is found, relatives can then be tested for that one change.
The test is done after a talk with a genetic counsellor. The counsellor explains what a positive, negative or unclear result would mean for you, your children, and your brothers and sisters, before any blood is taken.
In most people it is long-standing infection with a germ called H. pylori, which keeps the stomach lining inflamed for decades. Salty and smoked food and tobacco add to the damage.
Yes. Treating it with antibiotics and an acid medicine lowers the risk, and the gain is larger when it is treated before the lining has thinned or changed. A repeat test confirms it has gone.
Most stomach cancer is not. A small share runs in families, through genes such as CDH1, the Lynch syndrome genes and the polyp syndrome genes. An unusual family pattern is the clue.
It is an inherited condition, usually caused by a change in the CDH1 gene. It causes diffuse stomach cancer at a young age and, in women, lobular breast cancer. Each child of a carrier has an even chance of inheriting it.
Because CDH1 cancer starts as tiny hidden groups of cells that endoscopy often misses. Removing the whole stomach, usually between 20 and 30, takes away the risk before cancer starts.
Not always. A test is suggested for diffuse cancer under 40, two or more stomach cancers in close relatives, stomach and lobular breast cancer together, or a report showing MMR loss. A genetic counsellor helps decide.
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 and biopsy reports, family history assessment, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Bhat, Gandhinagar. Endoscopy and biopsy, CT scans, stomach cancer surgery including total gastrectomy, and inpatient care.
Has a parent, brother or sister had stomach cancer, and you want to know what it means for you? Or has an endoscopy shown H. pylori or changes in the stomach lining? 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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