PROGNOSTIC FACTORS FOR GASTRIC-CANCER INFLUENCING CLINICAL-PRACTICE

Despite a slow decline in the incidence of gastric cancer over the las t 90 years, we can still expect to see over 100,000 patients die of th is disease each decade in England and Wales. The 5-year survival rate has not improved during this century, which is largely due to the stag e at diagnosis being unchanged. There are a number of prognostic deter minants in gastric cancer which have clinical relevance. Age is an imp ortant determinant; patients under 40 years commonly have more advance d diffuse lesions than older patients so that a higher index of suspic ion needs to be maintained in younger patients with persistent symptom s. Conflicting reports make it unclear wt;ether the duration of sympto ms bears any relationship to tumor stage, but there is some evidence t hat actively shortening the symptom duration by early investigation ca n have a beneficial effect in the proportion of patients diagnosed wit h early cancers. The site of the tumor is important; unfortunately, th e proportion of patients with cardia lesions is increasing and this ha s had the effect of reducing the overall survival. Tumor size should n ot play a part in the decision to resect a lesion as most studies show no clear relationship between tumor size and stage. Tumor stage is th e most important prognostic determinant and efforts to increase the pr oportion of stage I cancers presenting for surgery can be shown to alt er the natural history of the disease, by diagnosing it when it is sti ll surgically curable.