Gastric Cancer

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What is Gastric Cancer?

Gastric cancer is a rare and aggressive cancer that develops in the stomach, which is responsible for breaking down food during digestion. Most (90-95%) gastric cancers begin in the stomach’s inner lining and are called adenocarcinomas. Gastric cancer is the fourth leading cause of cancer-related deaths worldwide. However, its incidence has been steadily declining over the past few decades, now representing only 1.5% of all new cancer cases in the United States.

The Basics

Diagnosis and Prognosis

The Basics

Gastric cancer is a rare and aggressive cancer that develops in the stomach, which is responsible for breaking down food during digestion. Most (90-95%) gastric cancers begin in the stomach’s inner lining and are called adenocarcinomas. There are two main types of stomach adenocarcinomas: intestinal, which have a slightly better prognosis and are more likely to have certain molecular changes amenable to targeted therapy, and diffuse, which are more aggressive and more difficult to treat. [see References: 1]

Regular endoscopies are a common screening method for detecting gastric cancers early, but they are typically only done in regions with a higher incidence, such as Asia, or in patients with a higher risk of developing the disease. Early-stage (localized) gastric cancers often have no or only vague, nonspecific symptoms, making it difficult to detect. Most symptoms do not occur until the cancer has spread to other tissues. As a result, more than 60% of gastric cancers are diagnosed at advanced stages, when the cancer has already spread beyond the stomach and is more difficult to treat.[2]

Gastric cancer is the fourth leading cause of cancer-related deaths worldwide.[3] However, its incidence has been steadily declining over the past few decades, now representing only 1.5% of all new cancer cases in the United States.[4] This decline is thought to be attributed to better storage methods for perishable foods, access to clean water, and treatment for Helicobacter pylori infections.

Gastric cancer has a high likelihood of spreading to the peritoneal cavity. Traditionally, this has been treated with palliative systemic chemotherapy, but this approach is linked to poor outcomes and treatment response. As a result, there has been a growing interest in more aggressive treatments that directly target the abdominal cavity, such as cytoreductive surgery with or without HIPEC. Although the current data is limited, emerging research suggests that select patients can benefit from this approach.

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Risk Factors

Age: Most commonly occurs between late 60s and 80s
Gender: Occurs twice as frequently in males
Diets high in smoked foods, salted fish and meat, and pickled vegetables
Helicobacter pylori (H. pylori) bacterial infection
Persistent, non-healing ulcers
Smoking tobacco
Ethnicity: More common in African Americans, Hispanics, Native Americans, and Asian/Pacific Islanders
Genetics: Family history of gastric cancer, Lynch syndrome, familial adenomatous polyposis (FAP), BRCA 1/2, Li-Fraumeni syndrome, and Peutz-Jeghers syndrome (PJS)

Signs & Symptoms

Weight loss
Nausea
Vomiting
Early satiety
Persistent abdominal pain
Anemia

Evaluation

Physical exam
Upper endoscopy (EGD)
Biopsy
Imaging tests of the chest and abdomen (CT scan, MRI, or PET/CT)
Blood work, including tumor markers (CEA, CA 125, and CA 19-9)
Laparoscopy
May include a barium swallow study

Key Facts

Stage at Diagnosis

The majority (>60%) of gastric cancers are diagnosed at an advanced stage, where cancer has already spread beyond the stomach to surrounding tissues and/or lymph nodes, making it more difficult to treat and resulting in a poorer progosis.

Role of Chemotherapy

Gastric cancers that spread to the peritoneum were historically treated with systemic chemotherapy for palliation. However, the prognosis was poor and chemotherapy’s limited ability to reach the abdominal cavity led researchers to explore alternative locoregional treatment options.

Multimodal Treatments
Gastric cancer is highly aggressive and typically requires a combination of treatments (multimodal therapy), including surgery, chemotherapy, and/or radiation therapy.

CRS/HIPEC
Cytoreductive Surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has shown improved overall and progression-free survival compared to CRS or systemic chemotherapy alone. However, due to limited data and evolving research, CRS/HIPEC should only be considered for carefully selected patients at specialized peritoneal surface malignancy centers. New techniques to deliver chemotherapy directly to the abdominal cavity, such as laparoscopic HIPEC and PIPAC (pressurized intraperitoneal aerosol chemotherapy), are being investigated. These approaches aim to reduce tumor burden, alleviate symptoms, and make patients eligible for surgery, potentially enabling complete tumor removal and improved survival.

Treatment

Gastric cancer is aggressive and typically requires a combination of treatments (multimodal therapy). This often requires surgery, chemotherapy, and/or radiation therapy.

Surgery:

The initial evaluation of gastric cancer primarily focuses on determining whether the disease has spread and if the patient is a candidate for surgery. Surgery offers the best chance for prolonged survival, especially if the cancer is diagnosed at an early stage before it has spread (metastasized). In such cases, surgery may provide the only realistic chance for a cure.[5, 6]

The type of surgery depends on the location of the cancer. In rare cases, an endoscopic resection may be used to remove small, localized, early-stage cancers.[7] However, most cases require a gastrectomy, which involves removing part (subtotal) or all (total) of the stomach. In some cases, nearby lymph nodes or portions of the esophagus or small intestine may also be removed. Advances in surgery now allow for minimally invasive techniques, such as robotic or laparoscopic surgery, though the best approach depends on factors like tumor extent, the need to preserve digestive function, and minimizing recovery time.[8-10] Preoperative (neoadjuvant) chemotherapy may be recommended to help shrink the tumor, allowing for less extensive surgery.

[11]

In more advanced cases, where the cancer has spread to the abdominal cavity (peritoneal carcinomatosis), a combination of treatments with surgery and chemotherapy (systemic and intraperitoneal) can also be effective. The extent of surgery depends on the spread of disease and the goal of the surgery. If the disease has spread, but is able to be completely removed, surgery should aim to remove all visible cancer, which can improve survival.[12, 13] Surgery may require the removal of part or all of several organs including the stomach, liver, lymph nodes, omentum, and small bowel. In cases where the tumor is too advanced to be fully removed, palliative surgery may be performed to relieve symptoms like pain or to prevent a blockage.[14]

A multidisciplinary approach involving a surgical oncologist, medical oncologist, and radiation oncologist is crucial to determine the best treatment plan and surgical timing. Patients should consult with all relevant specialists before proceeding with surgery.

Chemotherapy:

Most patients will require systemic chemotherapy since gastric cancers tend to be very aggressive and the majority are detected after they have spread. For patients who are candidates for surgery, chemotherapy is commonly given before surgery (neoadjuvant chemotherapy) to shrink the tumor, making it easier to remove. After surgery, chemotherapy is usually continued (adjuvant chemotherapy) to treat any remaining cancer cells and reduce the risk of recurrence.[15, 16] If the cancer is at an advanced, inoperable stage, chemotherapy alone may be given to help relieve symptoms. Common chemotherapy drugs used to treat gastric cancer are 5-FU, capecitabine (Xeloda), platinum-based drugs (cisplatin, oxaliplatin), and taxanes (docetaxel, paclitaxel). Chemotherapy can also be given in combination with radiation therapy (chemoradiation) or delivered directly into the abdominal cavity (intraperitoneal chemotherapy).[17] An experienced medical oncologist will determine the appropriate chemotherapy regimen, and a multidisciplinary team will help plan the best sequence of treatments.

Radiation:

Radiation therapy may be used before surgery to try to shrink a tumor, making it easier to remove, or after surgery to target any remaining cancer cells. It is often combined with chemotherapy, especially with 5-FU, in a treatment known as chemoradiation. For patients with advanced gastric cancer who are not surgical candidates, radiation or chemoradiation can be a palliative option to help relieve symptoms such as pain and bleeding. The role of radiation therapy is currently being explored in clinical trials, particularly regarding its combination with chemotherapy and the best timing for its use.[18] An experienced radiation oncologist, working alongside medical and surgical oncologists, can help determine if radiation therapy is appropriate and establish the most effective treatment sequence for each patient.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC):

Gastric cancer has a high likelihood of spreading to the peritoneal cavity, even though it may be missed on preoperative imaging.[19-22] Once this occurs, it becomes much more difficult to treat. Historically, systemic chemotherapy was the primary treatment for this scenario, but it has shown limited effectiveness.[23] As a result, physicians have sought alternative approaches to target the peritoneal cavity more effectively, with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) emerging as a promising option.[24]

CRS involves the surgical removal of visible cancer from the peritoneal cavity, while HIPEC delivers heated chemotherapy directly into the abdominal cavity during surgery. This combination has been shown to improve overall survival in select patients with advanced gastric cancers who are able to have all visible cancer removed and are in good functional and nutritional health. For instance, one study comparing CRS/HIPEC with systemic chemotherapy alone found that patients in the CRS/HIPEC group had a median overall survival of 11.3 months, compared to just 4.3 months in the chemotherapy-only group.25 Additionally, the CYTO-CHIP study found that CRS/HIPEC led to significantly longer survival and recurrence-free survival compared to CRS alone, with median overall survival of 18.8 months vs 12.1 months, and median recurrence-free survival of 13.6 months vs 7.8 months.[26]

While several studies have shown promising results for CRS/HIPEC in improving outcomes,[27-30] others have reported little to no benefit. Other studies have found similar results with improved outcomes in select patients treated with CRS/HIPEC.[31] Given the mixed results, it is clear that careful patient selection is crucial for achieving the best outcomes. Key factors for determining if CRS/HIPEC is appropriate include the feasibility of complete tumor removal, the extent of disease, the patient’s overall health and nutritional status, cancer type, and their response to other treatments.[26, 28, 30, 32-34] Due to the complexity of this approach, having an experienced peritoneal surface malignancy surgeon is essential.

Laparoscopic HIPEC & PIPAC:

In addition to traditional HIPEC, other techniques such as laparoscopic HIPEC and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have been explored for directly treating the peritoneal cavity in gastric cancer. These methods aim to reduce the disease burden, measured by the peritoneal cancer index (PCI), and improve patient’s quality of life by alleviating symptoms related to peritoneal disease. These approaches are often used alongside systemic chemotherapy and can help make patients eligible for surgery. A study on laparoscopic HIPEC combined with preoperative chemotherapy showed promising results, significantly reducing the PCI and allowing 63% of patients to undergo complete cytoreduction. These patients had a median survival of 20.5 months.

[34, 35] PIPAC involves delivering chemotherapy as an aerosol under elevated pressure, which is thought to improve drug absorption and ensure better coverage of the peritoneal surface.[see References: 36] Although the data is still evolving, a systematic review of the available literature found that PIPAC is most often used for palliative purposes at this point. The review concluded that PIPAC appears to be a safe and feasible treatment.[37]

Diagnosis and Prognosis

The prognosis for gastric cancer is most accurately estimated after the final pathology from surgical resection is completed; however, initial clinical evaluation can help guide early treatment decisions and surgery. Prognosis is strongly linked to the stage of disease at diagnosis. Early stage gastric cancers, particularly those confined to the stomach, have 5-year survival rates of greater than 90%, with recurrence risk typically less than 5%.[44-46] In contrast, the 5-year survival rate for stage IV gastric cancer is reported to be as low as 4%.[47] Other key prognostic factors include histologic type, lymph node involvement, and the completeness of cytoreduction, with worse survival seen in patients with signet ring cell histology, positive lymph nodes, and residual disease after initial surgery.[48-51] Interestingly, survival outcomes are often reported to be better in Asian populations compared to Western populations. This disparity may be due to genetic differences, treatment factors, or other unknown reasons.

[47, 52]

Recurrence

Recurrence rates for gastric cancer can be as high as 60%, with several factors influencing prognosis, including tumor size, lymph node metastases, tumor pathology, and surgical resection margins.[38-40] Most recurrences occur within the first 2 years after surgery and they are more likely to occur at distant sites (42-47%), rather than the original location or nearby areas (locoregional).[39, 41, 42] Once recurrence occurs, treatment becomes very challenging and the prognosis is generally poor. Therefore, the initial treatment approach focuses on multimodal therapies aimed at preventing distant metastases and delaying recurrence.[43] Current treatment options for recurrent gastric cancer focus on controlling the disease, managing symptoms, and improving quality of life. These treatments may include chemotherapy, targeted therapy, surgery, and participating in clinical trials. The choice of treatment is individualized, depending on factors such as the location of recurrence, previous treatments, the patient’s overall health and performance status, and the goals of care.

Research

Clinical Trials

Because gastric cancer remains a very aggressive and rare malignancy, many patients will be recommended to explore clinical trials. There are over 200 actively recruiting clinical trials for gastric cancer registered online as of February 2025. Below is a sample of a few of the clinical trials listed on www.ClinicalTrials.gov. Your oncologists can also help you review clinical trial options and recommendations.

A Phase II Trial of Neoadjuvant Laparoscopic HIPEC with Chemoradiation (NCT04308837)

Status: Recruiting
This phase II single arm trial aims to evaluate the efficacy of a multi-modality approach to treating patients with locally advanced gastric cancer by incorporating diagnostic laparoscopy with HIPEC and neoadjuvant chemoradiation followed by surgical resection and adjuvant chemotherapy.
Inclusion Criteria: diagnosis of T3/T4 gastric cancer who plan to undergo surgical treatment, medically able to undergo treatment, no previous treatment for gastric cancer

Robotic Cytoreduction and HIPEC for Treatment of Gastric Cancer with Limited Peritoneal Metastasis, ROBO-CHIP Study (NCT05753306)

Status: Recruiting
This phase II trial aims to determine assess the efficacy robotic cytoreduction and HIPEC in treating patients with gastric cancer that has spread to the peritoneum, specifically by evaluating complications and disease-free survival
Inclusion criteria: Ages 18-80 years old, histologic diagnosis of gastric cancer with low-volume peritoneal metastases, demonstrated response to systemic chemotherapy, able to undergo surgery

Phase II Study of the Effects of Laparoscopic HIPEC in Patients with Advanced Gastric Cancer (NCT04107077)

Status: Recruiting
This phase II single arm study aims to determine how the use of laparoscopic HIPEC affects PD-L1 expression, disease burden, and resectability
Inclusion criteria: Age ≥18 years old, histologically confirmed gastric cancer with peritoneal spread, completed a minimum of 2-4 months of systemic chemotherapy, good performance status, expected survival >3 months

PIPAC for the Treatment of Peritoneal Carcinomatosis in Patients with Ovarian, Uterine, Appendiceal, Colorectal, or Gastric Cancer (NCT04329494)

Status: Recruiting
This phase I trial studies the side effects and safety of PIPAC in treating patients with cancer that as spread to the abdominal cavity
Inclusion criteria: Diagnosis of ovarian, uterine, gastric, appendiceal, or colorectal cancer with peritoneal spread, clinically able to undergo treatment, history of progressing on at least one other treatment, not a candidate for CRS/HIPEC, diagnostic laparoscopy demonstrates disease that is amenable for PIPAC treatment

Aldesleukin with Nivolumab and Standard Chemotherapy for Treatment of Gastric Cancer with Peritoneal Metastasis (NCT05802056)

Status: Recruiting
This phase 1b trial aims to determine if complementing standard chemotherapy with aldesleukin and novolumab results in a greater response compared to standard chemotherapy alone in patients with gastric cancer that has spread to the peritoneum
Inclusion Criteria: Age ≥18 years old, histologic diagnosis of gastric cancer with peritoneal spread, clinically able to undergo treatment, new diagnosis currently receiving first line systemic chemotherapy or planning to start chemotherapy

Other Resources

More information on gastric cancer:

National Cancer Institute

cancer.gov / stomach

American Cancer Society

cancer.org / stomach-cancer

Patient Support

Gastric Cancer Foundation

Debbie's Dream Foundation

No Stomach for Cancer

gastriccancer.org

debbiesdream.org

nostomachforcancer.org

Hope for Stomach Cancer

stocan.org

Facing cancer is hard.
But you are not alone - we’re right here with you.

Patient and Caregiver Network

Stories of hope

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References

1. American Cancer Society. (2022, January 22). What is stomach cancer?: Types of stomach (gastric) cancer. Types of Stomach (Gastric) Cancer | American Cancer Society. https://www.cancer.org/cancer/types/stomach-cancer/about/what-is-stomach-cancer.html 2. Xia JY, Aadam AA. Advances in screening and detection of gastric cancer. J Surg Oncol. 2022 Jun;125(7):1104-1109. doi: 10.1002/jso.26844. PMID: 35481909; PMCID: PMC9322671. 3. Ilic M, Ilic I. Epidemiology of stomach cancer. World J Gastroenterol. 2022 Mar 28;28(12):1187-1203. doi: 10.3748/wjg.v28.i12.1187. PMID: 35431510; PMCID: PMC8968487. 4. American Cancer Society. (2024 January 19). Stomach (gastric) cancer key statistics. Stomach (Gastric) Cancer Key Statistics | American Cancer Society. https://www.cancer.org/cancer/types/stomach-cancer/about/key-statistics.html#:~:text=A bout%2026%2C890%20new%20cases%20of,risk%20factors%20for%20stomach%20can cer 5. Johnston FM, Beckman M. Updates on Management of Gastric Cancer. Curr Oncol Rep. 2019 Jun 24;21(8):67. doi: 10.1007/s11912-019-0820-4. PMID: 31236716. 6. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020 Aug 29;396(10251):635-648. doi: 10.1016/S0140-6736(20)31288-5. PMID: 32861308. 7. Roh CK, Choi S, Seo WJ, Cho M, Son T, Kim HI, Hyung WJ. Indocyanine green fluorescence lymphography during gastrectomy after initial endoscopic submucosal dissection for early gastric cancer. Br J Surg. 2020 May;107(6):712-719. doi: 10.1002/bjs.11438. Epub 2020 Feb 7. PMID: 32031248. 8. Hiki N, Katai H, Mizusawa J, Nakamura K, Nakamori M, Yoshikawa T, Kojima K, Imamoto H, Ninomiya M, Kitano S, Terashima M; Stomach Cancer Study Group of Japan Clinical Oncology Group. Long-term outcomes of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG0703). Gastric Cancer. 2018 Jan;21(1):155-161. doi: 10.1007/s10120-016-0687-0. Epub 2017 Jan 16. PMID: 28093654. 9. Pavlidis TE, Pavlidis ET, Sakantamis AK. The role of laparoscopic surgery in gastric cancer. J Minim Access Surg. 2012 Apr;8(2):35-8. doi: 10.4103/0972-9941.95524. PMID: 22623823; PMCID: PMC3353610. 10. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. J Clin Oncol. 2016 Apr 20;34(12):1350-7. doi: 10.1200/JCO.2015.63.7215. Epub 2016 Feb 22. PMID: 26903580. 11. Sato Y, Mizusawa J, Katayama H, Nakamura K, Fukagawa T, Katai H, Haruta S, Yamada M, Takagi M, Tamura S, Yoshimura T, Tokunaga M, Yoshikawa T, Boku N, Sano T, Sasako M, Terashima M. Diagnosis of invasion depth in resectable advanced gastric cancer for neoadjuvant chemotherapy: An exploratory analysis of Japan clinical oncology group study: JCOG1302A. Eur J Surg Oncol. 2020 Jun;46(6):1074-1079. doi: 10.1016/j.ejso.2020.02.038. Epub 2020 Mar 4. PMID: 32173178. 12. Hu HM, Tsai HJ, Ku HY, Lo SS, Shan YS, Chang HC, Chao Y, Chen JS, Chen SC, Chiang CJ, Li AF, Wang HP, Wang TE, Bai LY, Wu MS, Chen LT, Liu TW, Yang YH. Survival outcomes of management in metastatic gastric adenocarcinoma patients. Sci Rep. 2021 Nov 30;11(1):23142. doi: 10.1038/s41598-021-02391-z. PMID: 34848751; PMCID: PMC8633380. 13. Fugazzola P, Ansaloni L, Sartelli M, Catena F, Cicuttin E, Leandro G, De' Angelis GL, Gaiani F, Di Mario F, Tomasoni M, Coccolini F. Advanced gastric cancer: the value of surgery. Acta Biomed. 2018 Dec 17;89(8-S):110-116. doi: 10.23750/abm.v89i8-S.7897. PMID: 30561428; PMCID: PMC6502221. 14. Waddell T, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D; European Society for Medical Oncology (ESMO); European Society of Surgical Oncology (ESSO); European Society of Radiotherapy and Oncology (ESTRO). Gastric cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct;24 Suppl 6:vi57-63. doi: 10.1093/annonc/mdt344. PMID: 24078663. 15. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ, MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006 Jul 6;355(1):11-20. doi: 10.1056/NEJMoa055531. PMID: 16822992. 16. Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, Ducourtieux M, Bedenne L, Fabre JM, Saint-Aubert B, Genève J, Lasser P, Rougier P. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011 May 1;29(13):1715-21. doi: 10.1200/JCO.2010.33.0597. Epub 2011 Mar 28. PMID: 21444866. 17. Coccolini F, Cotte E, Glehen O, Lotti M, Poiasina E, Catena F, Yonemura Y, Ansaloni L. Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials. Eur J Surg Oncol. 2014 Jan;40(1):12-26. doi: 10.1016/j.ejso.2013.10.019. Epub 2013 Nov 5. PMID: 24290371. 18. Ng SP, Leong T. Role of Radiation Therapy in Gastric Cancer. Ann Surg Oncol. 2021 Aug;28(8):4151-4157. doi: 10.1245/s10434-021-09639-y. Epub 2021 Mar 10. PMID: 33689079. 19. Coccolini F, Gheza F, Lotti M, Virzì S, Iusco D, Ghermandi C, Melotti R, Baiocchi G, Giulini SM, Ansaloni L, Catena F. Peritoneal carcinomatosis. World J Gastroenterol. 2013 Nov 7;19(41):6979-94. doi: 10.3748/wjg.v19.i41.6979. PMID: 24222942; PMCID: PMC3819534. 20. Roviello F, Marrelli D, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, De Stefano A; Italian Research Group for Gastric Cancer. Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Br J Surg. 2003 Sep;90(9):1113-9. doi: 10.1002/bjs.4164. PMID: 12945079. 21. Wu X, Li Z, Li Z, Jia Y, Shan F, Ji X, Bu Z, Zhang L, Wu A, Ji J. Hyperthermic intraperitoneal chemotherapy plus simultaneous versus staged cytoreductive surgery for gastric cancer with occult peritoneal metastasis. J Surg Oncol. 2015 Jun;111(7):840-7. doi: 10.1002/jso.23889. Epub 2015 Apr 10. PMID: 25864884. 22. Thiels CA, Ikoma N, Fournier K, Das P, Blum M, Estrella JS, Minsky BD, Ajani J, Mansfield P, Badgwell BD. Repeat staging laparoscopy for gastric cancer after preoperative therapy. J Surg Oncol. 2018 Jul;118(1):61-67. doi: 10.1002/jso.25094. Epub 2018 Jun 7. PMID: 29878364; PMCID: PMC7703853. 23. Janunger KG, Hafström L, Glimelius B. Chemotherapy in gastric cancer: a review and updated meta-analysis. Eur J Surg. 2002;168(11):597-608. doi: 10.1080/11024150201680005. PMID: 12699095. 24. Khan H, Johnston FM. Current role for cytoreduction and HIPEC for gastric cancer with peritoneal disease. J Surg Oncol. 2022 Jun;125(7):1176-1182. doi: 10.1002/jso.26894. PMID: 35481913; PMCID: PMC9322542. 25. Rudloff U, Langan RC, Mullinax JE, Beane JD, Steinberg SM, Beresnev T, Webb CC, Walker M, Toomey MA, Schrump D, Pandalai P, Stojadinovic A, Avital I. Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J Surg Oncol. 2014 Sep;110(3):275-84. doi: 10.1002/jso.23633. Epub 2014 Jul 5. PMID: 25042700; PMCID: PMC6301031. 26. Bonnot PE, Piessen G, Kepenekian V, Decullier E, Pocard M, Meunier B, Bereder JM, Abboud K, Marchal F, Quenet F, Goere D, Msika S, Arvieux C, Pirro N, Wernert R, Rat P, Gagnière J, Lefevre JH, Courvoisier T, Kianmanesh R, Vaudoyer D, Rivoire M, Meeus P, Passot G, Glehen O; FREGAT and BIG-RENAPE Networks. Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer With Peritoneal Metastases (CYTO-CHIP study): A Propensity Score Analysis. J Clin Oncol. 2019 Aug 10;37(23):2028-2040. doi: 10.1200/JCO.18.01688. Epub 2019 May 14. PMID: 31084544. 27. Hall JJ, Loggie BW, Shen P, Beamer S, Douglas Case L, McQuellon R, Geisinger KR, Levine EA. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for advanced gastric cancer. J Gastrointest Surg. 2004 May-Jun;8(4):454-63. doi: 10.1016/j.gassur.2003.12.014. PMID: 15120371. 28. Hotopp T. HIPEC and CRS in peritoneal metastatic gastric cancer - who really benefits? Surg Oncol. 2019 Mar;28:159-166. doi: 10.1016/j.suronc.2019.01.005. Epub 2019 Jan 8. PMID: 30851894. 29. Fujimoto S, Takahashi M, Mutou T, Kobayashi K, Toyosawa T, Isawa E, Sumida M, Ohkubo H. Improved mortality rate of gastric carcinoma patients with peritoneal carcinomatosis treated with intraperitoneal hyperthermic chemoperfusion combined with surgery. Cancer. 1997 Mar 1;79(5):884-91. doi: 10.1002/(sici)1097-0142(19970301)79:53.0.co;2-c. PMID: 9041149. 30. Yang XJ, Huang CQ, Suo T, Mei LJ, Yang GL, Cheng FL, Zhou YF, Xiong B, Yonemura Y, Li Y. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011 Jun;18(6):1575-81. doi: 10.1245/s10434-011-1631-5. Epub 2011 Mar 23. PMID: 21431408; PMCID: PMC3087875. 31. Kim KW, Chow O, Parikh K, Blank S, Jibara G, Kadri H, Labow DM, Hiotis SP. Peritoneal carcinomatosis in patients with gastric cancer, and the role for surgical resection, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy. Am J Surg. 2014 Jan;207(1):78-83. doi: 10.1016/j.amjsurg.2013.04.010. Epub 2013 Oct 21. PMID: 24157224. 32. Coccolini F, Catena F, Glehen O, Yonemura Y, Sugarbaker PH, Piso P, Montori G, Ansaloni L. Complete versus incomplete cytoreduction in peritoneal carcinosis from gastric cancer, with consideration to PCI cut-off. Systematic review and meta-analysis. Eur J Surg Oncol. 2015 Jul;41(7):911-9. doi: 10.1016/j.ejso.2015.03.231. Epub 2015 Apr 14. PMID: 25936764. 33. Glehen O, Gilly FN, Arvieux C, Cotte E, Boutitie F, Mansvelt B, Bereder JM, Lorimier G, Quenet F, Elias D; Association Française de Chirurgie. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010 Sep;17(9):2370-7. doi: 10.1245/s10434-010-1039-7. Epub 2010 Mar 25. PMID: 20336386. 34. Yonemura Y, Ishibashi H, Hirano M, Mizumoto A, Takeshita K, Noguchi K, Takao N, Ichinose M, Liu Y, Li Y. Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer. Ann Surg Oncol. 2017 Feb;24(2):478-485. doi: 10.1245/s10434-016-5487-6. Epub 2016 Aug 9. PMID: 27506661. 35. Yonemura Y, Prabhu A, Sako S, Ishibashi H, Mizumoto A, Takao N, Ichinose M, Motoi S, Liu Y, Nishihara K, Brandl A, Fushida S. Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis. Cancers (Basel). 2020 Jan 1;12(1):116. doi: 10.3390/cancers12010116. PMID: 31906405; PMCID: PMC7016959. 36. Nadiradze G, Giger-Pabst U, Zieren J, Strumberg D, Solass W, Reymond MA. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with Low-Dose Cisplatin and Doxorubicin in Gastric Peritoneal Metastasis. J Gastrointest Surg. 2016 Feb;20(2):367-73. doi: 10.1007/s11605-015-2995-9. Epub 2015 Oct 28. PMID: 26511950; PMCID: PMC4722080. 37. Garg PK, Jara M, Alberto M, Rau B. The role of Pressurized IntraPeritoneal Aerosol Chemotherapy in the management of gastric cancer: A systematic review. Pleura Peritoneum. 2019 Mar 5;4(1):20180127. doi: 10.1515/pp-2018-0127. PMID: 31198852; PMCID: PMC6545873. 38. Seyfried F, von Rahden BH, Miras AD, Gasser M, Maeder U, Kunzmann V, Germer CT, Pelz J, Kerscher AG. Incidence, time course and independent risk factors for metachronous peritoneal carcinomatosis of gastric origin--a longitudinal experience from a prospectively collected database of 1108 patients. BMC Cancer. 2015 Feb 19;15:73. doi: 10.1186/s12885-015-1081-8. PMID: 25879885; PMCID: PMC4337241. 39. Spolverato G, Ejaz A, Kim Y, Squires MH, Poultsides GA, Fields RC, Schmidt C, Weber SM, Votanopoulos K, Maithel SK, Pawlik TM. Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis. J Am Coll Surg. 2014 Oct;219(4):664-75. doi: 10.1016/j.jamcollsurg.2014.03.062. Epub 2014 Jun 26. PMID: 25154671. 40. Yu CC, Levison DA, Dunn JA, Ward LC, Demonakou M, Allum WH, Hallisey MT. Pathological prognostic factors in the second British Stomach Cancer Group trial of adjuvant therapy in resectable gastric cancer. Br J Cancer. 1995 May;71(5):1106-10. doi: 10.1038/bjc.1995.214. PMID: 7734309; PMCID: PMC2033774. 41. D'Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004 Nov;240(5):808-16. doi: 10.1097/01.sla.0000143245.28656.15. PMID: 15492562; PMCID: PMC1356486. 42. Liu D, Lu M, Li J, Yang Z, Feng Q, Zhou M, Zhang Z, Shen L. The patterns and timing of recurrence after curative resection for gastric cancer in China. World J Surg Oncol. 2016 Dec 8;14(1):305. doi: 10.1186/s12957-016-1042-y. PMID: 27931221; PMCID: PMC5146887. 43. Mokadem I, Dijksterhuis WPM, van Putten M, Heuthorst L, de Vos-Geelen JM, Haj Mohammad N, Nieuwenhuijzen GAP, van Laarhoven HWM, Verhoeven RHA. Recurrence after preoperative chemotherapy and surgery for gastric adenocarcinoma: a multicenter study. Gastric Cancer. 2019 Nov;22(6):1263-1273. doi: 10.1007/s10120-019-00956-6. Epub 2019 Apr 4. PMID: 30949777; PMCID: PMC6811385. 44. Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, Omae M, Kubota M, Ishiyama A, Hirasawa T, Chino A, Inamori M, Yamamoto Y, Yamamoto N, Tsuchida T, Tamegai Y, Nakajima A, Hoshino E, Igarashi M. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy. 2012 Feb;44(2):122-7. doi: 10.1055/s-0031-1291486. Epub 2012 Jan 23. PMID: 22271022. 45. Choi IJ, Lee JH, Kim YI, Kim CG, Cho SJ, Lee JY, Ryu KW, Nam BH, Kook MC, Kim YW. Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. Gastrointest Endosc. 2015 Feb;81(2):333-41.e1. doi: 10.1016/j.gie.2014.07.047. Epub 2014 Oct 3. PMID: 25281498. 46. Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S. Recurrence after curative resection of early gastric cancer. Ann Surg Oncol. 2010 Feb;17(2):448-54. doi: 10.1245/s10434-009-0772-2. Epub 2009 Nov 11. PMID: 19904573. 47. Hundahl SA, Stemmermann GN, Oishi A. Racial factors cannot explain superior Japanese outcomes in stomach cancer. Arch Surg. 1996 Feb;131(2):170-5. doi: 10.1001/archsurg.1996.01430140060016. PMID: 8611074. 48. Bria E, De Manzoni G, Beghelli S, Tomezzoli A, Barbi S, Di Gregorio C, Scardoni M, Amato E, Frizziero M, Sperduti I, Corbo V, Brunelli M, Bersani S, Tortora G, Scarpa A. A clinical-biological risk stratification model for resected gastric cancer: prognostic impact of Her2, Fhit, and APC expression status. Ann Oncol. 2013 Mar;24(3):693-701. doi: 10.1093/annonc/mds506. Epub 2012 Nov 6. PMID: 23131390. 49. Verdecchia A, Mariotto A, Gatta G, Bustamante-Teixeira MT, Ajiki W. Comparison of stomach cancer incidence and survival in four continents. Eur J Cancer. 2003 Jul;39(11):1603-9. doi: 10.1016/s0959-8049(03)00360-5. PMID: 12855268. 50. Smyth EC, Fassan M, Cunningham D, Allum WH, Okines AF, Lampis A, Hahne JC, Rugge M, Peckitt C, Nankivell M, Langley R, Ghidini M, Braconi C, Wotherspoon A, Grabsch HI, Valeri N. Effect of Pathologic Tumor Response and Nodal Status on Survival in the Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial. J Clin Oncol. 2016 Aug 10;34(23):2721-7. doi: 10.1200/JCO.2015.65.7692. Epub 2016 Jun 13. PMID: 27298411; PMCID: PMC5019747. 51. Stark AP, Ikoma N, Chiang YJ, Estrella JS, Das P, Minsky BD, Blum MM, Ajani JA, Mansfield P, Badgwell BD. Characteristics and Survival of Gastric Cancer Patients with Pathologic Complete Response to Preoperative Therapy. Ann Surg Oncol. 2019 Oct;26(11):3602-3610. doi: 10.1245/s10434-019-07638-8. Epub 2019 Jul 26. PMID: 31350645. 52. Markar SR, Karthikesalingam A, Jackson D, Hanna GB. Long-term survival after gastrectomy for cancer in randomized, controlled oncological trials: comparison between West and East. Ann Surg Oncol. 2013 Jul;20(7):2328-38. doi: 10.1245/s10434-012-2862-9. Epub 2013 Jan 24. PMID: 23340695.

Gastric Cancer

What is Gastric Cancer?

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More information on gastric cancer:

National Cancer Institute

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Gastric Cancer Foundation

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Facing cancer is hard. But you are not alone - we’re right here with you.

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