Stomach Cancer

Gastric or stomach cancer is a significant health problem worldwide. The high mortality associated with this malignancy is due to the late stage of stomach cancer when it is often diagnosed and the lack of effective treatments. Although diagnostic techniques and stomach cancer surgery techniques have improved, the mortality rate remains high. Early stomach cancer without lymph node metastasis is highly curable, whereas advanced-stage stomach cancer is associated with a poor prognosis.

There has been a continuing decline in the incidence and death rate from stomach cancer in the US over the past 50 years. Presently, an estimated 13,500 people die annually from stomach cancer in the US, which translates to approximately six deaths per 100,000 cases. In the US, stomach cancer is the thirteenth most prevalent malignancy and ranks eighth in terms of cancer-related deaths. Worldwide, stomach cancer is the second most common cause of cancer-related deaths, surpassed only by lung cancer.

While there has been a decrease in the incidence of distal stomach cancer, proximal stomach cancer incidence has increased and carries a poor prognosis despite surgical resection. Stomach cancer ranks in the top five causes of cancer-related deaths for US minorities.

The incidence of stomach cancer is highest in Japan, Chile, and Costa Rica. Nordic countries, such as Scandinavia, have shown an increased prevalence in recent decades with an incidence rate two to three times that found in the US. With the highest incidence rates of stomach cancer in Japan, officials have implemented aggressive screening programs that have led to earlier diagnosis, improved surgical outcomes, and increased survival.

Males have a greater incidence of stomach cancer than females; no country shows a greater incidence of women over men developing this disease. Black Americans, Native Americans, and Hispanics are twice as likely to develop stomach cancer as whites in the US. The average age of onset is during the age range of 50 to 80.

Several conditions are strongly linked with the development of stomach cancer including dietary intake, infections, socioeconomic class, and prior stomach surgery for benign peptic ulcer disease. Other factors associated with an increased risk of stomach cancer include patients with blood group A, those with a history of pernicious anemia which is associated with acholorhydria, and those with atrophic gastritis. Cigarette smoking in combination with alcohol intake also has been proven to place one at a higher risk for stomach cancer.

Dietary intake has been one of the most widely studied risk factors for the development of stomach cancer. N-nitroso-compounds found in smoked, pickled, preserved, and cured foods all have been implicated as contributing links to the development of this disease. Low socioeconomic class has been reported to be a risk factor in the development of stomach cancer but no specific link has been identified.