Gastric cancer is the second most common cancer in the world after lung cancer. Over 20,000 new cases of gastric cancer are diagnosed every year in the United States and more than 50% will die of the disease. Many Asian countries (Japan, Korea, China, Taiwan) have a very high rate of gastric cancer and screening procedures are used to detect it early. Because initial clinical symptoms are usually nonspecific and dismissed as not relevant, gastric cancer is frequently diagnosed at an advanced stage with a high mortality rate. The overall 5 year survival rate from gastric cancer is less than 20%. The 5 year survival rate is different for each stage of the disease at the time of diagnosis.
In addition to ethnic origin and hereditary factors, multiple risk factors have been identified that increase the incidence of gastric cancer. They include:
Infection with Helicobacter pylori (H. Pylori) is a gram negative bacteria that is very common. Its known association with ulcer formation was known for years. Recently, several studies confirmed that H. Pylori is also a primary risk factor for gastric cancer. H. pylori causes gastritis will cell proliferation that increases the risk of DNA damage and malignant transformation. Infection at an early age and atrophic gastritis appear to carry the greater risk. Several precancerous conditions have been recognized that predispose an individual to develop gastric cancer. They include:
Chronic atrophic gastritis
Previous gastric surgery
The overall 5 year survival rate from gastric cancer is less than 20%. The 5 year survival rate is different for each stage of the disease at the time of diagnosis. The histologic grade of the cancer and its location along the stomach are also determining survival factors. The most frequently used classification for gastric cancer take into account the size of the tumor, its spread to lymph nodes and involvement of distant organs (metastasis).
Approximately 95% of gastric cancers are adenocarcinomas of the intestinal and diffuse histologic type. The intestinal type forms glandular type structures whereas the diffuse type exhibits lack of cell cohesion. Cancer of the stomach can spread directly, through the lymphatics or through the blood system. The visible lesion (naked eye) frequently underestimates the degree of the disease. Preoperative assessment with endoscopic (esophagogastroduodenoscopy) directed biopsies, endoscopic ultrasound and CT (computed tomography) or MRI (magnetic resonance imaging) scans is essential to estimate the extent of the disease.
Tumor-Node-Metastasis (TNM) System
o Tis: Carcinoma in situ, intraepithelial tumor without invasion of lamina propia o T1: Tumor invades lamina propia or submucosa o T2: Tumor invades muscularis propia or subserosa o T3: Tumor penetrates serosa without invasion of adjacent structures o T4: Tumor invades adjacent structures
Regional lymph Nodes
o N0: No regional lymph nodes involved o N1: 1-6 regional lymph nodes involved o N2: 7-15 regional lymph nodes involved o N3: More than 15 regional lymph nodes involved
o M0: No distant metastasis o M1: Distant metastasis
Factors that influence the survival rate in gastric cancer are depth of cancer invasion through the stomach wall and the presence or absence of regional lymph node involvement. The greater the depth of invasion and the number of affected lymph nodes, the lower the chance of survival. Staging at the time of diagnosis is the best predictor for recurrence and/or cure.
Stage 0: Tis, N0, M0
Stage Ia: T1,N0 or N1, M0
Stage 1b: T1, N2, M0 or T2a/b, N0, M0
Stage II: T1, N2, M0 or T2a/b, N1, M0 or T2, N0, M0
Stage IIIa: T2a/b, N2, M0 or T3, N1, M0 or T4, N0, M0
Stage IIIb: T3, N2, M0
Stage IV: T1-3, N3, M0 or T4, N1, M0 or any T, any N, M1
Stage 0: Greater than 90%
Stage Ia: 60% to 80%
Stage 1b: 50% to 60%
Stage II: 30% to 40%
Stage IIIa: 20%
Stage IIIb: 10%
Stage IV: Less than 5%
Because of its low incidence in the United States, screening for gastric cancer is not carried out in the asymptomatic population. Nonetheless, the use of upper gastrointestinal endoscopy, double contrast barium swallow and CT (computed tomography) for assessment of patients with symptoms that are unresponsive to initial nonspecific therapy should be undertaken. Up to 50% of gastric cancers will have an elevated CEA (carcinoembryonic antigen) and up to 30% will have an elevated AFP (α-fetoprotein) or CA19-9 (serum carbohydrate antigen 19-9).
If you believe that you or your loved have been misdiagnosed, victims of a delayed diagnosis of gastric cancer or wrongly treated for any type of cancer and suspect the injury may be the result of a medical provider’s error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your gynecologic condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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