Stomach cancer natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Parminder Dhingra, M.D. [3], Mohammed Abdelwahed M.D[4]

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If left untreated, the five-year survival rates of gastric cancer range from almost no survival for patients with disseminated disease to almost 50% survival for patients with localized distal gastric cancers confined to resectable regions. Higher recurrence rates are seen in those who have piecemeal or incomplete resections. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor. Complications of gastric cancer are ascites, gastrointestinal bleeding, distant metastasis to other organs, weight loss, recurrence of cancer, and treatment complications. The prognosis of patients with gastric cancer is related to tumor extent that includes direct tumor extension and lymph nodes involvement. The five-year survival rate for treated early gastric cancer is over 90 percent; nearly 100 percent for mucosal tumors, and 80 to 90 percent for submucosal tumors.

Natural History

The symptoms of gastric cancer usually develop in the fifth decade of life, and start with loss of appetite and loss of weight. The symptoms of gastric cancer typically progress to dysphagia, abdominal pain, and vomiting. Without treatment, 63 percent of patients with early gastric cancer will progress to advanced disease within five years. Metastasis occurs in 80-90% of individuals with stomach cancer.[1]


Complications of gastric cancer include the following:


  • Recurrence following curative resection was local or regional in 40 % and systemic in 60%.
  • Regional recurrences may be more frequent in patients treated with surgery alone or surgery plus postoperative chemotherapy without radiotheapy, and among those who have a fewer number of negative resected lymph nodes.[2]
  • Sites of regional recurrence include the luminal margins, the resection bed, and the regional nodes.[3]
  • The predominant sites of systemic recurrence are the liver and peritoneum.[4]
  • Metastatic disease beyond the abdomen is uncommonly the first site of recurrence aside from the supraclavicular nodes.[5]
  • In a Japanese series, 9.2 % with early gastric cancers had a second cancer within the first year after therapy.[6]
  • The overall incidence of recurrence is 9.5 %t at five years, 13.1 % at seven years, and 22.7 % at 10 years.[7]

Surgery complications

Chemotherapy complications


Five-year survival

Prognosis with lymph node involvement

  • Long-term survival was 95 percent in patients with no lymph node involvement, 88 percent in those with one to three nodes involved, and 77 percent in those with more than three nodes involved.[17][18]
Stage 5-year relative survival (%), (2004-2010)
All stages 28.3%
Localized 64.1%
Regional 28.8%
Distant 4.2%
Unstaged 20.2%
  • Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of stomach cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[19]

5-year survival of gastric cancer in USA.PNG


  1. Tsukuma H, Oshima A, Narahara H, Morii T (2000). "Natural history of early gastric cancer: a non-concurrent, long term, follow up study". Gut. 47 (5): 618–21. PMC 1728114. PMID 11034575.
  2. Li F, Zhang R, Liang H, Liu H, Quan J (2013). "The pattern and risk factors of recurrence of proximal gastric cancer after curative resection". J Surg Oncol. 107 (2): 130–5. doi:10.1002/jso.23252. PMID 22949400.
  3. Karpeh MS, Leon L, Klimstra D, Brennan MF (2000). "Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients". Ann Surg. 232 (3): 362–71. PMC 1421150. PMID 10973386.
  4. Ikoma N, Chen HC, Wang X, Blum M, Estrella JS, Fournier K; et al. (2017). "Patterns of Initial Recurrence in Gastric Adenocarcinoma in the Era of Preoperative Therapy". Ann Surg Oncol. 24 (9): 2679–2687. doi:10.1245/s10434-017-5838-y. PMID 28332034.
  5. Bickenbach KA, Gonen M, Strong V, Brennan MF, Coit DG (2013). "Association of positive transection margins with gastric cancer survival and local recurrence". Ann Surg Oncol. 20 (8): 2663–8. doi:10.1245/s10434-013-2950-5. PMID 23536054.
  6. Nakajima T, Oda I, Gotoda T, Hamanaka H, Eguchi T, Yokoi C; et al. (2006). "Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?". Gastric Cancer. 9 (2): 93–8. doi:10.1007/s10120-006-0372-9. PMID 16767364.
  7. Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Nakajima T; et al. (2015). "Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection". Endoscopy. 47 (12): 1113–8. doi:10.1055/s-0034-1392484. PMID 26165734.
  8. Sierzega M, Kolodziejczyk P, Kulig J, Polish Gastric Cancer Study Group (2010). "Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach". Br J Surg. 97 (7): 1035–42. doi:10.1002/bjs.7038. PMID 20632269.
  9. Fukagawa T, Gotoda T, Oda I, Deguchi Y, Saka M, Morita S; et al. (2010). "Stenosis of esophago-jejuno anastomosis after gastric surgery". World J Surg. 34 (8): 1859–63. doi:10.1007/s00268-010-0609-y. PMID 20458580.
  10. Mala T, Hewitt S, Høgestøl IK, Kjellevold K, Kristinsson JA, Risstad H (2015). "[Dumping syndrome following gastric surgery]". Tidsskr Nor Laegeforen. 135 (2): 137–41. doi:10.4045/tidsskr.14.0550. PMID 25625992.
  11. Paik HJ, Choi CI, Kim DH, Jeon TY, Kim DH, Son GM; et al. (2014). "Risk factors for delayed gastric emptying caused by anastomosis edema after subtotal gastrectomy for gastric cancer". Hepatogastroenterology. 61 (134): 1794–800. PMID 25436381.
  12. Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S (2010). "Recurrence after curative resection of early gastric cancer". Ann Surg Oncol. 17 (2): 448–54. doi:10.1245/s10434-009-0772-2. PMID 19904573.
  13. Choi IJ, Lee JH, Kim YI, Kim CG, Cho SJ, Lee JY; et al. (2015). "Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection". Gastrointest Endosc. 81 (2): 333–41.e1. doi:10.1016/j.gie.2014.07.047. PMID 25281498.
  14. Percivale P, Bertoglio S, Muggianu M, Aste H, Secco GB, Martines H; et al. (1989). "Long-term postoperative results in 54 cases of early gastric cancer: the choice of surgical procedure". Eur J Surg Oncol. 15 (5): 436–40. PMID 2792394.
  15. Schlemper RJ, Itabashi M, Kato Y, Lewin KJ, Riddell RH, Shimoda T; et al. (1997). "Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists". Lancet. 349 (9067): 1725–9. doi:10.1016/S0140-6736(96)12249-2. PMID 9193382.
  16. Hiki Y, Shimao H, Mieno H, Sakakibara Y, Kobayashi N, Saigenji K (1995). "Modified treatment of early gastric cancer: evaluation of endoscopic treatment of early gastric cancers with respect to treatment indication groups". World J Surg. 19 (4): 517–22. PMID 7676693.
  17. Kim JP, Hur YS, Yang HK (1995). "Lymph node metastasis as a significant prognostic factor in early gastric cancer: analysis of 1,136 early gastric cancers". Ann Surg Oncol. 2 (4): 308–13. PMID 7552619.
  18. Ohashi S, Okamura S, Urano F, Maeda M (2007). "Clinicopathological variables associated with lymph node metastasis in submucosal invasive gastric cancer". Gastric Cancer. 10 (4): 241–50. doi:10.1007/s10120-007-0442-7. PMID 18095080.
  19. 19.0 19.1 19.2 19.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD,, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.

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