Stomach Cancer vs. Stomach Ulcers - Differences in Symptoms and Signs

Stomach cancer and stomach ulcers may have similar initial symptoms.

• Stomach cancer is a type of cancer that begins in the stomach. The most common type of stomach cancer is adenocarcinoma, which develops from the cells of the innermost lining of the stomach (the mucosa).
• Stomach ulcers (peptic ulcers) are open sores in the upper digestive (gastrointestinal, GI) tract.
• There are two types of peptic ulcers. Gastric ulcers, which form in the lining of the stomach, and duodenal ulcers, which form in the upper part of the small intestine.
• Sometimes there are no signs or symptoms of stomach cancer or duodenal or gastric ulcers, and when they do occur, they may include nausea and loss of appetite with no clear cause.
• Other similar signs and symptoms of stomach cancer and stomach ulcers include weight loss and anemia. Symptoms of anemia include:
  • Fatigue (a late-stage stomach cancer symptom)
  • Lack of energy
  • Weakness
  • Rapid heartbeat
  • Pale skin
• Early signs and symptoms of stomach cancer that are different from stomach ulcers include:
  • Mild upper abdominal discomfort
  • Difficulty swallowing due to a tumor
  • A feeling of fullness after eating a small amount of food
• Late signs and symptoms of stomach cancer that are different from gastric or duodenal ulcers include:
  • Fatigue
  • Severe nausea and vomiting
  • Weight loss
  • Anemia
  • Vomiting blood or dark material that looks like coffee grounds, or passing black stools caused by bleeding
• The first early symptom of a stomach ulcer is severe upper abdominal pain. Usually, this type of abdominal pain does not occur in stomach cancer.
• The most common symptoms of stomach ulcers are abdominal pain and vomiting.
• Stomach cancer is caused by risk factors that include:
  • Low socioeconomic status
  • Male gender
  • Smoking
  • Advanced age
  • Prior diagnosis of pernicious anemia (vitamin B12 deficiency)
  • A diet deficient in fresh fruits and vegetables, and rich in salted or smoked fish or meats and poorly preserved foods
  • Family history of stomach cancer
  • Having type A blood
  • Chronic Helicobacter pylori (H. pylori) infections
  • Prior removal of part of the stomach to treat a benign (noncancerous) stomach or a duodenal ulcer
• Stomach ulcers or peptic ulcers are caused by an imbalance between stomach acid and an enzyme called pepsin, coupled with the digestive tract's inability to protect itself from these harsh substances. Risk factors that contribute to this imbalance that causes stomach ulcers include:
  • H. pylori infection
  • Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen (Advil) and naproxen (Aleve, Naprosyn).
  • Alcohol
  • Physical stress
  • Caffeine
  • Smoking
  • Radiation therapy
  • Advanced age with conditions such as arthritis
  • Prior ulcers or intestinal bleeding
• Duodenal ulcers are noncancerous (benign). Occasionally, gastric ulcers can become cancerous (gastric cancer).
• Vomiting blood, passing black stools, or blood in the stool (blood loss) also may be signs of stomach cancer and peptic ulcers. If you have these symptoms, call your doctor or go to the nearest hospital Emergency Department or Urgent Care facility.

Picture of cancer in the lower part of the stomach

Picture of Stomach Ulcers (Peptic, Duodenal, Gastric)

What Is Stomach Cancer?

Stomach cancer is the fourth most frequent cause of cancer-related death worldwide. The most common form of cancer that affects the stomach is adenocarcinoma, which arises in the glands of the innermost layer of the stomach. Gastric cancer tends to spread through the wall of the stomach and from there into the adjoining organs (pancreas and spleen) and lymph nodes. It can spread through the bloodstream and lymph system (metastasize) to distant organs such as the liver, bones, and lungs.

What Is a Stomach Ulcer (Peptic Ulcer)?

A peptic or stomach ulcer is an open sore in the upper digestive tract. There are two types of peptic ulcers, a gastric ulcer, which forms in the lining of the stomach, and a duodenal ulcer, which forms in the upper part of the small intestine.

Stomach Cancer Symptoms and Signs

Early symptoms of stomach cancer tend to be vague and nonspecific. Seek medical attention if you have any of these symptoms.

• Mild upper abdominal discomfort associated with nausea and loss of appetite
• Difficulty swallowing because of a tumor involving the upper part of your stomach, near the esophagus
• Feeling of fullness after taking only a small amount of food

The following symptoms may indicate advanced cancer.

• Fatigue
• Weight loss
• Iron deficiency anemia
• Overt blood loss - Vomiting blood or a material that looks like coffee grounds or passing black stools
• Severe nausea and vomiting - A late symptom caused by blockage of the stomach drainage by the enlarging cancer

Stomach Ulcer (Gastric and Duodenal) Symptoms and Signs

Ulcers do not always cause symptoms. Sometimes, a serious complication such as bleeding or a sudden, bad upper abdominal pain is the first sign of an ulcer. The most common symptom of peptic ulcers is abdominal pain. Stomach ulcer pain:

• Usually in the upper middle part of the abdomen, above the belly button (navel) and below the breastbone
• Can feel like burning, or gnawing, and it may go through to the back
• Often comes several hours after a meal when the stomach is empty
• Often is worse at night and early morning
• Can last anywhere from a few minutes to several hours
• Pain may be relieved by food, antacids, or vomiting

Other symptoms of peptic ulcers include:

• Nausea
• Vomiting
• Loss of appetite
• Loss of weight

Severe ulcers may cause bleeding in the stomach or duodenum. Bleeding is sometimes the only symptom of an ulcer. This bleeding can be fast or slow. Fast bleeding reveals itself in one of the following ways:

• Vomiting of blood or dark material that looks something like coffee grounds: This is an emergency and warrants an immediate visit to an emergency department.
• Blood in the stool or black, tarry, sticky-looking stools

Slow bleeding is often more difficult to detect, because it has no dramatic symptoms.

• The usual result is low blood cell count (anemia).
• The symptoms of anemia are tiredness (fatigue), lack of energy (lethargy), weakness, rapid heartbeat (tachycardia), and pale skin (pallor).

Stomach Cancer Causes and Risk Factors

Stomach cancer remains the second most frequent cause of cancer-related death worldwide, with particularly high frequencies in Japan, China, Korea, parts of Eastern Europe, and Latin America. Established risk factors for stomach cancer include:

• Low socioeconomic status
• Male sex
• Cigarette smoking
• Advanced age
• A prior diagnosis of pernicious anemia (a chronic progressive disease caused by the failure of the body to absorb vitamin B-12)
• A diet deficient in fresh fruits and vegetables and rich in salted or smoked fish or meats and poorly preserved foods
• Treating benign stomach or duodenal ulcer disease by removing part of your stomach is associated with an increased risk of cancer developing in the remaining stomach, especially at least 15 years after the surgery.
• Recent studies have demonstrated a higher frequency of stomach cancer in people chronically infected with Helicobacter pylori, a common cause of chronic gastritis and peptic ulcer disease.
• A family history of stomach cancer is a further risk factor in the disease.
• People with blood type A also have an increased risk.

Stomach Ulcer Causes

When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food. The food is partially digested in the stomach and then moves on to the duodenum to continue the process. Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall. In the past it was thought that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress. Now it is understood that people with ulcers have an imbalance between acid and pepsin coupled with the digestive tract's inability to protect itself from these harsh substances.

Research done in the 1980s showed that some ulcers are caused by infection with a bacterium named Helicobacter pylori, usually called H pylori. Not everyone who gets an ulcer is infected with H pylori. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers if taken regularly.

Some types of medical therapy can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach increasing the chances of getting an ulcer and slow the healing of existing ulcers.

• Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), and newer anti-inflammatory medications (such as celecoxib [Celebrex])
• Alcohol
• Stress: physical (severe injuries or burns, major surgery)
• Caffeine
• Cigarette smoking
• Radiation therapy:-used for diseases such as cancer
• People who take aspirin or other anti-inflammatory medications are at an increased risk even if they do not have H pylori infection.
• Elderly people with conditions such as arthritis are especially vulnerable.
• People who have had prior ulcers or intestinal bleeding are at a higher-than-normal risk.

If a person takes these medications regularly, alternatives should be discussed with a health-care professional. This is especially true if the affected individual has an upset stomach or heartburn after taking these medications.

Stomach Ulcers Spread by Feces

H pylori bacteria is spread through the stools (feces) of an infected person. The stool contaminates food or water (usually through poor personal hygiene).
The bacteria in the stool make their way into the digestive tracts of people who consume this food or water. This is called fecal-oral transmission and is a common way for infections to spread. The bacteria are found in the stomach, where they are able to penetrate and damage the lining of the stomach and duodenum. Many people who are exposed to the bacteria never develop ulcers. People who are newly infected usually develop symptoms within a few weeks.

Researchers are trying to discover what is different about the people who develop ulcers.

• Infection with H pylori occurs in all ages, races, and socioeconomic classes.
• It is more common in older adults, although it is thought that many people are infected in childhood and carry the bacteria throughout their lifetimes.
• It is also more common in lower socioeconomic classes because these households tend to have more people living together, sharing bathrooms and kitchen facilities.
• African Americans and Hispanic Americans are more likely to have the bacteria than Caucasians and Asian Americans.

It is important to distinguish between ulcers caused by H pylori and those caused by medications because the treatment is completely different.
Ulcers can be linked with other medical conditions.

People who worry excessively are usually thought to have a condition called generalized anxiety disorder. This disorder has been linked with peptic ulcers.

A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.

• If you have burning pain in your upper stomach that is relieved by eating or taking antacids, call a health-care professional for an appointment. Don't assume you have an ulcer. Certain other conditions can cause similar symptoms.
• If you vomit blood or have other signs of gastrointestinal bleeding, go to an emergency department right away. Peptic ulcers can cause massive bleeding, which requires blood transfusion or surgery.
• Severe abdominal pain suggests perforation or tearing of an ulcer. This is an emergency that may require surgery to fix a hole in your stomach.
• Vomiting and abdominal pain also can be a sign of an obstruction, another complication of peptic ulcers. This also may require emergency surgery.