Stomach cancer natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
[[Metastasis]] occurs in 80-90% of individuals with stomach cancer. | Without treatment, 63 percent of patients with early gastric cancer will progress to advanced stage disease within five years.[[Metastasis]] occurs in 80-90% of individuals with stomach cancer.<ref name="pmid11034575">{{cite journal| author=Tsukuma H, Oshima A, Narahara H, Morii T| title=Natural history of early gastric cancer: a non-concurrent, long term, follow up study. | journal=Gut | year= 2000 | volume= 47 | issue= 5 | pages= 618-21 | pmid=11034575 | doi= | pmc=1728114 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11034575 }}</ref> | ||
==Complications== | ==Complications== | ||
*[[Ascites]] | * [[Ascites]] | ||
*[[Gastrointestinal bleeding]] | *[[Gastrointestinal bleeding]] | ||
* | *Distant metastasis to other organs of body | ||
*[[Weight loss]] | *[[Weight loss]] | ||
*Recurrence: | *Recurrence | ||
In a Japanese series, 58 of 633 patients (9.2 percent) with early gastric cancers had synchronous cancers, defined as a second cancer found within the first year | *Recurrence following curative resection was local or regional in 40 percent and systemic in 60% 3]. | ||
* Regional recurrences may be more frequent in patients treated with surgery alone or surgery plus postoperative chemotherapy without RT, and among those who have a fewer number of negative resected lymph nodes in the operative specimen.<ref name="pmid22949400">{{cite journal| author=Li F, Zhang R, Liang H, Liu H, Quan J| title=The pattern and risk factors of recurrence of proximal gastric cancer after curative resection. | journal=J Surg Oncol | year= 2013 | volume= 107 | issue= 2 | pages= 130-5 | pmid=22949400 | doi=10.1002/jso.23252 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949400 }}</ref> | |||
* Sites of regional failure include the luminal margins, the resection bed, and the regional nodal basins.<ref name="pmid10973386">{{cite journal| author=Karpeh MS, Leon L, Klimstra D, Brennan MF| title=Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients. | journal=Ann Surg | year= 2000 | volume= 232 | issue= 3 | pages= 362-71 | pmid=10973386 | doi= | pmc=1421150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10973386 }}</ref> | |||
* The predominant sites of systemic recurrence in the era of preoperative therapy are the liver and peritoneum.<ref name="pmid28332034">{{cite journal| author=Ikoma N, Chen HC, Wang X, Blum M, Estrella JS, Fournier K et al.| title=Patterns of Initial Recurrence in Gastric Adenocarcinoma in the Era of Preoperative Therapy. | journal=Ann Surg Oncol | year= 2017 | volume= 24 | issue= 9 | pages= 2679-2687 | pmid=28332034 | doi=10.1245/s10434-017-5838-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28332034 }}</ref> | |||
* Metastatic disease beyond the abdomen is uncommonly the first site of recurrence aside from the supraclavicular nodes.<ref name="pmid23536054">{{cite journal| author=Bickenbach KA, Gonen M, Strong V, Brennan MF, Coit DG| title=Association of positive transection margins with gastric cancer survival and local recurrence. | journal=Ann Surg Oncol | year= 2013 | volume= 20 | issue= 8 | pages= 2663-8 | pmid=23536054 | doi=10.1245/s10434-013-2950-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23536054 }}</ref> | |||
*In a Japanese series, 58 of 633 patients (9.2 percent) with early gastric cancers had synchronous cancers, defined as a second cancer found within the first year.<ref name="pmid16767364">{{cite journal| author=Nakajima T, Oda I, Gotoda T, Hamanaka H, Eguchi T, Yokoi C et al.| title=Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance? | journal=Gastric Cancer | year= 2006 | volume= 9 | issue= 2 | pages= 93-8 | pmid=16767364 | doi=10.1007/s10120-006-0372-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16767364 }}</ref> | |||
*The overall incidence of metachronous cancers was 8.2 percent, the majority of which were able to be resected endoscopically. the cumulative incidence of metachronous early gastric cancers was 9.5 percent at five years, 13.1 percent at seven years, and 22.7 percent at 10 years.<ref name="pmid26165734">{{cite journal| author=Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Nakajima T et al.| title=Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection. | journal=Endoscopy | year= 2015 | volume= 47 | issue= 12 | pages= 1113-8 | pmid=26165734 | doi=10.1055/s-0034-1392484 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26165734 }}</ref> | |||
==== Surgery complications ==== | |||
* Anastomotic leakage<ref name="pmid20632269">{{cite journal| author=Sierzega M, Kolodziejczyk P, Kulig J, Polish Gastric Cancer Study Group| title=Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. | journal=Br J Surg | year= 2010 | volume= 97 | issue= 7 | pages= 1035-42 | pmid=20632269 | doi=10.1002/bjs.7038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20632269 }}</ref> | |||
* Anastomotic strictures<ref name="pmid20458580">{{cite journal| author=Fukagawa T, Gotoda T, Oda I, Deguchi Y, Saka M, Morita S et al.| title=Stenosis of esophago-jejuno anastomosis after gastric surgery. | journal=World J Surg | year= 2010 | volume= 34 | issue= 8 | pages= 1859-63 | pmid=20458580 | doi=10.1007/s00268-010-0609-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20458580 }}</ref> | |||
* Obstruction | |||
* Dumping is a phenomenon caused by the destruction or bypass of the pyloric sphincter. Dumping symptoms include gastrointestinal discomfort (eg, nausea, vomiting, cramps, and diarrhea<ref name="pmid25625992">{{cite journal| author=Mala T, Hewitt S, Høgestøl IK, Kjellevold K, Kristinsson JA, Risstad H| title=[Dumping syndrome following gastric surgery]. | journal=Tidsskr Nor Laegeforen | year= 2015 | volume= 135 | issue= 2 | pages= 137-41 | pmid=25625992 | doi=10.4045/tidsskr.14.0550 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25625992 }}</ref> | |||
* Gastric stasis, which is the more common slow transit complication, may develop as a result of postsurgical atony, vagal denervation, or from a small gastric remnant following surgical resection. Symptoms consist of epigastric fullness with meals (early satiety), often followed by emesis of undigested food, abdominal pain, and weight loss.<ref name="pmid25436381">{{cite journal| author=Paik HJ, Choi CI, Kim DH, Jeon TY, Kim DH, Son GM et al.| title=Risk factors for delayed gastric emptying caused by anastomosis edema after subtotal gastrectomy for gastric cancer. | journal=Hepatogastroenterology | year= 2014 | volume= 61 | issue= 134 | pages= 1794-800 | pmid=25436381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25436381 }}</ref> | |||
==== Chemotherapy complications ==== | |||
* | |||
==Prognosis== | ==Prognosis== | ||
===5-Year Survival=== | ===5-Year Survival=== | ||
The prognosis of patients with gastric cancer is related to tumor extent and includes both nodal involvement and direct tumor extension beyond the gastric wall. | The prognosis of patients with gastric cancer is related to tumor extent and includes both nodal involvement and direct tumor extension beyond the gastric wall. | ||
The overall five-year survival rate for treated early gastric cancer in most modern era series is over 90 percent: nearly 100 percent for mucosal tumors, and 80 to 90 percent for submucosal tumors [75-78]. early-stage disease accounts for only 10% to 20% of all cases diagnosed in the United States. | The overall five-year survival rate for treated early gastric cancer in most modern era series is over 90 percent: nearly 100 percent for mucosal tumors, and 80 to 90 percent for submucosal tumors [75-78]. early-stage disease accounts for only 10% to 20% of all cases diagnosed in the United States. | ||
| Line 65: | Line 85: | ||
* 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.<ref name="SEER">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, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref> | * 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.<ref name="SEER">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, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref> | ||
<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:5-year survival of gastric cancer in USA.PNG|584x584px]]</figure-inline></figure-inline></figure-inline> | <figure-inline class="mw-default-size"><figure-inline><figure-inline><figure-inline>[[Image:5-year survival of gastric cancer in USA.PNG|584x584px]]</figure-inline></figure-inline></figure-inline></figure-inline> | ||
==References== | ==References== | ||
Revision as of 23:32, 16 November 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
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Overview
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.
Natural History
Without treatment, 63 percent of patients with early gastric cancer will progress to advanced stage disease within five years.Metastasis occurs in 80-90% of individuals with stomach cancer.[1]
Complications
- Gastrointestinal bleeding
- Distant metastasis to other organs of body
- Weight loss
- Recurrence
- Recurrence following curative resection was local or regional in 40 percent and systemic in 60% 3].
- Regional recurrences may be more frequent in patients treated with surgery alone or surgery plus postoperative chemotherapy without RT, and among those who have a fewer number of negative resected lymph nodes in the operative specimen.[2]
- Sites of regional failure include the luminal margins, the resection bed, and the regional nodal basins.[3]
- The predominant sites of systemic recurrence in the era of preoperative therapy 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, 58 of 633 patients (9.2 percent) with early gastric cancers had synchronous cancers, defined as a second cancer found within the first year.[6]
- The overall incidence of metachronous cancers was 8.2 percent, the majority of which were able to be resected endoscopically. the cumulative incidence of metachronous early gastric cancers was 9.5 percent at five years, 13.1 percent at seven years, and 22.7 percent at 10 years.[7]
Surgery complications
- Anastomotic leakage[8]
- Anastomotic strictures[9]
- Obstruction
- Dumping is a phenomenon caused by the destruction or bypass of the pyloric sphincter. Dumping symptoms include gastrointestinal discomfort (eg, nausea, vomiting, cramps, and diarrhea[10]
- Gastric stasis, which is the more common slow transit complication, may develop as a result of postsurgical atony, vagal denervation, or from a small gastric remnant following surgical resection. Symptoms consist of epigastric fullness with meals (early satiety), often followed by emesis of undigested food, abdominal pain, and weight loss.[11]
Chemotherapy complications
Prognosis
5-Year Survival
The prognosis of patients with gastric cancer is related to tumor extent and includes both nodal involvement and direct tumor extension beyond the gastric wall.
The overall five-year survival rate for treated early gastric cancer in most modern era series is over 90 percent: nearly 100 percent for mucosal tumors, and 80 to 90 percent for submucosal tumors [75-78]. early-stage disease accounts for only 10% to 20% of all cases diagnosed in the United States.
The remaining patients present with metastatic disease in either regional or distant sites.
The overall survival rate in these patients at 5 years ranges from almost no survival for patients with disseminated disease to almost 50% survival for patients with localized distal gastric cancers confined to resectable regional disease. Even with apparent localized disease, the 5-year survival rate of patients with proximal gastric cancer is only 10% to 15%. Although the treatment of patients with disseminated gastric cancer may result in palliation of symptoms and some prolongation of survival, long remissions are uncommon.
Survival rates are similar between patients who undergo endoscopic resection and those who undergo surgical resection (five-year survival of 96 and 94 percent in one study)[12]
The recurrence rate after surgery is approximately 1 to 5 percent in reports from Korea[13]
and Japan and 5 to 15 percent in studies from Western centers.[14]
These variable recurrence rates partially reflect differences in length of follow-up, but may also be due to differences in the pathologic diagnosis of malignancy[15]. Among patients undergoing endoscopic resection, recurrence rates have been reported to be between 0 and 30%.[16]
Higher recurrence rates are seen with those who have piecemeal or incomplete resections.
Prognosis with lymph node involvement[17]
The literature suggests that up to 10 percent of mucosal early gastric cancers and 20 to 30 percent of submucosal early gastric cancers will have lymph node metastases
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[18]
- Between 2004 and 2010, the 5-year relative survival of patients with stomach cancer was 29%.[19]
- When stratified by age, the 5-year relative survival of patients with stomach cancer was 31.4% and 26% for patients <65 and ≥ 65 years of age respectively.[19]
- The survival of patients with stomach cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of stomach cancer:[19]
| 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]
<figure-inline class="mw-default-size"><figure-inline><figure-inline><figure-inline>
</figure-inline></figure-inline></figure-inline></figure-inline>
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.