The stomach is part of the digestive system. It lies just under the diaphragm (the sheet of muscle just under your lungs). The top of the stomach is connected to the oesophagus (foodpipe). The other end of the stomach is connected to the first part of the small intestine, the duodenum.
Stomach (Gastric) cancer is an aggressive cancer. Most stomach cancers are advanced when they are diagnosed. About 8 out of 10 (80%) people diagnosed with stomach cancer are stage four, meaning the cancer has already spread when they are diagnosed.
Peritoneal spread in Stomach Cancer
Peritoneal spread and recurrence is commonly seen in gastric cancer. 60% of the patients with more advanced cancer of the stomach despite what is thought to be a curative resection will have peritoneal recurrence. 20-40% of all gastric cancer patients die as a direct result of peritoneal dissemination.
HIPEC can be used in 2 ways for stomach cancer
- At the time of initial surgery: In patients undergoing curative surgery for stomach cancer, there are certain high risk factors for peritoneal spread. These are positive lymph nodes, T3/T4 tumors, high grade tumors, and patients with a positive fluid cytology. Studies have shown that when HIPEC is performed at the time of initial surgery in these patients its helpful in preventing peritoneal spread. This approach however, is investigational and is done in the setting of clinical trials only.
- Patients with peritoneal spread: This maybe at the time of initial presentation or in case of recurrence. Chemotherapy is required foremost. In certain patients whom the disease is limited or can be completely removed, Cytoreductive Surgery and HIPEC is an option. The outcomes in terms of long term survival are not as good as the other cancers for which CRS and HIPEC is used.