The staging of stomach cancer is largely derived from the surgical findings and the histological examination of the resected specimen. The exact nomenclature of staging is not relevant to the lay person but it is clear that if there is metastatic disease (i.e. secondaries outside the stomach) obvious on the abdominal scan, then the patient is incurable and a total removal of the stomach is not in the patient’s interest in that the disease has already ‘bolted’.
Where the disease is operable (i.e the disease is apparently confined within the stomach) then the extent of the disease by histology (i.e. microscopic exam of the resected specimen ) is the key to prognosis (the future chance of survival).
The first point of interest is as to whether the serosa (the membrane lining the outside of the stomach) has been breached by tumour, there being a 50% five year survival in those whose disease has not breached this lining membrane and only 15% in those in whom it has. The second histological point of interest is the status of the regional lymph nodes.
In patients whose disease has not reached to the regional lymph nodes, the five year survival approximates to 31%, whereas in patients whose nodes are involved microscopically by cancer, the overall likelihood of surviving five years is only 17%.
Therefore, without going into lengthy staging subcategories, the outlook is determined by whether the disease is ostensibly confined to the stomach on pre-operative scanning and then on the histological examination of the resected stomach specimen with particular regard to the serosa and the regional lymph nodes.
