Gastric Cancer Recurrence
Although the prognosis of stomach cancer in early stages is measured to be satisfactory, cases of gastric cancer recurrence are found to occur in few patients. This recurrence may occur after the curative resection of this medical condition. Owing to the advancement in the procedures of gastric cancer diagnosis (double contrast roentgenography and endoscopy), the detection rate of stomach cancer in initial stages has been elevated. The prognosis of the patients with stomach cancer in the initial stages is very favorable after remedial gastrectonomy performed with the dissection of the infected lymph nodes.
The five to ten years survival rate for such patients is more than 90 percent. However, it has been revealed that gastric cancer recurrence can be observed among the patients with early signs of this disease or patients who have undergone curative gastric resection. Some reports revealed that the metastasis in the lymph nodes and the depth of invasion are the major risk factors that result into advanced gastric cancer recurrence. However, very few incidences of early stage gastric cancer has been evaluated which shows relatively low incidence of recurrence patterns, recurrence rate and the prognostic features of recurrence. This relative difference in these incidences may be due to the use of the curative resection in the early gastric cancer (EGC).
Risk factors of gastric cancer recurrence:
The recurrence rate of stomach cancer in submucosal condition is significantly greater than in the mucosal condition. This rate was also higher among the patients with lymph node metastasis than the patients without the involvement of the lymph nodes. When the lymph node condition due to the cancer is subdivided as per the N stage, the five year survival rate for the patient at the NO, N1, N2 and N3 stages were around 99, 96, 72 and 0 percent respectively. Gender, age, size of the tumor, histological type and the macroscopic type found to be unrelated to the incidence of gastric cancer recurrence.
Multivariate examinations that were carried out with the help of significant features identified by invariable examination (metastasis of lymph node, depth of incursion), confirmed that lymph node metastasis was the major prognostic cause for the recurrence of this cancer.
Patter and location of gastric cancer recurrence:
Among twenty one gastric cancer cases, four (19 percent) were locoregional recurrence cases, two (around 9.5 percent) were peritoneal dissemination cases, nine (43 percent) were due to the cancer spread at distant levels and six (29 percent) includes mixed form of recurrence.
Recurrence at locoregional level:
During the time of gastric cancer surgery, among four local lymph node recurrence cases, two included perigastric lymph node metastasis. The gap between the primary surgery and recurrence were 1.5 year. In N0 cancer it was more than one year (18.5 months), and for N1 cancers, it was around 7 to 18 months.
Recurrence at peritoneal level:
The abdominal computed tomography is used to detect the peritoneal recurrences; these are cytological examinations. In this case, the lymph node metastases can be found during the primary surgery. The gap between the primary surgery and incidence of recurrence was found to be around 3 to 10 months.
Recurrence at distant level:
Among the nine incidences of distant metastasis, two were cervical and liver lymph node metastases while seven were due to the multiple metastases. These incidences involve two stages of N0, three stages of N1 and N2 and one stage of N3 while performing the primary surgery.
Incidence of mixed recurrence:
Among the six incidences of mixed recurrences, one was peritoneal type of distant recurrence, one was loco-peritoneal form of recurrence and four were loco-distant form of recurrences. This incidence included three stages of N0, two stages of N1 and on stage of N2 during the primary surgery.
Prognosis of gastric cancer:
The average survival rate after the gastric cancer recurrence is around 4. 4 months. The treatments options for the recurrence were chemotherapy for some cases while conservative management for others. The average survival rate of gastric cancer patients with chemotherapy after recurrence was 5.8 months while for the patients who has undergone conservative management after recurrence was 3.1 months. This is the approximate data and not the exact one.
In the five incidences of gastric cancers (metachronous) in the remnant stomach, sufficient margins without tumor and no simultaneous cancer occurrence were found at the time of primary surgery. Two cases of mucosal and three cases of submucosal tumors were found without the development of tumors in the lymph nodes.
The gastric cancer recurrence for each patient may vary as it depends on the invasion depth of the tumors as well as the metastasis in the lymph nodes.