Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Gastric Cancer
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:

  • Dietary nitrates
  • Hypochlorhydria
  • Helicobacter pylori
  • Cigarette smoking
  • Certain foods
  • Familial history

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

  • Chronic atrophic gastritis
  • Pernicious anemia
  • Previous gastric surgery
  • Gastric dysplasia
  • Adenomatous polyps
  • Menetrier disease
  • Hereditary factors

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

  • Primary Tumor
   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
   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
  • Distant Metastasis
   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

Survival rates

  • 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
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