A 5-Year Look at Diagnosis and Treatment of Gastric Cancer—The 2nd Highest Cancer Incidence in Korea

Ranking 2nd (14.9%) in domestic cancer incidence for 2010, gastric cancer is the most common cancer, except for thyroid cancer, in Korea. (Source: National Cancer Registration Statistics 2010, Division of Cancer Registration & Surveillance) The SNU Hospital recently released a report on 5-year trends in diagnosis and treatment of gastric cancer. 

  Based on its 21-year gastric cancer statistics and database for 1986~2009 plus mortality data 2010, the SNU Cancer Hospital's Gastric Cancer Center (Director Yang, Han-Kwang) conducted a comparative analysis of the SNU Hospital's diagnosis and treatment of gastric cancer patients between 2006 and 2011. This year, its findings were unveiled at the 85th Meeting of the Japanese Gastric Cancer Association and the 34th Meeting of the Korean Gastric Cancer Association.

  Compared with 2006, gastric cancer diagnosis via health check-up increased in 2011 with a growth of stage Ⅰ gastric cancer cases. Such rise in early gastric cancer patients resulted in expansion of non-invasive endoscopic surgery, laparoscopic surgery, and pylorus-preserving gastrectomy. It also proved groundless to say that young patients rather than elderly ones have a bad prognosis for gastric cancer due to a quicker spread of cancer cells. 

  Gastric cancer doesn't reveal any specific symptom until it seriously progresses. Of those gastric cancer patients treated at the SNU Hospital in 2011, 65% were diagnosed as gastric cancer via health check-up although they showed no particular symptom. Of those patients with specific symptoms, more than half (76%) complained of uncomfortable feelings in the pit of the stomach which was similar to gastritis. Thus, gastroscopy has greater significance for early detection of gastric cancer to which self-symptom diagnosis is almost inapplicable.

 The ratio of gastric cancer diagnosis via health check-up significantly jumped from 51.5% in 2006 to 71% in 2011. In particular, the share of gastric cancer diagnosis via health check-up rose from 52.7% in 2006 to 72.3% in 2011 among those in their 40s or above who were eligible for national medical screening. As of 2011, stage Ⅰ gastric cancer accounted for about 79.9% of gastric cancer diagnoses via health check-up, thereby illustrating the effectiveness of national medical screening. The ratio of stage Ⅰ gastric cancer in gastric cancer cases also grew from 60.5% in 2006 to 70.6% to 2011. In other words, the survival rate of gastric cancer patients also went up. 

  A growth of early gastric cancer notably expanded minimally invasive therapy like laparoscopic/robotic surgery or endoscopic resection. In 2006, surgery and endoscopic resection respectively accounted for 90% and 10% of gastric cancer treatment. In 2011, the ratio of endoscopic resection rose to about 19%. In surgical types, laparoscopic/robotic surgery grabbed 10% of gastric cancer surgeries in 2006, but the ratio jumped to 48% in 2011. Although the ratio fell from 8.5% in 2006 to 4.1% in 2011, there were still stage IV gastric cancer patients who couldn't benefit from curative treatment as a result of their belated health check-up.     

  “To detect gastric cancer in early stage, those aged 40 or above should have gastroscopy at least once every 1~2 years regardless of particular symptoms. If you have a family history of gastric cancer, you should receive medical examination no matter how young you are,” said YANG, Han-Kwang, Prof. of Surgery. 

  Gastric cancer incidence gradually declined among those in their 20s~30s ineligible for national medical screening. According to the SNU Hospital's data, they accounted for 12% of total gastric cancer cases for 1986~2000, but such ratio dropped to 5% in 2011.    

  For those in their 20s, gastric cancer diagnosis via health check-up also grew from 25% in 2006 to 37.5% in 2011, thereby demonstrating that young people show greater interest in gastric cancer and gradually receive gastroscopy via occupational health check-up. The ratio of stage Ⅰ gastric cancer stood at 67% among those in their 40s or above and 53% those in their 20s~30s, and the proportion of stage Ⅲ or stage Ⅳ gastric cancer—to which surgical resection is inapplicable—remained at 21% among those in their 40s and 29% among those in their 20s~30s. The share of stage Ⅰ gastric cancer rose among those in 20s~30s, but it was below the level of those in their 40s eligible for national medical screening, thereby implying the significance of health check-up. 

  Youth can have a poor prognosis for gastric cancer if gastric cancer progresses to some extent due to failure of early detection. But, it is groundless that cancer spreads in proportion to youth and poor therapeutic effects are found in youth. 

  According to the SNU Hospital's data, there were few gaps in the 5-year survival rate among age groups. The 5-year survival rate for stage Ⅰ gastric cancer was 95.1%, 94.6%, and 89.8% among those in their 20s, 30s, and 40s separately. In stage Ⅱ gastric cancer, such ratio stood at 76.3%, 69.3%, 73.5% among those in their 20s, 30s, and 40s respectively. In stage Ⅲ gastric cancer, it remained at 31.5%, 31.2%, and 38.6% among those in their 20s, 30s, and 40s respectively.    

   “Diagnosis of gastric cancer among those in their 20s~30s doesn't necessarily mean their poor therapeutic effect or poor prognosis compared with other age groups. So, those in their 20s~30s need to actively join treatment according to a medical specialist's recommendation,” told Prof. YANG, Han-Kwang.

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