Cancers: 95% are adenocarcinomas. The remaining 5% include: carcinoids, lymphomas, and GI stromal tumors. Adenocarcinomas originate from the epithelium (inner lining), but commonly metastasize (spread) quickly through the wall of the stomach, the blood stream or the lymphatic system. The most frequent symptoms are weight loss, abdominal pain, vomiting and anorexia. Diagnosis is made by upper endoscopy and biopsy. Staging to determine how advanced the cancer is includes a CT scan and laparoscopy.  Patients who have a positive cytology (cancer cells in peritoneal fluid) found by laparoscopy have life expectancy of 3 to 9 months and would not benefit from a laparotomy (big abdominal incision) and a gastrectomy (removal of part or all the stomach). Carcinoids and GI stromal tumors are usually curable by removing a portion of the stomach, often laparoscopically.  Treatment of gastric lymphomas requires surgery, or chemotherapy or both. Thankfully, surgery alone is efficacious, as is chemotherapy alone, both curing about 75% of patients.

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Ulcers: Most ulcers can be treated with medicine and do not require surgery.60% of gastric and 90% of duodenal ulcers are secondary to Helicobacter pylori infections and eradication of this bacteria will treat most ulcers. Indications for surgery include: bleeding, perforation, obstruction, or failure to respond to medical therapy.