Diagnosis of Gastric Cancer

John Han-Chih Chang, MD and Kenneth Blank, MD
Last Modified: November 1, 2001

Dear Editors,  
My husband and I are stationed in England. We just recently received information from back home that my mother has been diagnosed with stomach cancer. We are in the dark being so far away from home. Could you help us find information about this disease and what complications may arise? If you could lead us in the right direction, that would be greatly appreciated. Thank you ever so much.  

John Han-Chih Chang, MD and Kenneth Blank, MD, Editorial Assistants for OncoLink, respond:

Dear TW,  
hank you for your interest and question.

Stomach or gastric cancer is the second most common cause of cancer death in the world, but it is not frequent entity in the United States. It has a higher incidence in Japan and other Asian countries. It is associated with diets high in nitrosamines or meat preservatives found in smoked or salted foods. It has also been linked to chronic atrophic gastritis.

The problem with gastric cancers is that they are usually diagnosed in more advanced stages, because early lesions are asymptomatic. Most have spread beyond the stomach to the regional lymph nodes or directly into the adjacent organs or structures. This would indicate a poor prognosis.

The mainstay of treatment at this time is radical surgery with removal of the primary gastric tumor with the entire stomach or part of it. This is reconnected with an anastamosis to the small bowels. Some advocate diagnostic and/or therapeutic extensive dissection of all regional lymph nodes. This technique has been supported strongly by the Japanese. Most believe, however, that this procedure does not improve outcome.

There have been studies that have revealed a 40% ? 80% local failure rate. This means that the tumor reappears in the operative bed and/or regional lymph nodes after surgery alone 40-80% of the time. Due to the possible lack of success with surgery alone, new avenues were pursued with adjuvant chemotherapy and/or radiation therapy post-operatively or definitively (for those who are not surgical candidates).

Randomized trials of treatment post surgery have revealed that chemotherapy alone patients fair worse than those that receive radiation combined with chemotherapy in improving loco-regional recurrence. However, minimal evidence has been demonstrated whether any of this helpful in survival improvement compared to surgery alone. In other words, it is preferable to spare the patient the possible side effects of radiation and/or chemotherapy until such time as that they need those treatments. This remains a very controversial issue with the significant studies having been performed by the gastrointestinal tumor study group and the Europeans.

There is a current national trial underway randomizing patients to adjuvant treatment post-operatively versus no further therapy. This trial's results may finally answer the question of the utility of adjuvant therapy in gastric cancer. There has been literature in support of using adjuvant therapy for poor prognostic indices such as positive lymph nodes and margins. Again, the jury is still out. Despite all the negative literature about adjuvant therapy, we believe in certain incidences that the loco-regional cancer control is essential to a significant quality of life.

As always, please discuss these issues with your mother's cancer physicians.