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Approximately 3% of cancer deaths in men and even fewer in women are due to stomach cancer. The 5-year survival rate for all patients with adenocarcinoma of the stomach diagnosed between 1983 and 1987 was 17%. Moreover, tumors thought to be localized at the time of attempted curative resection carried survival rates of around 50%. These statistics demonstrate the insidious nature of stomach cancer, which has remained unchanged despite diagnostic advances such as stomach cancer, canser, stomac, stomic
It is estimated that 24,000 new cases of stomach cancer stomach cancer, canser, stomac, stomic.
The incidence of stomach cancer varies from country to country as well as regionally within countries. In the United States, the incidence of stomach cancer among African Americans, Asian Americans, and Hispanics is almost double that among whites. Studies of migrants from Japan to the United States indicate only a moderate decrease in their risk, even if they migrate at an early age. Second-generation
Dietary factors have received significant attention as potential factors in the development of stomach
Epidemiologic data support the fact that the decline in stomach cancer in the United States has paralleled significant improvements in food, hygiene, and sanitation as well as general dietary improvements, including year-round availability of fresh fruits and vegetables. Stomach cancer appears
There is growing evidence that H. pylori infection plays a role in the development of stomach cancer. Striking parallels exist between regional rates of stomach cancer and H. pylori infection. For example, in Central American regions, where virtually all adults are infected, stomach cancer rates are among the
Adenomatous gastric polyps are rare but carry a distinct potential for the development of malignancy. They occur most frequently between the fifth and seventh decades of life and have few symptoms or
Pernicious anemia and Menetrier's disease have both been associated with stomach cancer. Based on the autopsy series by Zamcheck and associates in 1955, it was concluded that approximately 10% of
Menetrier's disease has clinical and roentgenologic findings that closely resemble multiple gastric polyps, and stomach cancer has been reported to occur in approximately 10% of cases. Interestingly, the
Gastric adenocarcinoma can arise from gastric mucosal cells anywhere within the stomach. Tumors formerly arose with much greater frequency in the antral and pyloric regions. However, most recent series indicate a much higher rate of involvement of the cardia and gastroesophageal junction than in the
Staging of stomach cancer has evolved significantly over the past two decades. The Union Internacionale Contra la Cancrum (UICC) was the first to publish a classification system for stomach cancer in 1966, and this was updated in 1968. The American Joint Committee on Cancer (AJCC)
| Primary Tumor (T) | |
| T1 | Tumor limited to mucosa and submucosa regardless of its extent or location |
| T2 | Tumor involves the mucosa and the submucosa (including the muscularis propria) and extends to or into the serosa but does not penetrate through the serosa |
| T3 | Tumor prenetrates through the serosa without invading contiguous structures |
| T4 | Tumor penetrates through the serosa and invades the contiguous structures |
| Nodal Involvement (N) | |
| N0 | No metastases to regional lymph nodes |
| N1 | Involvement of perigastric lymph nodes within 3 cm. of the primary tumor along the lesser or greater curvature |
| N2 | Involvement of the regional lymph nodes, more than 3 cm. from the primary tumor, which are removable at operation, including those located along the left gastric, splenic, celiac, and common hepatic arteries |
| N3 | Involvement of other intra-abdominal lymph nodes that are not removable at operation, such as the para-aortic, hepatoduodenal, retropancreatic, and mesenteric nodes |
| Distant Metastasis (M) | |
| M0 | No (known) distant metastasis |
| M1 | Distant metastasis present |
| Surgical Results (R) | |
| R0 | No residual tumor |
| R1 | Microscopic residual tumor |
| R2 | Macroscopic residual tumor |
| Stage | TNM Classification | ||
|---|---|---|---|
| 0 | Tis | N0 | M0 |
| IA | T1 | N0 | M0 |
| IB | T1 | N1 | M0 |
| T2 | N0 | M0 | |
| II | T1 | N2 | M0 |
| T2 | N1 | M0 | |
| T3 | N0 | M0 | |
| IIIA | T2 | N2 | M0 |
| T3 | N1 | M0 | |
| T4 | N0 | M0 | |
| IIIB | T3 | N2 | M0 |
| T4 | N1 | M0 | |
| IV | T4 | N2 | M0 |
| Any T | Any N | M1 | |
Stomach cancer is staged according to the characteristics of the primary tumor (T), nodal metastases (N), and presence of metastatic disease (M). The most important prognostic indicators remain the depth of penetration by the primary tumor, the presence of cancer in local regional lymph nodes, and
Regrettably, symptoms of early stomach cancer are vague and unspecific. They may mimic symptoms of benign gastric ulcer disease and may either be ignored by the patient or treated medically without further
Studies cite highly variable rates of symptoms in newly diagnosed patients. Weight loss is clearly a symptom common to the series, occurring in from 20% to 60% of patients. The percentage of patients who present with abdominal pain is even more variable, ranging from 20% to 95%. A recent study of
Routine laboratory tests should include hematocrit, erythrocyte evaluation, liver function tests, and stool guaiac. In most cases of advanced disease, laboratory evidence of anemia develops; liver function tests
Patients with stomach cancer must be evaluated for comorbid conditions such as cardiovascular, pulmonary, or renal disorders. Patients with profound weight loss and metabolic complications of their cancer may be at higher surgical risk. Although these are not contraindications to exploration, they warn
When laparotomy is performed, the initial exploration must be thorough, with careful examination and
R1 resection of early gastric carcinoma is usually curative. Survival rates of 95% or greater are regularly reported in Japanese series reviewing large numbers of early stomach cancer patients. For these lesions, resection typically includes the lesion with an adequate margin, as described earlier, and perigastric lymph nodes within 3 cm. of the lesion. Attempts should be made to preserve vagal branches if resection of the lesser curvature is not necessary. Proximal- and middle-third lesions, especially along the greater curvature, allow for preservation of pyloric function. Distal-third lesions may require antrectomy with R1 reconstruction. Five to 6% of mucosal and 15 to 20% of submucosal early stomach cancers are accompanied by positive lymph nodes.
Provocative reports have described endoscopic treatment of early stomach cancer using cauterization, local injection of drugs, and laser therapy. At present, lesions that appear to be amenable to endoscopic surgery include 1 cm. or smaller protruding-type lesions and 1 cm. or smaller depressed lesions with no ulcer or ulcer scar. Currently, these techniques should be reserved for patients at high risk for conventional operations due to age or concomitant medical problems. Patients must be informed that the results of endoscopic treatment are unknown, whereas surgical therapy typically yields high cure rates.
During the first half of this century, the suggested extent of resection for stomach cancer became more and more radical. By the 1950s, total gastrectomy was routinely advocated and was accompanied by a high morbidity and mortality. Because of the high complication rate without demonstrable survival advantage, the recommended operation became somewhat less radical. As currently practiced in the
The use of adjuvant chemotherapy, radiotherapy, and chemoimmunotherapy has recently been summarized by Agboola. Reports of adjuvant chemotherapy in the treatment of adenocarcinoma of the stomach are generally pessimistic, although some trials have indicated success in selected subgroups of patients. A group of 134 patients underwent curative resection, and patients with T1 to T3 lesions and