What Is Stage 2 Stomach Cancer

How Can I Prevent Stomach Cancer

Treat stomach infections. If you have ulcers from an H. pylori infection, get treatment. Antibiotics can kill the bacteria, and other drugs will heal the sores in the lining of your stomach to cut your risk of cancer.

Eat healthy. Get more fresh fruits and vegetables on your plate every day. Theyâre high in fiber and in some vitamins that can lower your cancer risk. Avoid very salty, pickled, cured, or smoked foods like hot dogs, processed lunch meats, or smoked cheeses. Keep your weight at a healthy level, too. Being overweight or obese can also raise your risk of the disease.

Donât smoke. Your stomach cancer risk doubles if you use tobacco.

Watch aspirin or NSAID use. If you take daily aspirin to prevent heart problems or NSAID drugs for arthritis, talk to your doctor about how these drugs might affect your stomach.

Show Sources

American Cancer Society: “Can Stomach Cancer Be Found Early,” “Treatment Choices by Type and Stage of Stomach Cancer,” “Chemotherapy for Stomach Cancer,” “Radiation Therapy for Stomach Cancer,” “Targeted Therapies for Stomach Cancer.”

Mayo Clinic: “Stomach Cancer.”

Where Do These Numbers Come From

The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for stomach cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:

• Localized: There is no sign that the cancer has spread outside of the stomach.
• Regional: The cancer has spread outside the stomach to nearby structures or lymph nodes.
• Distant: The cancer has spread to distant parts of the body, such as the liver.

Survival Rates By Disease Extent

The National Cancer Institute utilizes a different approach to survival estimates under its Surveillance, Epidemiology, and End Results Program.

Rather than basing five-year estimates on the disease stage, the SEER program does so based on how extensively the cancer has spread. This is categorized in one of the following three ways.

• Localized: No sign of cancer outside of the lung
• Regional: Cancer that has spread to nearby lymph nodes or structures
• Distant: Cancer that has spread to distant organs

One of the advantages of the SEER system is that it can be applied to both NSCLC and SCLC. On the downside, there is a significant overlap in definitions. For example, stage 1 and stage 2a NSCLC are considered localized, since there is no lymph node involvement. On the other hand, stage 2b NSCLC is considered regional, since lymph nodes are involved. As such, it falls into the same category as stage 3a NSCLC.

Under the SEER classification system, the five-year survival rate for stage 2a lung cancer is 59%, while the five-year survival rate for stage 2b lung cancer is 31.7%.

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The Ajcc Tnm Staging System

The staging system most often used for stomach cancer is the American Joint Committee on Cancer TNM system, which was last updated in 2018.

This system is used to stage all stomach cancers except those starting in the gastroesophageal junction or those that start in the cardia and are growing into the gastroesophageal junction. Those cancers are staged like cancers of the esophagus. Other types of cancer that can start in the stomach, such as gastrointestinal stromal tumors and lymphomas, are staged differently as well.

The TNM system for stomach cancer is based on 3 key pieces of information:

The T category describes the extent of the main tumor, including how far it has grown into the layers of the stomach wall and if it has reached nearby structures or organs.

The 5 layers of the stomach wall include:

• Mucosa: the innermost layer, where nearly all stomach cancers start. The mucosa has 3 parts: epithelial cells, a layer of connective tissue , and a thin layer of muscle .
• Submucosa: a supporting layer under the mucosa
• Muscularis propria: a thick layer of muscle that moves and mixes the stomach contents
• Subserosa
• Serosa: the outer, wrapping layer of the stomach

The N category describes any cancer spread to nearby lymph nodes.

The M category describes any spread to distant parts of the body, such as the liver or lungs.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.

What Questions Should I Ask My Doctor

• Where is the cancer located?
• What stage of cancer do I have? What does this mean for my prognosis?
• What treatments are available to me?
• What are the benefits of this treatment? Potential risks?
• What other treatment options are available?
• How will my cancer diagnosis and treatment impact my everyday life?
• Should I get a second opinion?

A note from Cleveland Clinic

Stomach cancer isnt always preventable, but it may be treatable if caught early. Depending on your cancer diagnosis, your provider may recommend surgery to remove cancer cells or tumors. They may suggest a combination of treatments that can kill or shrink the cancer cells. Ultimately, your prognosis depends on multiple factors you can discuss with your provider. Dont hesitate to ask about treatment options, including their benefits and risks. Seek your providers guidance on what your cancer diagnosis means for you.

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Targeted Drug Therapy Or Immunotherapy

Targeted drug therapy can be used to treat advanced stomach cancer. These drugs attack specific characteristics of the cancer. Some of these are:

• imatinib , for stromal tumors
• ramucirumab , for advanced stomach cancer when other treatments arent effective
• regorafenib , for stromal tumors
• sunitinib , for stromal tumors
• trastuzumab , for HER2-positive tumors

Immunotherapy drugs boost your immune system to help attack cancer.

Pembrolizumab is an immunotherapy drug used to treat stomach cancer that has returned or spread in people who have tried but didnt respond to or stopped responding to two or more types of chemotherapy.

How Is It Diagnosed

Since people with stomach cancer rarely show symptoms in the early stages, the disease is often not diagnosed until its more advanced.

Diagnosing stomach cancer involves receiving a physical exam to check for any abnormalities. A doctor may also look for possible bleeding in the stomach by using a test to check for blood in your stool along with a blood test to look for anemia.

More diagnostic tests for stomach cancer may need to be done if your doctor believes you show signs of the disease. Diagnostic tests specifically look for suspected tumors and other abnormalities in the stomach and esophagus. These tests may include:

• an upper gastrointestinal endoscopy

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Stage Ii Stomach Cancer

Stage II stomach cancers have two sub-stages: A and B. The sub-stage depends on how far into the stomach wall the cancer is and whether it remains in the stomach wall. Some tumors have grown all the way to the outermost layer of the stomach. Some remain in the lining or stomach wall, but cancer cells are in the lymph nodes by the stomach. Others have grown into connective tissue around the stomach or into the cells lining the inside of the abdominal cavity. There may or may not be cancer cells in nearby lymph nodes.

Treatment is similar to stage I. When the cancer is not anywhere outside the stomach, treatment can still be successful. The likelihood of success decreases if cancer is outside the stomach in lymph nodes or other tissues.

Surgery To Ease Your Symptoms

If your stomach cancer has spread beyond your stomach, it may not be possible to remove it using surgery.

However, if your stomach has been significantly affected by cancer it can cause a blockage, which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting and feeling very full after eating.

If your stomach is blocked, there are a few options:

• stenting a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic after being inserted, the stent will be expanded and open up the stomach
• partial or total gastrectomy to remove the blockage and improve your symptoms

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Stage Iii Stomach Cancer

Stage III means stomach cancer has grown outside the stomach. There are three sub-stages: A, B and C. The sub-stage depends on how many lymph nodes have cancer and whether it has spread to organs near the stomach, such as the diaphragm, liver, spleen, pancreas, colon, small intestine, and kidney. However, stage III stomach cancers have not spread to distant lymph nodes or body sites.

The main treatment is still surgery with a combination of chemotherapy and radiation therapy. For people who cant have surgery, doctors will use chemotherapy and radiation therapy as main treatments. Treatment is less likely to be successful at this stage. The five-year survival rate for stomach cancer that has spread outside the stomach is 31%. This means 31% of people with this stage of stomach cancer are still alive five years after diagnosis. This number can change with the sub-stage. In general, IIIA survival rate is higher than this, while IIIC is lower.

Side Effects Of Stomach Cancer Treatments

All cancer treatments can have side effects. Your treatment team will discuss these with you before you start treatment. Talk to your doctor or nurse about any side effects you are experiencing.

Some side effects can be upsetting and difficult, but there is help if you need it. Call Cancer Council Victoria Tel. or email to speak with a caring cancer nurse for support.

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Who Gets Stomach Cancer

An estimated 26,380 people are expected to be diagnosed with stomach cancer in the U.S. in 2022. The number of new cases per 100,000 people in the U.S. has steadily declined in recent decades.

Doctors dont know what causes stomach cancer, but they have identified risk factors that include:

• Gender: Men are more likely to develop stomach cancer.
• Race and ethnicity: In the U.S., the disease is more common among Latinos, Asian/Pacific Islanders and Black people than in white people.
• Age: Stomach cancer rates increase sharply in people older than 50.
• Bacterial infection:H. pylori, a type of bacterial infection of the stomachs inner lining, can lead to inflammation and ulcers. It is found in most stomach cancer patients.
• Diet: Diets high in salted, pickled, fermented, smoked and preserved foods, including processed meats, can increase risk. Diets low in fresh fruit and vegetables also increase risk.
• Smoking
• Family history: Having a parent, sibling or child with stomach cancer increases risk.
• Genetic syndromes: Several inherited genetic defects increase the risk. OHSU offers genetic counseling, testing and risk assessment to help patients identify and manage risk.

What To Do Before Treatment Starts

Before you start your treatment it is recommended you:

• Improve diet and nutrition people with stomach cancer often lose a lot of weight and can become malnourished. Your doctor may refer you to a dietitian for advice on how to slow down the weight loss. This will help improve your strength, reduce side effects, and may mean the treatment works better.
• Stop smoking if you smoke, aim to quit before starting treatment. If you keep smoking, you may not respond as well to treatment. For support, see your doctor or call Quit
• Begin or continue an exercise program exercise will help build up your strength for recovery. Talk to your doctor or physiotherapist about the right type of exercise for you.

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Surgery To Help Control The Symptoms Of Stomach Cancer

You may need surgery to relieve a blockage in the stomach. This helps food pass through your stomach more easily.

The aim of this surgery is to help improve your symptoms, not to cure the cancer.

Targeted cancer medicines aim to stop the cancer from growing.

You may have them with chemotherapy to treat advanced stomach cancer.

How Do Doctors Find Out Your Stage

There are different ways to find out your stage. Your doctor might use:

• clinical staging before treatment and if you don’t have surgery
• pathological staging if you do have surgery
• post neoadjuvant staging if you have chemotherapy before surgery

Clinical staging means the doctor stages you after examining you and looking at test and scan results. Doctors use clinical staging to plan your treatment. Its also the best way to stage people who arent having surgery. You might see your clinical stage written as cTNM.

Pathological staging means the doctor stages you after examining the tissue that the surgeon removes during an operation. This is also called surgical staging. The doctors combine your clinical stage results with the surgical results. Pathological staging is generally a more precise way to find out how far your cancer has spread. Your pathological stage might be different to your clinical stage. You might see your pathological stage written as pTNM.

Post neoadjuvant staging means you have had chemotherapy before surgery and the doctor stages you again after surgery. You might see your post neoadjuvant stage written as ypTNM.

For stomach cancer, the clinical, pathological, and post neoadjuvant staging are all different. In this section we describe the pathological and clinical stages.

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How Can You Detect Stomach Cancer Early

Be sure to contact your medical provider if you feel like something is not right. There are screening tests for stomach cancer when people are at risk for or are experiencing signs and symptoms. Diagnostic evaluations for gastric cancer include:

• Complete medical history and physical exam
• Upper gastrointestinal endoscopy to view the esophagus, stomach and small intestine after sedation. A small, flexible tube is inserted into the mouth with a tiny camera on the end that allows the doctor to see inside your stomach.
• Biopsy of stomach tissue to be evaluated under a microscope
• CT scan to visualize organs during X-ray
• Endoscopic ultrasound to diagnose and treat stomach cancer at the same time by visualizing organs and nearby blood vessels
• Positron emission tomography scan to illuminate cancer cells. A radioactive sugar tracer is used because cancer cells use more sugar than healthy cells and the tracer illuminates the cancer cells.

Very Early Stage Cancers

These cancers are still only in the inner lining layer of the stomach and have not grown into deeper layers of the stomach wall.

Very early stage cancers can typically be treated by surgery, with either subtotal gastrectomy or total gastrectomy . Nearby lymph nodes are removed as well.

Some small stage 0 cancers can be treated by endoscopic resection. In this procedure the cancer and some layers of the stomach wall are removed through an endoscope passed down the throat. This procedure is done more often in countries like Japan, where stomach cancer is often detected early during screening. It is rare to find stomach cancer so early in the United States, so this treatment has not been used as often here. If it is done, it should be at a cancer center that has experience with this technique.

If the results of surgery show that all of the cancer has been removed, the person can usually be followed closely, without needing any further treatment. If its not clear that all of the cancer has been removed, chemotherapy and radiation are likely to be recommended. Another option might be a more extensive surgery to remove the cancer.

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Survival Rates Are Based On Research

Survival rates are based on studies with a large number of patients, so an averaged survival rate cannot predict any one person’s prognosis.

A five-year-survival rate of 70% may sound dismal, but the truth is that you very well may live a whole lot longer than five years. Some people are even cured of their stomach cancer. This is most likely to occur when the cancer is found at an early stage. Unfortunately, stomach cancer is often not found until it’s more advanced.

Survival numbers also vary according to cancer stage. For example, a large retrospective multicenter Italian study of patients with early gastric cancer published in 2006 reported long-term survival after surgical resection of 92%, 82%, 73%, and 27%, respectively, for patients with 0, 1 to 3, 4 to 6, and > 6 positive nodes. In recent years, the survival of gastric cancer has improved mainly for stage I-III.

The five-year survival rate for stomach cancer is simply a statisticit’s meant to guide you and your healthcare provider so you have an idea of what to expect, but it’s not supposed to be taken as a hard-and-fast rule.

Stage 4 Stomach Cancer Timeline

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