Stomach cancer or also called gastric cancer is a type of cancer that originates in the cells of the stomach, and depending on its degree of invasion can affect all three layers of gastric tissue; the mucosa, the muscle and the serosa or peritoneum.
Knowing life expectancy and how it varies according to the stage of the cancer can be critical to planning and making informed decisions about treatment, palliative care and even personal issues.
What is stomach cancer?
Gastric cancer can develop from pre-cancerous lesions such as polyps or certain types of ulcers, gradually, such as abnormal changes in stomach lining cells, which are non-cancerous and potentially convertible, and can also undergo further changes and become dysplastic, meaning they have a normal appearance, but have an increased risk of becoming cancerous.
The types of stomach cancer encompass a wide variety depending on the cells where it originates, with specific characteristics, the most common being:
– Adenocarcinoma, being the most common representing between 90-95% of cases, and being able to be of two types, intestinal with a somewhat better diagnosis with genetic changes in the cancerous cells that could allow a targeted treatment, and diffuse which spreads faster and being more difficult to treat.
– Lymphomas which, although they usually start in other parts of the body, some can originate in the stomach wall.
– Gastrointestinal stromal tumours, which tend to be less common and can arise in all parts of the digestive tract, most start in the stomach.
– Neuroendocrine tumours, most of these tumours grow slowly and do not spread to other organs, but some can spread rapidly depending on their replication rate or Ki grade.
Risk factors for stomach cancer
Several factors can be identified that can make a person more prone to stomach cancer. One of these is infection with Helicobacter pylori bacteria, especially when this infection persists for a long time.
Other factors are associated with lifestyle, such as high intake of foods containing nitrates or nitrites (such as canned foods) and excessive consumption of salt, including salty foods. Smoking is a risk factor in almost all cancers.
Alcohol consumption is a risk factor for the development of stomach and oesophageal cancer.
Not only are there external factors, but there are also genetic factors that predispose to stomach cancer, such as inherited mutations or a history of stomach cancer in first-degree relatives. Early diagnosis of cancer is essential, not only to start treatment, but also to prevent the development of side effects and the spread of cancer to other organs close to the stomach.
Life expectancy in stomach cancer by stage
Stage 1 stomach cancer
- At this stage, the cancer is still in the second or third layer of the gastric wall, and has not yet spread to the lymph nodes near the stomach.
- As it is a localised tumour, without spreading beyond the stomach, the survival rate is around 75% at 5 years.
- Factors such as early detection, good general health and a favourable response to treatment can be taken into account to improve the prognosis.
Stage 2 Stomach Cancer
At this stage, three different scenarios can occur:
- Cancer is found in the second layer of the gastric wall and has spread to lymph nodes further away from the tumour.
- Cancer is found only in the third layer of the stomach and has spread to lymph nodes closer to the stomach.
- Cancer is found in all four layers of the stomach, but has not spread to the lymph nodes.
The survival rate at this stage is approximately 68%.
Stage 3 Stomach Cancer
In the third stage of gastric cancer, three different scenarios can occur:
- Cancer is found in the third layer of the gastric wall and has spread to lymph nodes further away from the tumour.
- Cancer is found in all four layers of the gastric wall and has spread to lymph nodes either near or far away from the tumour.
- Cancer is found in all four layers of the gastric wall and has spread to nearby tissues, and may or may not have spread to lymph nodes in close proximity to the tumour.
The survival rate at this stage varies between 18% and 36%, depending on the sub-stage.
Stage 4 Stomach Cancer
In this last stage, the tumour has spread to nearby tissues, to lymph nodes far from the tumour, and to other parts of the body. The survival rate at this stage is approximately 5% in the absence of highly specialised treatments.
According to current evidence the best treatment option for patients with stage 4 stomach cancer spread to the peritoneum is debulking surgery with associated Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which consists of administering chemotherapy at temperatures between 40-43 degrees, irrigating the entire affected area once all tumour nodules have been removed from the peritoneum. This is an option for patients with a PCI or peritoneal cancer index of less than 7.
If the peritoneal involvement is more extensive and the PCI is greater than 7, PIPAC (pressurised intraperitoneal aerosol chemotherapy) is an option in combination with chemotherapy and/or systemic immunotherapy that has reported survival of up to 21 months, with very good tolerance and quality of life. In addition, it has been reported that up to 19% of patients treated with PIPAC become candidates for cytoreduction surgery and HIPEC due to a decrease in ICH.
In Japan, the use of liquid intraperitoneal chemotherapy (NIPEC) concomitant with systemic chemotherapy for the treatment of peritoneal metastases is widespread.
In stages 2 and 3, the main treatment is gastrectomy, which is the removal of the stomach and lymph nodes affected by the cancer. In addition, some people receive simultaneous chemotherapy and radiotherapy to enhance the effect of the radiotherapy.
The role of PIPAC during conventional gastric cancer surgery (gastrectomy and lymphadenectomy) is being studied to prevent the development of peritoneal metastases.
Factors influencing life expectancy
Early diagnosis: detecting cancer in its early stages significantly increases the patient’s life expectancy. If it is diagnosed before it spreads to the lymph nodes or other tissues, it is easier to implement effective treatments to eliminate the cancer. Therefore, first-degree relatives and patients with risk factors may benefit from gastroscopy screening.
Appropriate treatment: correct treatment for each stage of cancer also improves life expectancy. For this, early and accurate detection of the stage of the cancer and referral to centres with a peritoneal pathology unit if metastasis or peritoneal carcinomatosis is present is crucial.
General health and age of the patient: life expectancy is longer in patients with good general health and in younger patients, although this depends on the stage of the tumour and its spread in the body.
Stomach cancer is divided into four stages or phases depending on its spread in the stomach, nearby or distant lymph nodes, and the organs to which it may have spread. Survival varies according to the stage and the time of detection.
- Approach possible at any stage: regardless of the stage, it may be possible to approach stomach cancer.
- Multidisciplinary approach: treatment of stomach cancer requires a multidisciplinary approach, involving several specialists to ensure comprehensive and personalised care.
- Specialists and advanced treatments: IVOQA offers oncological surgeons specialised in subtotal and total gastrectomy by minimally invasive means, such as laparoscopy or robotic surgery, and in open surgery. We also have advanced molecular panels and treatments such as PIPAC, ePIPAC and NIPEC for patients with peritoneal carcinomatosis.
