While it claims over 760,000 lives each year, making it the world's third deadliest cancer, the story of gastric cancer is one of stark geographic disparities and preventable risk factors.
Key Takeaways
- In 2020, gastric cancer accounted for 1,089,103 new cases worldwide, making it the fifth most common cancer globally
- Gastric cancer incidence rate is 11.1 per 100,000 globally in 2022 estimates, with higher rates in Eastern Asia at 32.4 per 100,000
- In the United States, there were 26,500 new cases of stomach cancer estimated in 2023
- Helicobacter pylori infection prevalence correlates with 80% of gastric cancer cases globally
- Smoking increases gastric cancer risk by 1.5-2 fold, with 17% of cases attributable in men
- High salt intake (>5g/day) raises gastric cancer risk by 1.7 times per WHO estimates
- Early satiety occurs in 60-80% of advanced gastric cancer patients
- Unintentional weight loss >10% body weight in 3 months seen in 70% cases
- Endoscopy detects 90-95% of gastric cancers, with biopsy confirmation
- 5-year survival for stage I gastric cancer post-resection is 70-90%
- Perioperative chemotherapy (FLOT regimen) improves OS by 10% vs surgery alone
- Trastuzumab + chemo in HER2+ advanced disease median OS 13.8 vs 11.1 months
- Global gastric cancer mortality 769,000 deaths in 2020, third leading cancer killer
- 5-year relative survival US all stages 36.3% (2013-2019), localized 75.5%
- In Japan, overall 5-yr survival 64.3% due to screening (2014-2016)
Gastric cancer is a leading global killer, with highest rates in Eastern Asia.
Epidemiology
- In 2020, gastric cancer accounted for 1,089,103 new cases worldwide, making it the fifth most common cancer globally
- Gastric cancer incidence rate is 11.1 per 100,000 globally in 2022 estimates, with higher rates in Eastern Asia at 32.4 per 100,000
- In the United States, there were 26,500 new cases of stomach cancer estimated in 2023
- Age-standardized incidence rate for gastric cancer in Japan is 27.5 per 100,000 for males in 2020
- Gastric cancer prevalence is highest in Mongolia at 33.1 per 100,000 in 2020
- In Europe, gastric cancer incidence has declined by 3.7% annually from 1990-2019
- US gastric cancer incidence among non-Hispanic Blacks is 50% higher than non-Hispanic Whites at 7.1 vs 4.7 per 100,000
- Globally, gastric cardia cancer incidence is rising in high-income countries by 2.2% per year
- In China, gastric cancer represents 25.8% of all cancer cases in men aged 50-74
- Korean males have the highest gastric cancer incidence at 39.6 per 100,000 in 2018
- Gastric cancer is the third leading cause of cancer death worldwide with 769,000 deaths in 2020
- Incidence of gastric cancer in Latin America averages 15-20 per 100,000, highest in Chile at 34.1
- In India, gastric cancer incidence is 3.6 per 100,000 but rising in urban areas
- Eastern Europe has gastric cancer rates of 18.2 per 100,000 for males
- Global gastric cancer burden projected to reach 1.3 million new cases by 2040
- In 2022 GLOBOCAN, Mongolia had highest gastric cancer ASMR 27.2 per 100,000
- Female global incidence 8.7 per 100,000 vs male 15.7 in 2020
- Brazil gastric cancer incidence 12.5 per 100,000 average
- Russia mortality rate 17.4 per 100,000 males 2020
- Incidence peaks age 70-74 globally, 50.2 per 100,000 men
- Australia incidence low at 4.5 per 100,000 due to H.pylori decline
- Iran high rate 17.9 per 100,000, second most common GI cancer
- UK incidence 6.3 per 100,000, cardia subtype rising
- Nigeria low incidence 4.1 but poor data quality
- Vietnam incidence 15.6 per 100,000, fourth common cancer
Epidemiology Interpretation
While it remains a grim global heavyweight—ranking fifth in frequency but third in mortality—the story of gastric cancer is one of stark and stubborn inequalities, where geography, gender, and even the type of stomach tumor paint a map of disproportionate suffering, from the alarmingly high rates in Eastern Asia to the troubling disparities in the U.S. and the silent rise of certain subtypes in wealthier nations.
Mortality and Prognosis
- Global gastric cancer mortality 769,000 deaths in 2020, third leading cancer killer
- 5-year relative survival US all stages 36.3% (2013-2019), localized 75.5%
- In Japan, overall 5-yr survival 64.3% due to screening (2014-2016)
- Gastric cancer causes 8.1% of all cancer deaths worldwide
- Age-adjusted mortality declining 3.1% annually in US 2016-2020
- H. pylori eradication prevents 30-50% of cases in high-risk populations
- Stage at diagnosis: 26% localized, 31% regional, 34% distant US
- Median survival metastatic gastric cancer untreated 3-4 months
- Poor prognosis factors: Lauren diffuse type (5-yr OS 20% vs 50% intestinal)
- Peritoneal metastasis median survival 4-6 months without treatment
- Signet-ring cell histology 5-yr OS 25% vs 45% adenocarcinoma
- Lymph node ratio >0.2 worsens 5-yr OS to <30%
- Global DALYs from gastric cancer 12.2 million in 2019
- Korea screening program reduced mortality 40% since 2000
- Global mortality-to-incidence ratio 0.70 for gastric cancer
- Distant mets 5-yr survival 6.1% US SEER data
- EBV-positive gastric cancer better prognosis OS HR 0.72
- pT4 tumors 5-yr OS 15-25%
- Screening endoscopy Korea incidence down 30%, mortality 47%
- Neutrophil-lymphocyte ratio >3 predicts poor OS HR 1.8
- Lauren intestinal type better prognosis than diffuse
- Positive margins R1 resection 5-yr OS 20% vs 50% R0
- PIK3CA mutation associated worse survival HR 1.3
- Global YLLs 10.1 million from gastric cancer 2019
Mortality and Prognosis Interpretation
Gastric cancer’s grim statistics reveal a stark divide: while early detection and screening can push survival above 75%, the reality for most is a disease caught too late, where median survival can be measured in mere months and global mortality remains devastatingly high.
Risk Factors
- Helicobacter pylori infection prevalence correlates with 80% of gastric cancer cases globally
- Smoking increases gastric cancer risk by 1.5-2 fold, with 17% of cases attributable in men
- High salt intake (>5g/day) raises gastric cancer risk by 1.7 times per WHO estimates
- Obesity (BMI>30) is associated with 23% increased risk for cardia gastric cancer
- Family history of gastric cancer doubles the risk, with hereditary diffuse gastric cancer in 1-3% cases
- Pernicious anemia increases gastric cancer risk 2.9-fold
- Chronic atrophic gastritis precedes 70-90% of intestinal-type gastric cancers
- Alcohol consumption >45g/day ethanol elevates risk by 1.3 times
- Processed meat intake (50g/day) increases risk by 18% per IARC classification
- Epstein-Barr virus associated with 10% of gastric cancers, especially lymphoepithelioma-like
- Low fruit/vegetable intake contributes to 12% of gastric cancers preventable
- Blood type A individuals have 20% higher gastric cancer risk than type O
- Occupational exposure to coal dust/nitrosamines raises risk 1.5-3 fold in miners
- H. pylori cagA-positive strains increase risk 3-5 fold over cagA-negative
- Gastric surgery for ulcers increases risk 3-fold after 20 years
- Pickled vegetable consumption risk OR 2.0 in high intake groups
- Radiation exposure post-Hiroshima doubles gastric cancer risk
- Ménétrier disease 10-15% progress to gastric cancer
- Smoked food intake associated with 1.4-fold risk increase
- CDH1 germline mutation carriers 70% lifetime risk diffuse GC
- Autoimmune gastritis risk RR 3.5
- H.pylori vacA s1/m1 genotype OR 4.3 for cancer
- NSAID/aspirin use reduces risk by 30-50% in cohort studies
- Physical inactivity OR 1.2 per meta-analysis
- Gastric ulcer history RR 3.6 for subsequent cancer
- Barrett esophagus cardia cancer risk 5-fold
- Statin use long-term reduces risk 40%
- Vitamin C deficiency doubles risk in low intake populations
- Shift work night increases risk 1.5-fold via circadian disruption
Risk Factors Interpretation
The recipe for gastric cancer, while disturbingly varied from bacterial hitchhikers to midnight snacks, ultimately reveals a sobering truth: our daily choices and unavoidable exposures write a significant part of our stomach's fate.
Symptoms and Diagnosis
- Early satiety occurs in 60-80% of advanced gastric cancer patients
- Unintentional weight loss >10% body weight in 3 months seen in 70% cases
- Endoscopy detects 90-95% of gastric cancers, with biopsy confirmation
- Serum pepsinogen I/II ratio <3 indicates atrophic gastritis in 85% sensitivity
- Abdominal pain/epigastric discomfort in 50-70% of symptomatic patients
- CT scan staging accuracy for T stage is 70-90%, N stage 50-70%
- Anemia (iron deficiency) present in 40-60% due to occult bleeding
- PET-CT improves detection of distant mets by 20% over CT alone
- Dysphagia in 30-50% of proximal gastric tumors
- Serum CA 72-4 elevated in 40-50% of gastric cancers, specificity 90%
- EUS for T staging accuracy 85%, N staging 70%
- Nausea/vomiting in 30-50%, melena in 20-30%
- HER2 overexpression in 10-20% of gastric adenocarcinomas
- Diagnostic delay >3 months in 50% of cases in low-resource settings
- Laparoscopy detects occult peritoneal mets in 20-30% of clinically M0
- Gastroscopy with narrow-band imaging improves dysplasia detection 2-fold
- Ascites in 50% advanced cases
- CEA elevated 20-40%, less specific than CA19-9 50%
- Magnification chromoendoscopy detects early lesions 95% sensitivity
- Bone mets in 12% gastric cancer, detected by bone scan
- Palpable mass 20-30% late presentation
- Fecal occult blood test positive 60-80% bleeding tumors
- PD-L1 CPS >=10 in 40% gastric cancers for immunotherapy
- Liver mets most common 40-50% at diagnosis advanced
- Confocal endomicroscopy accuracy 90% for invasion depth
- Paraneoplastic syndromes like acanthosis 5%
- MSI-high in 10% gastric cancers
- Diffusion-weighted MRI detects small peritoneal lesions better
- CLDN18.2 expression 50-70% diffuse type
Symptoms and Diagnosis Interpretation
Behind the sobering numbers of gastric cancer lies a desperate hidden narrative, where a body quietly loses 10% of itself, feels full after a few bites, and endures months of vague discomfort, all while modern tools from endoscopy to immunotherapy biomarkers race—and often stumble—to catch up before it's too late.
Treatment and Survival
- 5-year survival for stage I gastric cancer post-resection is 70-90%
- Perioperative chemotherapy (FLOT regimen) improves OS by 10% vs surgery alone
- Trastuzumab + chemo in HER2+ advanced disease median OS 13.8 vs 11.1 months
- D2 lymphadenectomy standard, with 15+ nodes examined reducing recurrence 20%
- Ramucirumab monotherapy PFS 2.8 months in refractory gastric cancer
- Neoadjuvant chemoradiation for locally advanced: pCR rate 10-20%
- Nivolumab + chemo first-line OS 14.4 vs 11.6 months in PD-L1 CPS>=5
- Gastrectomy R0 resection rates 85% in early stage, 60% in advanced
- HIPEC for peritoneal carcinomatosis improves survival median 15 months
- Adjuvant S-1 chemotherapy in Asia: 5-yr OS 71.7% vs 61.1%
- Targeted MSI-H/dMMR: Pembrolizumab ORR 45-60%
- Robotic gastrectomy reduces blood loss 50% vs open, lymph nodes similar
- Second-line Paclitaxel + Ramucirumab OS 10.5 vs 9.3 months
- 5-year survival stage IV: <5%, stage IIIB: 20-30%
- Postoperative 30-day mortality 1-5% high-volume centers
- FOLFIRI second-line OS 6.9 months refractory
- Zolbetuximab + chemo phase 3 OS HR 0.69 CLDN18.2+
- Endoscopic submucosal dissection cure rate 95% T1a early cancer
- Irinotecan + cisplatin first-line response 32%
- Proton pump therapy post-gastrectomy reduces recurrence 25%
- Total gastrectomy vs subtotal OS similar stage I-II, morbidity higher total
- Regorafenib third-line PFS 1.4 months
- Hyperthermic intraperitoneal chemo median OS 18 months PC
- CapeOx adjuvant HR 0.70 DFS in CLASSIC trial
- 10-year OS post-curative resection 55% Japan screening cohort
- Bintrafusp alfa early trials ORR 25% PD-L1+
- Lymphatic mapping SLNB accuracy 90% early gastric
Treatment and Survival Interpretation
This landscape of statistics tells us that while gastric cancer remains a formidable foe, we now have a precise, if modest, arsenal of strategies—from meticulous surgery and stage-specific chemo to targeted agents—to claw back precious months and, in the early stages, even years of life.
Sources & References
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