To determine the stage of cancer, doctors rely on an international system called “TNM”. A stomach cancer can then be at stage 0, 1, 2, 3 or 4 at the time of screening, depending on its degree of extension.
In France, about 6,500 new cases of stomach cancer are diagnosed and 4,500 people die every year, says the National Cancer Institute. However, this cancer is in sharp decline thirty years in France, now ranking 13th among the most common cancers, reports the French National Society of Gastro-Enterology (SNFGE). Like all cancers, that of the stomach is classified according to its stage, according to its extent in the body.
“To determine the stage of cancer, doctors rely on an international staging systemthe system TNM (used for Tumor, NOTodes, Metastasis, which means, tumor, lymph nodes, metastases)“, explains Professor Frédérique Peschaud, visceral and digestive surgeon. Doctors take into account the depth of the tumor in the different layers of the stomach as well as its possible extension to neighboring organs (which corresponds to the letter T), whether or not the lymph nodes have been affected by cancerous cells (which corresponds to the letter NOT) and the presence or absence of metastases in more distant parts of the body (which corresponds to the letter M). Depending on these elements, the stage of the cancer is defined. Stomach cancer can be stage 0, 1, 2, 3 or 4 (Or I, II, III or IV because Roman numerals are commonly used):
- stage 0 which corresponds to a tumor called in situ (localized)
- stage 1 which corresponds to a single tumor of small size
- stage 2 which corresponds to a larger local volume
- stage 3 which corresponds to an invasion of the lymph nodes or surrounding tissues
- stage 4 which corresponds to a wider extension in the organism in the form of metastases.
What is stage 1 stomach cancer?
Stage I or 1 cancer is the least advanced stage and the easiest to treat. It corresponds to a small tumor that is in the innermost layer of the stomach, without lymph node invasion.
What is stage 2 stomach cancer?
Stage 2 (II) corresponds to a cancer of intermediate severity. It means that the tumor has grown through the walls of the stomach.
What is stage 3 stomach cancer?
Stage 3 (III) corresponds to a tumor that has spread to the lymph nodes.
What is stage 4 stomach cancer?
Stage 4 (IV) is the most difficult stage to treat because the patient has distant metastases, in other words to other parts of the body such as the lungs, bones, peritoneum… metastatic stomach cancer.
What is the life expectancy according to the stage?
“Life expectancy depends on the stage of the disease. But, survival statistics are general estimates that need to be interpreted with caution.“, confided to us our visceral and digestive surgeon. They do not make it possible to predict the survival of a particular patient. We do not have specific French statistics. According to the Canadian Cancer Society :
- If the cancer is present only in the stomach (localized), the 5-year survival is 69%
- If the cancer has invaded the lymph nodes around the stomach (regional), the 5-year survival is 31%
- If the cancer has spread to other parts of the body (metastases), the 5-year survival is 5%
Which treatment according to the stage?
The choice of treatments depends on the characteristics of the cancer : the place where it is located, its histological type, i.e. the type of cells involved, its stage, i.e. its degree of extension, and its grade, i.e. i.e. its degree of aggressiveness. The choice of treatments is subject to multidisciplinary consultation and is determined in agreement with the patient. For example :
→ Treatment by endoscopy or surgery alone may be offered if the cancer is at an early stage and that it is limited to the stomach lining
→ The surgery alone is the reference treatment for cancer a so-called localized stage (which has reached the submucosa or the muscularis and no lymph nodes are affected). Chemotherapy, performed before and after surgery, may be offered
→ Surgery, in combination with chemotherapy before and after the intervention is the gold standard treatment for cancer a locally advanced stage (the tumor has spread into the stomach wall and may have invaded neighboring or adjacent organs). Radiotherapy associated with chemotherapy performed after surgery (postoperative radiochemotherapy) may be proposed after discussion in the RCP.
→ Chemotherapy is the reference treatment for cancer a metastatic stage (it has invaded other organs in the form of one or more metastases). Sometimes surgery may be offered before chemotherapy.
Thanks to Pr Frédérique Peschaud, visceral and digestive surgeon.
- Stomach cancer (gastric cancer) – Learned Society for Diseases and Cancers of the Digestive System
- National Digestive Oncology Thesaurus
- Canadian Cancer Society