Gastric Cancer in China: From Prevention and Early Endoscopy to Precision Treatment

Gastric cancer has long been part of China’s cancer burden. Its incidence varies across regions, but the country still records a large number of cases each year. The good news is that prevention, Helicobacter pylori treatment, high-quality endoscopy, minimally invasive surgery, and biomarker-guided medicines are creating a more complete pathway from risk reduction to advanced-disease care.

The difference between an early cancer confined to the stomach lining and an advanced cancer involving lymph nodes or distant organs can be enormous. The central strategy is therefore simple: reduce avoidable risk, identify high-risk people, investigate persistent symptoms, and test every confirmed tumor for the markers that may change treatment.

Why Gastric Cancer Is Common in China

Gastric cancer does not have one cause. It usually develops through an interaction between chronic inflammation, infection, diet, smoking, genetics, age, and changes in the stomach lining.

Helicobacter pylori

Helicobacter pylori, or H. pylori, is a major cause of chronic gastritis and an important risk factor for non-cardia gastric cancer. Long-term infection can contribute to atrophic gastritis, intestinal metaplasia, dysplasia, and eventually cancer in a minority of infected people.

Most people with H. pylori will not develop gastric cancer, and some gastric cancers occur without the infection. Still, finding and treating H. pylori is one of the most direct evidence-based opportunities to reduce risk.

Salted, Smoked, and Preserved Foods

Diets high in salt and heavily preserved foods may damage the stomach lining and are associated with increased gastric cancer risk. Frequent consumption of processed meat, smoking, and heavy alcohol use can add risk. Fresh vegetables and fruit, safe food storage, and lower salt intake support prevention, but no single food guarantees protection.

Inherited and Family Risk

Most gastric cancers are not caused by a single inherited mutation. However, risk is higher in some families. Very young age at diagnosis, diffuse-type gastric cancer, lobular breast cancer, multiple affected relatives, or other characteristic patterns may suggest hereditary diffuse gastric cancer or another inherited syndrome.

Genetic counseling is important before testing because a confirmed pathogenic variant can affect surveillance, preventive surgery, and relatives. A family history alone does not mean that everyone needs the same plan.

For a broader introduction, read our guide to gastric and colorectal cancer treatment in Shanghai.

H. pylori Eradication: Test, Treat, and Confirm

H. pylori can be detected using a urea breath test, stool antigen test, endoscopic biopsy, or other methods. The best test depends on symptoms, age, alarm features, previous treatment, and whether endoscopy is needed.

Successful eradication reduces future gastric cancer risk, particularly when treatment occurs before advanced precancerous changes develop. It does not reduce risk to zero, and patients with severe atrophic gastritis, intestinal metaplasia, dysplasia, previous gastric cancer, or strong family history may still need endoscopic surveillance.

Antibiotic resistance is common, so treatment should follow a locally appropriate regimen rather than an old prescription or self-selected antibiotics. A test of cure is essential, usually performed after treatment at an interval chosen by the physician. Acid-suppressing medicines, antibiotics, and bismuth can affect test accuracy and may need to be held under medical guidance.

Household or family testing may be discussed in certain settings, especially where reinfection risk or family clustering is a concern.

Symptoms: Do Not Label Everything “Gastritis”

Early gastric cancer may cause no symptoms. Indigestion, upper abdominal discomfort, bloating, early fullness, nausea, reduced appetite, or reflux are common and usually not cancer, but persistent or changing symptoms deserve evaluation.

Alarm features include unexplained weight loss, anemia, black stool, vomiting blood, progressive difficulty swallowing, repeated vomiting, a palpable mass, or a strong family history. These findings require prompt medical assessment and often endoscopy.

Endoscopy Changes the Story

Upper gastrointestinal endoscopy allows direct inspection of the stomach and targeted biopsy. High-definition imaging, image enhancement, chromoendoscopy, careful cleaning, adequate observation time, and an experienced endoscopist improve detection of subtle early lesions.

Screening recommendations vary by country and individual risk. People from high-incidence regions, those with a family history, previous gastric precancerous changes, or other relevant risk factors should discuss when to begin endoscopy and how often to repeat it.

Our early-detection guide for gastric, pancreatic, and liver cancer explains why symptom-free disease can be missed.

Early Gastric Cancer: Endoscopic Treatment May Be Curative

Selected early gastric cancers with a very low risk of lymph-node spread can be removed through endoscopic submucosal dissection, known as ESD. The procedure removes the lesion in one piece, allowing the pathologist to assess depth, margins, ulceration, differentiation, and blood-vessel or lymphatic invasion.

ESD can preserve the stomach and avoid major surgery for suitable lesions, but it is not appropriate for every early cancer. If pathology shows higher-risk features or incomplete removal, additional gastrectomy with lymph-node dissection may be recommended.

The contrast with advanced disease is significant: a mucosal lesion may be treated locally, while deeper cancer can require gastrectomy, lymph-node dissection, chemotherapy, and sometimes targeted or immune therapy.

Surgery for Localized and Locally Advanced Disease

Surgery may involve removal of part or all of the stomach, together with a structured lymph-node dissection. The operation depends on tumor location, size, stage, histology, and the ability to obtain safe margins.

Laparoscopic or robotic surgery may reduce incision-related trauma for selected patients, but minimally invasive access does not replace oncologic principles. Adequate lymph-node removal, safe reconstruction, margin control, and management of complications remain central.

For many locally advanced gastric cancers, chemotherapy is given before surgery, after surgery, or both. The sequence depends on clinical stage, pathology, general condition, and the treatment protocol used by the center.

A related minimally invasive gastric cancer surgery case illustrates how treatment can be individualized.

Shanghai Expertise: Fudan’s Gastrointestinal Cancer Platform

Fudan University Shanghai Cancer Center brings together gastrointestinal surgery, medical oncology, radiation oncology, endoscopy, pathology, imaging, molecular diagnostics, nutrition, and rehabilitation.

Its gastrointestinal cancer teams, including specialists such as Prof. Liu Fenglin and colleagues across digestive oncology, focus on standardized surgery, multidisciplinary treatment, minimally invasive techniques, and clinical research. Complex cases benefit from joint review rather than a decision based on one scan or one department.

Learn more about gastric cancer care at Fudan University Shanghai Cancer Center.

Precision Treatment: Test the Tumor, Not Just the Stage

Advanced gastric cancer treatment increasingly depends on biomarkers. Testing strategy varies by pathology, stage, available tissue, previous treatment, and local approval.

HER2

HER2-positive gastric or gastroesophageal junction cancer may respond to HER2-targeted treatment combined with chemotherapy. HER2 expression can vary within the same tumor and can change over time, so repeat biopsy or retesting may be considered when clinically relevant.

PD-L1, MSI, and Mismatch Repair

PD-L1 expression can help guide the use of immune checkpoint inhibitors in combination with chemotherapy or other treatments. MSI-high or mismatch-repair-deficient tumors may be particularly sensitive to immunotherapy. The treatment decision should reflect the full clinical context rather than one number alone.

Claudin 18.2 and Other Targets

Claudin 18.2 has become an important biomarker in selected HER2-negative gastric cancers, with targeted treatment available in some settings. Additional molecular findings may create clinical-trial opportunities, but most require specialist interpretation.

Antibody-Drug Conjugates

Antibody-drug conjugates, or ADCs, deliver a potent anticancer agent through an antibody directed at a tumor-associated target. HER2-directed ADCs have expanded treatment options for some previously treated HER2-positive gastric cancers.

These medicines can cause serious side effects, including low blood counts, nausea, fatigue, and, with certain agents, lung injury. New cough, fever, or shortness of breath should be reported promptly.

Read more about chemotherapy, targeted therapy, and immunotherapy for gastric cancer in Shanghai.

Nutrition Before, During, and After Treatment

Nutrition is central to gastric cancer care. The disease can cause poor appetite, early fullness, bleeding, obstruction, and weight loss. Surgery changes the stomach’s capacity and the way food passes through the digestive system.

Support may include:

• Dietitian assessment before chemotherapy or surgery;
• Small, frequent, protein-rich meals;
• Oral nutrition supplements when ordinary food is insufficient;
• Monitoring iron, vitamin B12, folate, vitamin D, calcium, and other nutrients;
• Management of dumping syndrome, reflux, diarrhea, or early fullness;
• Separation of large fluid volumes from meals if advised;
• Gradual strength and walking exercises during recovery;
• Tube or intravenous nutrition only when medically necessary.

After total gastrectomy, lifelong vitamin B12 replacement is commonly required. Weight trends, muscle strength, hydration, and laboratory results should be followed rather than waiting for severe malnutrition.

Follow-Up and Recurrence Management

Follow-up depends on stage, operation, pathology, treatment, symptoms, and nutritional risk. It may include clinical review, blood tests, imaging, and endoscopy according to the treating team’s plan.

Patients should keep the original pathology, biomarker reports, operation note, chemotherapy doses, imaging files, and nutritional records. If disease recurs, the team should review HER2, PD-L1, MSI/MMR, Claudin 18.2, previous treatment, and current organ function before selecting the next line.

Questions for the Multidisciplinary Team

• What is the exact pathology, location, and clinical stage?
• Could the lesion be removed by ESD, or is gastrectomy required?
• Should chemotherapy be given before surgery?
• What type of gastrectomy and lymph-node dissection is planned?
• Has the tumor been tested for HER2, PD-L1, MSI/MMR, and other relevant biomarkers?
• Is targeted treatment, immunotherapy, or an ADC appropriate?
• How will nutrition be supported before and after treatment?
• Does H. pylori need treatment, and how will eradication be confirmed?
• Is genetic counseling indicated because of age, pathology, or family history?

International patients comparing teams can use our guide to choosing a gastric cancer specialist in Shanghai.

How CMCS Supports International Patients in Shanghai

China Medical Concierge Shanghai (CMCS) is a health management and medical concierge company, not a hospital. We help international patients organize medical information, identify appropriate specialists in Shanghai, and coordinate care before, during, and after appointments.

Depending on the case, CMCS can assist with:

• Organizing endoscopy, pathology, CT, biomarker testing, H. pylori results, operative records, and previous treatment details;
• Coordinating evaluation by gastrointestinal surgery, medical oncology, endoscopy, pathology, genetics, nutrition, or a multidisciplinary team;
• Preparing a concise bilingual case summary and prioritized consultation questions;
• Supporting appointment planning, travel preparation, on-site communication, and examination scheduling;
• Helping patients track chemotherapy, surgery, targeted treatment, immunotherapy, nutrition, and follow-up milestones;
• Facilitating necessary communication with family members after receiving the patient’s authorization.

Remote record review or video consultation requires the physician’s approval and may not replace an in-person examination. Patients should provide authorization and complete, recent medical records before case coordination. CMCS can usually address approximately three to five core questions during initial screening. If specific medical coordination is required, the service scope and applicable fee will be explained in advance.

Conclusion: Less Salt, Earlier Endoscopy, Smarter Treatment

Gastric cancer prevention begins with H. pylori testing and treatment when appropriate, lower salt intake, less tobacco and heavy alcohol exposure, and recognition of inherited or family risk. Prevention does not end there. High-risk patients need a plan for endoscopy, and persistent symptoms deserve investigation.

After diagnosis, precise staging and biomarker testing connect patients to the right combination of endoscopic treatment, surgery, chemotherapy, targeted therapy, immunotherapy, ADCs, nutrition, and rehabilitation. The earlier the disease is seen, the more options the patient is likely to have.

Contact CMCS

For help organizing gastric cancer records, connecting with appropriate specialists in Shanghai, or planning a medical visit, contact us:

• Website: www.medicalsh.com
• Email: contract@medicalsh.com
• WhatsApp: https://wa.me/message/3AM6KAGCW2BAD1

You may also submit your information through our contact page.

Medical notice: This article is for health education only and does not provide a diagnosis or individualized treatment advice. H. pylori testing, endoscopy, surgery, chemotherapy, targeted therapy, immunotherapy, nutrition, and follow-up plans must be determined by qualified physicians using the patient’s complete medical information.