Stomach Cancer (পাকস্থলীর ক্যান্সার / Gastric Cancer) in Dhaka — Symptoms, Stages, Gastrectomy & Treatment in Bangladesh
✍️ Written by: Md. Salauddin Biswas
MA in Medical Anthropology, University of Heidelberg, Germany | Former Senior Research Associate, James P Grant School of Public Health, BRAC University | Health Content Writer & SEO Specialist | Published: BMC Human Resources for Health | EEAT-Optimized Medical Content
🩺 Medically reviewed and approved by: Dr. Muhammad Nazrul Islam
FCPS (Surgery) · MS (Colorectal Surgery) · FACS (Fellow, American College of Surgeons) Assistant Professor (Colorectal Surgery), Shaheed Suhrawardy Medical College & Hospital, Dhaka.
📅 Last reviewed: March 2026
Stomach Cancer Treatment in Bangladesh
Stomach Cancer / Gastric Cancer / পাকস্থলীর ক্যান্সার / পাকস্থলীর কোষের অনিয়ন্ত্রিত বৃদ্ধি
পাকস্থলীর ক্যান্সার (stomach cancer বা gastric cancer) হলো পাকস্থলীর (stomach) অভ্যন্তরীণ আবরণীর কোষে অনিয়ন্ত্রিত বৃদ্ধি। বাংলাদেশে এটি একটি গুরুত্বপূর্ণ ক্যান্সার — এবং H. pylori ব্যাকটেরিয়া সংক্রমণ এর সবচেয়ে বড় কারণ, যার প্রাদুর্ভাব বাংলাদেশে এশিয়ার মধ্যে সর্বোচ্চ।
Stomach cancer (also called gastric cancer) is a malignant tumour arising from the inner lining (mucosa) of the stomach. It is the fifth most common cancer worldwide and the fourth leading cause of cancer-related deaths globally.
In Bangladesh, stomach cancer is among the leading causes of cancer mortality — yet despite having one of the highest H. pylori infection rates in the world (over 60% of adults), Bangladesh has a paradoxically lower incidence of gastric cancer than Japan or Korea.
Most Bangladeshi patients present at an advanced stage — making early recognition of symptoms critical.
Stomach cancer symptoms are often vague and easily attributed to ordinary indigestion or gastritis — which is why most patients in Bangladesh are diagnosed at an advanced stage. Understanding the early warning signs of stomach cancer, knowing who is at risk, and acting promptly when symptoms arise can make the difference between curative and palliative treatment.
Dr. Muhammad Nazrul Islam manages stomach cancer surgery in Dhaka — including subtotal gastrectomy, total gastrectomy, D2 lymphadenectomy and palliative procedures — for patients referred from across Bangladesh.
This page covers everything a Bangladeshi patient or their family needs to know about stomach cancer: symptoms, causes, staging, treatment options and what to expect after gastrectomy.
সংক্ষেপে / Quick Summary
- Stomach cancer (gastric cancer / পাকস্থলীর ক্যান্সার) — malignant tumour of the stomach lining
- Most common cause in Bangladesh: H. pylori infection (found in >60% of Bangladeshi adults — one of the highest rates in Asia)
- Early symptoms are non-specific — indigestion, bloating, loss of appetite — easily confused with gastritis or ulcer
- Red flag symptoms requiring urgent endoscopy: unintentional weight loss + upper abdominal pain + difficulty swallowing
- Most Bangladeshi patients present at Stage III or IV — late presentation is the single biggest challenge
- The only curative treatment is surgery — gastrectomy (partial or total removal of the stomach) with D2 lymph node clearance
- Gastrectomy is performed at NICRH Dhaka and select private hospitals — Dr. Nazrul Islam performs gastrectomy for gastric cancer
- Stage I-II: 5-year survival 70-90% with surgery. Stage III: 35-70%. Stage IV: under 10% — curative surgery not possible
- H. pylori eradication is the single most important preventable cause — all H. pylori positive patients should be treated
বাংলাদেশে পাকস্থলীর ক্যান্সার / Stomach Cancer in Bangladesh — The H. pylori Paradox
Bangladesh presents one of the most fascinating epidemiological puzzles in global cancer research — a finding confirmed by peer-reviewed studies published in PubMed and the PMC database:
The Bangladesh Paradox — H. pylori and Gastric Cancer:
- H. pylori infects over 60% of Bangladeshi adults — one of the highest rates in Asia and the world
- H. pylori is the strongest known risk factor for gastric cancer — responsible for approximately 76% of all stomach cancers globally (Nature Medicine, 2025)
- Yet Bangladesh has a paradoxically LOW incidence of gastric cancer compared to Japan and Korea — where H. pylori infection rates are actually lower
- Research conducted at NICRH Dhaka (2013-2014) found H. pylori seropositive in 86.8% of gastric cancer patients vs 67.5% of controls — confirming the association
- The low gastric cancer rate despite high H. pylori prevalence is thought to be due to: lower virulence of Bangladeshi H. pylori strains (lower inflammation and intestinal metaplasia scores), different dietary patterns (high rice intake, low salt intake), and genetic host factors
Clinical implication for Bangladesh: Despite the overall low incidence, H. pylori positive patients — particularly those with atrophic gastritis, intestinal metaplasia or family history of gastric cancer — remain at significant risk and should be screened and treated. H. pylori eradication is the single most effective preventive measure available in Bangladesh.
পাকস্থলীর ক্যান্সারের লক্ষণ / Stomach Cancer Symptoms — Early and Late
Stomach cancer symptoms are notoriously non-specific in the early stages — they closely mimic ordinary gastritis, peptic ulcer disease and acid reflux, which are extremely common in Bangladesh. This is why most patients present late:
প্রাথমিক লক্ষণ / Early Stomach Cancer Symptoms
| Early Symptom / প্রাথমিক লক্ষণ | Details — Why It Gets Missed in Bangladesh |
|---|---|
| Persistent indigestion or heartburn (দীর্ঘস্থায়ী বদহজম) | Burning or discomfort in the upper abdomen after eating. Extremely common in Bangladesh — almost universally attributed to gastritis or acid reflux. The key warning sign is persistence despite treatment and in patients over 40. |
| Loss of appetite (ক্ষুধামন্দা) | Reduced desire to eat — particularly noticeable as food aversion rather than simple ‘not hungry’. Often dismissed as stress or seasonal illness in Bangladesh. |
| Feeling full quickly (অল্পতেই পেট ভরা যাওয়া) | Early satiety — feeling full after eating only a small amount. This is caused by the tumour reducing stomach capacity or infiltrating the stomach wall. Often mistaken for general weakness. |
| Mild upper abdominal pain or discomfort (উপরের পেটে ব্যথা) | Dull or vague ache in the epigastrium (upper middle abdomen) or right upper abdomen. Intermittent — often attributed to gastric ulcer or gas. |
| Nausea (বমিবমি ভাব) | Persistent nausea without a clear cause. Can occur after eating. Often attributed to gastritis or medication side effects. |
গুরুতর / লাল পতাকা লক্ষণ / Red Flag Symptoms — Seek Urgent Assessment
🚨 RED FLAG SYMPTOMS — URGENT ENDOSCOPY REQUIRED
These symptoms in any patient aged 40+ (or younger with H. pylori history / family history) require urgent upper GI endoscopy — do not wait for a standard outpatient appointment:
| Red Flag Symptom / লাল পতাকা | Clinical Significance |
|---|---|
| Unintentional weight loss (অনিচ্ছাকৃত ওজন হ্রাস) | Loss of 5kg or more without trying — one of the strongest red flag symptoms for any GI malignancy. Should trigger urgent investigation regardless of other symptoms. |
| Dysphagia — difficulty swallowing (গলা দিয়ে খাবার নামতে না পারা) | Difficulty swallowing solids, then liquids — indicates tumour at the gastroesophageal junction (cardia) or very large gastric tumour. Requires urgent endoscopy. |
| Persistent vomiting (ঘন ঘন বমি) | Repeated vomiting — especially vomiting undigested food hours after eating (pyloric obstruction) — indicates advanced tumour near the pylorus. |
| Vomiting blood (রক্তবমি / haematemesis) | Bright red or dark brown (‘coffee grounds’) vomit — indicates gastric bleeding from tumour. EMERGENCY — hospital admission required. |
| Black tarry stools (কালো পায়খানা / melaena) | Black, sticky, foul-smelling stools — indicate upper GI bleeding. Can be from stomach cancer, peptic ulcer or oesophageal varices. All require urgent endoscopy. |
| Palpable upper abdominal mass (পেটে চাকা) | A lump felt in the upper abdomen — indicates advanced tumour with significant mass. Often discovered by the patient themselves or during examination. |
| Persistent jaundice (জন্ডিস) | Yellow skin/eyes in the context of upper GI symptoms — may indicate liver metastases or biliary obstruction from gastric cancer or pancreatic involvement. |
| Ascites (পেটে পানি) | Fluid in the abdomen — in a cancer context, this indicates peritoneal metastases (Stage IV). Dramatically worsens prognosis. |
পাকস্থলীর ক্যান্সারের কারণ / Stomach Cancer Causes and Risk Factors
Understanding the causes of stomach cancer is particularly important in Bangladesh, where H. pylori prevalence is extremely high and dietary patterns are changing rapidly:
| Risk Factor / ঝুঁকির কারণ | Relevance to Bangladesh — Evidence Level |
|---|---|
| H. pylori infection (Helicobacter pylori) — STRONGEST RISK FACTOR | Present in >60% of Bangladeshi adults — among the highest in Asia. Found seropositive in 86.8% of stomach cancer patients studied at NICRH Dhaka (2013-2014). H. pylori causes chronic gastritis, intestinal metaplasia, atrophic gastritis — the stepwise progression (Correa cascade) to gastric adenocarcinoma. Eradicating H. pylori reduces future gastric cancer risk by approximately 35%. Triple therapy (PPI + amoxicillin + clarithromycin) is the standard first-line treatment in Bangladesh. |
| Diet high in salt, smoked or pickled foods (লবণযুক্ত খাবার, আচার) | Strong association. High salt intake damages the gastric mucosa and promotes H. pylori-related carcinogenesis. Bangladeshi diet is traditionally high in salt. Pickled vegetables (achar) and smoked fish are common in rural areas. The increasing consumption of processed/ultra-processed foods in urban Bangladesh is an emerging risk factor. |
| Diet low in fruits and vegetables (ফলমূল ও সবজির অভাব) | Fruits and vegetables contain antioxidants (vitamin C, beta-carotene) that protect against gastric carcinogenesis. Low fruit and vegetable intake — common among lower socioeconomic groups in Bangladesh — increases risk. |
| Tobacco smoking (ধূমপান) | Smoking doubles the risk of gastric cancer. Bangladesh has a high smoking prevalence — particularly among men. Smokeless tobacco (zarda, gul, naswar) — extremely common in Bangladesh — is also associated with upper GI cancers. |
| Family history of gastric cancer | First-degree relatives (parents, siblings) of gastric cancer patients have 2-3x higher risk. Hereditary diffuse gastric cancer (CDH1 mutation) is a rare but important genetic syndrome. Patients with strong family history should undergo H. pylori screening and consider endoscopic surveillance. |
| Chronic atrophic gastritis and intestinal metaplasia | Advanced pre-malignant lesions in the Correa cascade. Patients with endoscopically confirmed intestinal metaplasia are at significantly increased risk and should undergo regular endoscopic surveillance. |
| Previous gastric surgery | Patients who had partial gastrectomy for benign ulcer disease (now rare) have a higher lifetime risk of gastric cancer in the gastric remnant — typically 15-20 years after surgery. |
| Age and sex (বয়স ও লিঙ্গ) | Male sex (2:1 ratio vs female), age over 50. However, Bangladesh data from NICRH shows that H. pylori-infected younger patients have a relatively higher risk ratio than older patients — a pattern distinct from Western series. |
| Blood group A | Blood group A is associated with moderately increased gastric cancer risk — mechanism unclear. Relevant as a background risk factor. |
| Obesity and GERD | Obesity and chronic gastroesophageal reflux (GERD) are associated with cardia gastric cancer (tumours at the junction of stomach and oesophagus). Urban obesity rates in Bangladesh are rising, making this an emerging risk. |
রোগ নির্ণয় / How Is Stomach Cancer Diagnosed?
Endoscopy is the single most important diagnostic test for stomach cancer. No blood test or scan can replace it. All patients with red flag symptoms should have an upper GI endoscopy — available in Dhaka at most major hospitals:
| Test / পরীক্ষা | What It Shows — Role in Bangladesh |
|---|---|
| Upper GI Endoscopy (OGD) (এন্ডোস্কোপি) — ESSENTIAL | The definitive diagnostic test. A flexible camera is passed through the mouth to examine the oesophagus, stomach and duodenum under direct vision. Suspicious areas are biopsied. Endoscopy can detect early cancers that are invisible on CT. Available widely in Dhaka (private hospitals, BSMMU, NICRH). Cost: BDT 3,000-8,000. Any patient over 40 with new or worsening upper GI symptoms should have an endoscopy — not just empirical antacid treatment. |
| Biopsy and histopathology (বায়োপসি) | Tissue taken during endoscopy is sent for histopathological analysis — the only way to confirm cancer vs ulcer vs gastritis. Also determines cancer type (adenocarcinoma vs lymphoma vs GIST) and HER-2/neu status (relevant for targeted therapy in advanced disease). |
| CT scan of chest, abdomen and pelvis (সিটি স্ক্যান) | Staging investigation — performed after endoscopic biopsy confirms cancer. Shows: tumour size and local extension, regional lymph node involvement, liver metastases, lung metastases, ascites. Essential before deciding on surgical vs palliative intent. Available widely in Dhaka. |
| Staging laparoscopy (স্টেজিং ল্যাপারোস্কোপি) | Minimally invasive procedure performed before gastrectomy. Detects peritoneal metastases (tiny deposits on the abdominal lining) that are invisible on CT in 15-20% of cases. A gastric cancer patient who appears resectable on CT may be found to have peritoneal metastases at staging laparoscopy — sparing them an unnecessary open operation. Performed at NICRH Dhaka and by Dr. Nazrul Islam. |
| EUS (Endoscopic Ultrasound) | Determines depth of tumour invasion (T stage) and local lymph node involvement — critical for deciding between endoscopic resection (early cancer only) and gastrectomy. Limited availability in Bangladesh. |
| H. pylori testing | All patients with gastric cancer should be tested for H. pylori (endoscopic biopsy, urea breath test, stool antigen). H. pylori eradication is recommended post-gastrectomy to reduce risk of metachronous cancer in the gastric remnant (partial gastrectomy). |
| Tumour markers (CEA, CA 19-9, CA 72-4) | Not diagnostic for gastric cancer — but elevated pre-operatively and used to monitor response to treatment and recurrence after surgery. Cheap and widely available in Dhaka. |
| PET-CT scan | Used in select centres for staging of resectable gastric cancer — detects occult metastases. Very limited availability in Bangladesh — only at a small number of private centres in Dhaka. |
পাকস্থলীর ক্যান্সারের স্তর / Stomach Cancer Staging — TNM System
Stomach cancer is staged using the TNM system (Tumour, Nodes, Metastasis) — which determines treatment options and predicts survival. Understanding staging is critical for Bangladeshi patients because most present at Stage III or IV:
| Stage | What It Means | 5-Year Survival (Surgery) |
|---|---|---|
| Stage 0 (Tis N0 M0) Carcinoma in situ |
Cancer confined to the innermost lining only (mucosa). No lymph node involvement. No spread. Rare in Bangladesh — almost never detected at this stage. | Over 90% — excellent. Endoscopic mucosal resection (EMR) may be sufficient. Gastrectomy gives near-curative results. |
| Stage I (T1-2 N0-1 M0) |
Tumour invades inner layers of stomach wall. May involve 1-2 nearby lymph nodes. No distant spread. | 70-90% with curative gastrectomy + D2 lymphadenectomy. Uncommon presentation in Bangladesh. |
| Stage II (T1-3 N0-2 M0) |
Tumour invades deeper layers OR involves more lymph nodes. No distant spread. Still potentially curable. | 55-75% with surgery + adjuvant chemotherapy. Perioperative FLOT chemotherapy increasingly used. |
| Stage III (T2-4 N1-3 M0) |
Tumour extends beyond stomach wall into adjacent structures OR significant lymph node involvement. No distant metastases. Most common resectable presentation in Bangladesh. | 25-50% with R0 gastrectomy + D2 lymphadenectomy + adjuvant chemotherapy. The most important stage to treat aggressively in Bangladesh. |
| Stage IV (any T, any N, M1) |
Distant metastases — liver, lungs, peritoneum, distant lymph nodes. Also includes peritoneal metastases (most common M1 site in Bangladesh). Curative surgery not possible. Palliative intent. | Under 10% (5-year). Median survival 8-14 months with systemic chemotherapy. Palliative gastrectomy or bypass occasionally performed for symptom control. |
Why Most Bangladeshi Patients Present at Stage III-IV:
- Early stomach cancer symptoms are identical to very common benign conditions (gastritis, peptic ulcer, GERD) — often treated empirically with antacids for months before investigation
- Low awareness of red flag symptoms among both patients and primary care providers
- Endoscopy is perceived as expensive or invasive — many patients avoid it until symptoms become severe
- No national stomach cancer screening programme in Bangladesh (unlike Japan and Korea, which screen all adults over 40-50 with annual endoscopy)
- Rural patients travel long distances to reach tertiary centres — delaying diagnosis by weeks to months
The most important message for Bangladesh: Do not treat persistent upper abdominal symptoms with antacids alone for more than 4-6 weeks in a patient over 40. Request an upper GI endoscopy. Early diagnosis is the only way to change the survival statistics.
চিকিৎসা / Stomach Cancer Treatment — Surgery, Chemotherapy and Palliation
Treatment of stomach cancer depends on the stage, extent of disease, and patient fitness for surgery. The multimodal approach — combining surgery, chemotherapy and sometimes radiotherapy — offers the best outcomes in Bangladesh.
অস্ত্রোপচার / Gastrectomy — The Name of the Stomach Cancer Operation
The stomach cancer operation is called Gastrectomy (গ্যাস্ট্রেক্টমি)
Gastrectomy — surgical removal of part or all of the stomach — is the only curative treatment for stomach cancer. The extent of resection depends on the tumour location and stage. D2 lymphadenectomy (removal of regional lymph nodes) is performed alongside gastrectomy as standard of care in Bangladesh and across Asia:
| Type of Gastrectomy | When Performed — What Is Removed — Reconstruction |
|---|---|
| Subtotal (Distal) Gastrectomy (সাবটোটাল গ্যাস্ট্রেক্টমি) | Tumour in the lower 2/3 of stomach (antrum, body). The distal 75-80% of the stomach is removed. The remaining stomach is connected to the small intestine (Billroth I, Billroth II or Roux-en-Y reconstruction). Preferred over total gastrectomy when oncologically equivalent — better nutritional outcomes and quality of life. The NICRH Dhaka team has published research on ‘Outcome of Uncut Roux-en-Y Gastrojejunostomy for Distal Gastric Cancer’. |
| Total Gastrectomy (টোটাল গ্যাস্ট্রেক্টমি) | Tumour in the upper stomach (cardia, fundus) or diffuse involvement of entire stomach. The entire stomach is removed. The oesophagus is connected directly to the small intestine (oesophagojejunostomy). More complex reconstruction — greater nutritional challenges post-operatively. The NICRH Dhaka team has published ‘Short-term Outcome of Total Radical Gastrectomy in Patients with Proximal Gastric Cancer’. |
| D2 Lymphadenectomy (D2 লিম্ফ নোড ডিসেকশন) | Performed alongside both subtotal and total gastrectomy. Removes the regional lymph nodes around the stomach (N1 and N2 stations — minimum 16 nodes required for adequate staging per AJCC 8th edition). D2 lymphadenectomy is the standard of care in Asia (Japan, Korea, Bangladesh) and is associated with lower local recurrence and better long-term survival than D1 dissection. The NICRH team performs ‘Modified D2 Gastrectomy’ — the standard in Bangladesh. |
| Staging Laparoscopy (before open surgery) | A keyhole examination of the abdominal cavity performed before gastrectomy to check for peritoneal metastases invisible on CT. If peritoneal metastases are found — gastrectomy is abandoned and palliative chemotherapy given instead. Prevents futile open surgery in 15-20% of cases. Performed at NICRH and by Dr. Nazrul Islam. |
| Palliative Gastrectomy / Bypass | For Stage IV patients with gastric outlet obstruction, uncontrollable bleeding or severe symptoms. Does not cure cancer — but relieves obstruction and improves quality of life. Gastrojejunostomy (stomach bypass) or gastric stenting are alternatives to palliative resection. |
কেমোথেরাপি / Chemotherapy for Stomach Cancer
| Setting | Regimen — Evidence — Bangladesh Context |
|---|---|
| Perioperative chemotherapy (before and after surgery — Stage II-III) | FLOT regimen (5-FU / leucovorin / oxaliplatin / docetaxel) — 4 cycles before surgery + 4 cycles after. The current global standard for resectable Stage II-III gastric cancer. Superior to the older ECF/ECX (MAGIC trial) regimen. Available at NICRH, BSMMU and major private oncology centres in Dhaka. Significantly improves R0 resection rate and 5-year survival. |
| Adjuvant chemotherapy (after surgery — Stage II-III, D2 gastrectomy) | CAPOX (capecitabine + oxaliplatin) — 8 cycles over 6 months. Standard in East Asia (CLASSIC trial). Available in Bangladesh. Improves 5-year survival from ~59% to ~74% in Stage II-III after D2 gastrectomy. |
| Palliative chemotherapy (Stage IV — non-curative) | FOLFOX or CAPOX as first-line. Ramucirumab + paclitaxel as second-line. Nivolumab (anti-PD-1 immunotherapy) for HER-2 negative patients with high PD-L1 expression. Trastuzumab for HER-2 positive patients. Many of these agents are available at NICRH and major Dhaka centres but cost is a significant barrier for many Bangladeshi patients. |
| Targeted therapy | Trastuzumab (Herceptin): for HER-2 positive gastric cancer (approximately 15-20% of cases). Added to first-line chemotherapy. HER-2 testing on biopsy specimen is available at NICRH Dhaka. Significant survival benefit in eligible patients. |
রেডিওথেরাপি / Radiotherapy for Stomach Cancer
Radiotherapy has a limited but important role in stomach cancer management in Bangladesh:
| Setting | Role |
|---|---|
| Postoperative chemoradiation (after R1 resection — positive margins) | When the surgeon cannot achieve clear surgical margins (R0 resection) — chemoradiation to the tumour bed with 5-FU-based chemotherapy. Available at NICRH and selected oncology centres in Dhaka. |
| Palliative radiotherapy | For pain control from bone metastases, bleeding from unresectable gastric tumour, or obstruction. Short course — available at NICRH and major centres. |
| Neoadjuvant radiotherapy | Not standard practice for gastric cancer (unlike oesophageal cancer) — used in selected centres only. |
অস্ত্রোপচারের পরে / Life After Gastrectomy — Recovery and Diet
সুস্থ হওয়ার সময়সীমা / Recovery Timeline After Gastrectomy
| Milestone | Subtotal Gastrectomy / Total Gastrectomy |
|---|---|
| Hospital stay | 7-14 days. ICU or HDU for the first 24-48 hours. Feeding jejunostomy (tube feeding) for the first 5-7 days while the anastomosis heals. |
| Oral feeding | Sips of water from day 3-4. Clear fluids from day 5. Soft diet from day 7-10 if tolerating well. |
| Pain management | Epidural analgesia or IV patient-controlled analgesia for the first 2-3 days. Oral painkillers from day 3. |
| Return to light activity | 4-6 weeks |
| Return to desk work | 6-8 weeks |
| Return to heavy work | 3-4 months |
| Full dietary adjustment | 3-6 months — eating pattern changes permanently after gastrectomy |
| Follow-up | CT scan at 6 months and 12 months post-surgery. Endoscopy at 12 months (for subtotal gastrectomy — to check gastric remnant). Tumour markers (CEA, CA 19-9) at 3-monthly intervals for 2 years. |
গ্যাস্ট্রেক্টমির পরে খাবার / Food for Stomach Cancer Patient After Gastrectomy
Diet After Gastrectomy — Bangladesh Guide:
After gastrectomy — whether subtotal or total — the patient no longer has a full-sized stomach reservoir. Eating habits must change permanently. The following guidance is tailored to the Bangladeshi diet:
| Principle | Practical Guidance for Bangladeshi Patients |
|---|
Eat small, frequent meals (ছোট ছোট খাবার বারবার) 6-8 small meals per day instead of 3 large ones. The stomach remnant (subtotal) or esophagojejunostomy (total) has very limited capacity. Overeating causes pain, vomiting and dumping syndrome. Start with 3-4 tablespoons per meal and gradually increase.
Avoid drinking with meals (খাওয়ার সময় পানি নয়)Do not drink water, cha (tea) or any liquid during meals — liquids push solid food through too quickly (dumping syndrome). Drink fluids 30-45 minutes before or after eating. Very important to explain to Bangladeshi families who traditionally serve cha with every meal.
Dumping syndrome (ডাম্পিং সিন্ড্রোম)Rapid emptying of food from the stomach into the small intestine — causes sweating, palpitations, faintness and diarrhoea 15-30 minutes after eating (early dumping) or 1-3 hours after eating (late dumping / hypoglycaemia). Managed by small meals, lying down after eating, avoiding simple sugars. Affects 10-20% of patients after gastrectomy.
Suitable foods (উপযুক্ত খাবার)Soft cooked rice (নরম ভাত) in small portions | Fish (মাছ) — steamed or lightly cooked — excellent protein source | Lentils (ডাল) — well cooked and soft | Boiled eggs | Soft vegetables (সবজি) | Banana (কলা) | Yoghurt (দই) | Soft roti. All traditional Bangladeshi staples are suitable — just in smaller quantities and without large amounts of oil or spice initially.
Foods to avoid / limitVery spicy food (initially — first 3 months) | Very oily or fried food (ভাজাপোড়া) | Large amounts of sweet/sugary food (triggers late dumping) | Raw vegetables and tough meat (hard to digest early on) | Carbonated drinks (causes bloating and discomfort) | Alcohol.
Vitamin and mineral supplements After total gastrectomy — B12 injection every 3 months (lifelong) — the stomach produces intrinsic factor for B12 absorption; without a stomach, oral B12 is not absorbed. Iron, calcium and vitamin D supplements are also commonly needed. Important for Bangladeshi patients who may not be aware of this long-term requirement.
সচরাচর জিজ্ঞাসা / Frequently Asked Questions — Stomach Cancer
পাকস্থলীর ক্যান্সারের প্রাথমিক লক্ষণ কী? / What are the early symptoms of stomach cancer?
Early stomach cancer symptoms are often non-specific: persistent indigestion or heartburn that does not respond to antacids, loss of appetite, feeling full quickly after eating small amounts, mild upper abdominal pain or discomfort, and nausea. These symptoms are easily confused with ordinary gastritis.
The key is persistence — if these symptoms continue for more than 4-6 weeks in a patient over 40, an upper GI endoscopy is essential. Do not accept empirical antacid treatment without investigation in this age group.
পাকস্থলীর ক্যান্সার কি সারানো যায়? / Can stomach cancer be cured?
Yes — stomach cancer can be cured if detected at an early stage (Stage I-II). The 5-year survival rate for Stage I stomach cancer treated with gastrectomy is 70-90%.
However, most Bangladeshi patients present at Stage III-IV, where curative treatment is much more difficult or impossible. Stage IV stomach cancer (with liver or peritoneal metastases) is not curable but can be managed with chemotherapy to extend life and maintain quality.
The most important action is early diagnosis — any patient with persistent upper GI symptoms should have an endoscopy, not just antacid tablets.
পাকস্থলীর ক্যান্সার অপারেশনের নাম কী? / What is the name of the stomach cancer operation?
The stomach cancer operation is called gastrectomy (গ্যাস্ট্রেক্টমি). There are two main types: subtotal (distal) gastrectomy — removal of the lower portion of the stomach — and total gastrectomy — removal of the entire stomach. Both are performed with D2 lymphadenectomy (removal of regional lymph nodes) as the standard of care in Bangladesh. Gastrectomy for stomach cancer is performed at NICRH Dhaka (government) and by Dr. Muhammad Nazrul Islam at selected private centres in Dhaka.
H. pylori কি পাকস্থলীর ক্যান্সার ঘটায়? / Does H. pylori cause stomach cancer?
Yes — H. pylori (Helicobacter pylori) is the strongest known cause of stomach cancer, responsible for approximately 76% of all gastric cancers worldwide. In Bangladesh, H. pylori infects over 60% of adults — one of the highest rates in Asia. A case-control study at NICRH Dhaka found H. pylori seropositive in 86.8% of gastric cancer patients. Despite this high prevalence, Bangladesh has a paradoxically low gastric cancer incidence — thought to be due to less virulent H. pylori strains and dietary factors. All H. pylori positive patients should be treated with triple therapy (PPI + amoxicillin + clarithromycin) to eradicate the infection and reduce future cancer risk.
পাকস্থলীর ক্যান্সার স্টেজ ৪-এ কতদিন বাঁচা যায়? / What is the survival rate for Stage 4 stomach cancer?
Stage 4 stomach cancer (with distant metastases to the liver, lungs or peritoneum) has a 5-year survival rate of under 10%. The median survival with systemic chemotherapy is approximately 8-14 months. This is not a reason for despair — modern chemotherapy, targeted therapy (trastuzumab for HER-2 positive disease) and immunotherapy (nivolumab) are improving outcomes. Palliative surgery or stenting can relieve obstruction and improve quality of life significantly. Every patient deserves an oncology consultation to discuss all available options.
পাকস্থলীর ক্যান্সার ও পেটের আলসারের মধ্যে পার্থক্য কী? / Stomach cancer vs stomach ulcer — how to tell the difference?
Gastric ulcer and early stomach cancer can have almost identical symptoms — both cause upper abdominal pain, indigestion and nausea. The critical difference is that gastric ulcers heal with treatment (PPIs, H. pylori eradication) while cancer does not. A gastric ulcer that does not heal completely after 6-8 weeks of treatment on endoscopic follow-up must be biopsied and reassessed — it may be malignant. All gastric ulcers in patients over 40 should be biopsied at the time of endoscopy and followed up to confirm healing. This cannot be determined by symptoms alone.
গ্যাস্ট্রেক্টমির পরে কী খাবেন? / What food is good for stomach cancer patient after surgery?
After gastrectomy: eat 6-8 small meals per day instead of 3 large ones. Suitable Bangladeshi foods include soft cooked rice (নরম ভাত), steamed fish, well-cooked dal, boiled eggs, soft vegetables, banana and yoghurt.
Avoid drinking liquids during meals — drink 30 minutes before or after. Avoid very spicy, oily or fried food for the first 3 months. Avoid simple sugars in large amounts (triggers dumping syndrome).
After total gastrectomy — B12 injections every 3 months (lifelong) are essential. Full dietary adjustment takes 3-6 months.
পাকস্থলীর ক্যান্সার কি প্রতিরোধ করা যায়? / Can stomach cancer be prevented?
The single most important preventive measure in Bangladesh is H. pylori testing and eradication. All H. pylori positive individuals — particularly those with a family history of gastric cancer, chronic atrophic gastritis or intestinal metaplasia on biopsy — should be treated with triple therapy.
Additional preventive measures: quit smoking and smokeless tobacco (zarda, gul), reduce salt and processed food intake, increase fruit and vegetable consumption, maintain healthy weight.
Regular endoscopic surveillance for patients with confirmed intestinal metaplasia or first-degree family history of gastric cancer.
ডাম্পিং সিন্ড্রোম কি? / What is dumping syndrome?
Dumping syndrome is a condition that occurs after gastrectomy when food moves too quickly from the remaining stomach into the small intestine.
Early dumping (15-30 minutes after eating) causes sweating, heart palpitations, faintness, diarrhoea and abdominal cramps.
Late dumping (1-3 hours after eating) causes low blood sugar symptoms — shakiness, fatigue, confusion. Dumping syndrome affects 10-20% of patients after gastrectomy.
It is managed by eating small meals, avoiding liquids with food, avoiding simple sugars, and lying down for 30 minutes after eating. Severe cases may require medication (octreotide) or dietary counselling.
গ্যাস্ট্রেক্টমি অপারেশন কি বিপজ্জনক? / Is gastrectomy surgery dangerous?
Gastrectomy is a major operation but is performed safely at NICRH Dhaka and by experienced surgeons like Dr. Nazrul Islam. The operative mortality rate (death within 30 days) is 1-3% in high-volume centres. Serious complications (anastomotic leak, bleeding, infection) occur in 5-10% of cases.
However, the risk of NOT operating on a resectable gastric cancer is far greater — untreated Stage II-III gastric cancer has a 5-year survival of under 10%. With surgery and chemotherapy, 5-year survival improves to 25-75% depending on stage. The benefits of curative gastrectomy far outweigh the surgical risks in eligible patients.
H. pylori কি এবং এর চিকিৎসা কীভাবে করা হয়? / What is H. pylori and how is it treated?
H. pylori (Helicobacter pylori) is a bacterium that lives in the stomach and causes chronic inflammation, leading to gastritis, ulcers and gastric cancer. Over 60% of Bangladeshi adults are infected with H. pylori. H. pylori is diagnosed by: endoscopic biopsy, urea breath test, or stool antigen test.
Standard treatment is triple therapy for 10-14 days: Proton pump inhibitor (PPI like omeprazole) + amoxicillin + clarithromycin. Alternative regimens include quadruple therapy (PPI + bismuth + metronidazole + tetracycline) if clarithromycin resistance is suspected. Success rate is 85-95% with appropriate therapy. All infected individuals should be treated to reduce the risk of gastric cancer, peptic ulcer disease and MALT lymphoma.
Stomach Cancer (পাকস্থলীর ক্যান্সার) Assessment & Surgery in Dhaka
Persistent upper abdominal discomfort, unexplained weight loss or difficulty swallowing in a patient over 40 must never be dismissed as ‘just gastritis’. These are the symptoms of stomach cancer — and the earlier they are investigated, the better the outcome.
An upper GI endoscopy is a quick, safe procedure available in Dhaka that can detect stomach cancer at a curable stage.
Dr. Muhammad Nazrul Islam performs gastrectomy — subtotal and total — with D2 lymphadenectomy for stomach cancer in Dhaka. He also coordinates with oncologists for perioperative chemotherapy (FLOT) and adjuvant treatment (CAPOX). For assessment, staging laparoscopy or surgical opinion on stomach cancer — do not delay.
📞 Call or WhatsApp: +88019 7684 2234
About the Author
Md. Salauddin Biswas
MA Medical Anthropology, University of Heidelberg | Senior Research Associate, BRAC University | Published in BMC Human Resources for Health (2015) and American Journal of Advances in Anthropology (2013). Research focus: healthcare access and patient behaviour in South Asia.
Medically Reviewed by
Dr. Muhammad Nazrul Islam
FCPS (Surgery) · MS (Colorectal Surgery) · FACS | General & Colorectal Surgeon, Dhaka | Asst. Professor, Shaheed Suhrawardy Medical College | 20+ years · 50,000+ procedures · 300,000+ patients | Full profile
Read More:
American Cancer Society Stomach Cancer Survival Rates
⚠️ Medical Disclaimer: This page is for general patient education only and does not replace professional medical advice. Symptoms described may have many causes — not all upper abdominal symptoms indicate cancer. However, persistent symptoms in patients over 40 require endoscopic investigation, not empirical treatment. For assessment, staging or surgical opinion on stomach cancer in Dhaka, contact Dr. Muhammad Nazrul Islam at +88019 7684 2234.
Serial: +88 09606990000