Why stomach cancer is often diagnosed too late

This story has significance for readers across Kenya and beyond.

Stomach cancer remains one of the leading causes of cancer-related deaths worldwide, with men continuing to bear a larger share of the burden.

The latest figures from the International Agency for Research on Cancer show that estimated deaths from stomach cancer among people aged 0 to 85 and above rose about 1.9 percent, from 642,000 in 2024 to 654,000 in 2025.

Men accounted for most of these deaths, with the number increasing from 419,000 in 2024 to 426,000 in 2025. Among women, deaths increased from 223,000 to 229,000 over the same period.

Kenya, too, recorded an increase, with stomach cancer deaths among men rising by 3.7 percent from 565 in 2024 to 586 in 2025. Among women, deaths jumped 3.5 percent from 488 to 505 over the same period.

Dr Joseph Abuodha, a consultant medical oncologist at Aga Khan University Hospital, says the number of deaths from stomach cancer almost reflects the number of new cases.

“The biggest question is why would these numbers come to this much and why would the death rate be high? It's because of predominantly late diagnosis,” he says.

Why it is easy to miss

One of the difficulties with stomach cancer is that some of its symptoms can look like ordinary stomach problems.

“A person may experience abdominal discomfort, bloating, pain or what they describe as ulcer-like symptoms. There may also be increased acidity or dyspepsia, symptoms such as bloating, acidity and abdominal discomfort.”

Other warning signs include darkening of the stool, which may indicate bleeding in the stomach, and early satiety, feeling full after eating much less food than one normally would.

Dr Abuodha gives a simple example. “If someone could comfortably eat a full plate of ugali six months ago but now feels full after half a plate, it could be because the stomach is not expanding as it should,” he explains.

Weight loss despite eating what appears to be an adequate amount of food is another symptom.

He notes none of these symptoms automatically means someone has stomach cancer. Many other stomach conditions can cause similar problems. That is part of what makes the disease difficult to identify early.

“What we find in patients who come to us with a diagnosis of cancer is that most of them will have come to hospital at some point for that diagnosis,” says Dr Abuodha.

The problem is that they may have been treated repeatedly for what appeared to be ordinary stomach problems.

A patient may have persistent pain, dyspepsia or acidity and be treated for ulcers, gastritis or H. pylori. The symptoms may temporarily settle, only to return.

“After a few sessions of treatment, you're not getting better, you need to go for an endoscopy.”

The challenge, he says, very early stomach cancer may have no obvious symptoms.

“A person may have no pain at all or may experience only mild discomfort that does not persist. In some cases, early stomach cancer is discovered while doctors are investigating an unrelated problem.”

For example, someone may undergo a CT scan because of abdominal pain and doctors notice something in the stomach that requires further investigation.

Once symptoms become more pronounced, however, the cancer may already be locally advanced. At that point, he says it may still be possible to cure it, but treatment becomes more difficult especially for those who present with more significant symptoms are more likely to have advanced disease.

“The stomach has an opening at the top, where food enters from the throat, and another at the bottom, where food passes into the intestines,” he explains. “If a cancer develops close to either opening, even a small growth can interfere with the passage of food. A feeling that food is getting blocked or is not passing properly can therefore appear relatively early when the cancer is in these areas.”

Still, this is not where stomach cancer most commonly develops. When it develops in the main part of the stomach, the early symptoms can be much less obvious.

The earliest symptoms that people may notice are often within that broad range of dyspepsia, that is, acidity, bloating and abdominal discomfort.

“The challenge is not simply knowing what stomach cancer looks like. It is recognising when ordinary symptoms have persisted for too long and need a closer look.”

He cautions that if symptoms of gastritis or an ulcer persist despite appropriate treatment, further investigation may be necessary.

“If pain changes or a new symptom appears, such as bleeding, vomiting blood or blood in the stool, the problem should be investigated rather than assumed to be simple gastritis.”

People with chronic H. pylori infection or gastritis should also have follow-up depending on the severity of their symptoms. For someone with chronic ulcers, a change in symptoms or the emergence of a new problem should prompt medical review.

There is, however, no direct association between irritable bowel syndrome (IBS) and stomach cancer.

Biggest risk factors

According to Dr Abuodha, the biggest risk factor is age. “The older a person gets, the more likely they are to develop the disease,” he says.

Long-standing dietary and lifestyle preferences also matter. Heavy alcohol use can irritate the stomach lining, while heavy cigarette smoking has also been associated with stomach cancer.

Anecdotal evidence also suggests that very spicy or irritating foods, particularly when consumed frequently, may cause ongoing stomach irritation. H. pylori is another important consideration and is associated with a specific type of stomach cancer.

“There are different types, including the more commonly recognised stomach cancer, as well as lymphoma and sarcoma of the stomach and other less common cancers,” he explains.

However, Dr Abuodha notes that less than five percent have a genetic component. Some genetic syndromes can increase the likelihood of developing stomach cancer, sometimes alongside other cancers.

Still, the majority of people who develop stomach cancer have no family history of the disease.

So why are men more affected? “There are about two men with stomach cancer for every woman. Men tend to have more of these risk factors. They may also respond differently to symptoms,” he says, adding that when men get pain, they don't look for healthcare options easily.

Treatment options

When stomach cancer is suspected, getting the diagnosis right is critical because it determines what treatment is appropriate and helps doctors understand the likely course of the disease.

The gold standard for diagnosis is histology, which involves taking a tissue sample during an endoscopy and examining it.

“None is better” than histology, Dr Abuodha says, explaining that other tests are used alongside it to determine treatment options and prognosis.

“Once stomach cancer has been confirmed, doctors may use a CT scan or PET scan to establish how far the disease has progressed. In some cases, an ultrasound through the endoscopy may also be used, particularly when dealing with small stomach cancers.”

Sometimes scans cannot provide the full picture. In such cases, doctors may perform surgical staging, using cameras inserted into the abdomen to look for signs that the cancer has spread and to take samples of anything suspicious.

For advanced stomach cancer, particularly stage four disease that has progressed after at least one chemotherapy option, an expanded gene panel may be recommended. The information can help guide treatment.

Late diagnosis is not always about a patient ignoring symptoms.

Still, there can also be delays within the healthcare system. Dr Abuodha says patients with suspicious symptoms should be referred quickly to the appropriate level of care. Another challenge is the cost and availability of certain diagnostic tests, including endoscopy.

He stresses that eating a well-balanced diet, eating less processed food and choosing quality food rather than focusing only on quantity are important.

Weight management matters because it affects several metabolic processes in the body. Exercise can also help with metabolism and the processing of sugars and fats while reducing inflammation and potential associations with cancer.

Dr Abuodha also advises caution among people who regularly take very hot or highly spicy meals, particularly if these are accompanied by stomach discomfort. Heavy alcohol use and cigarette smoking should be avoided or significantly reduced.

But not everyone carries the same level of risk. This can include someone who has had ulcers and undergone an endoscopy in which a suspicious lesion was found at the mouth of the stomach.

“Depending on the findings and the individual's circumstances, such patients may need repeat endoscopy every six to 12 months. People with a family history of stomach cancer who have not yet undergone genetic testing may be at risk also.”

Reporting originally appeared via Business Daily. Read the full source for additional context.