Gastric cancer. Diagnosis, treatment and prognosis in clinical routine

During 1972-1978, 235 cases of gastric cancer were diagnosed at the Central Hospital of Eskilstuna which serves 115 000 inhabitants. The diagnosis was histologically verified in 193 cases (82%). Only half of the cases were definitely diagnosed prior to exploratory laparotomy or death. More than one fourth of the patients had experienced symptoms consistent with gastric cancer for a period of 1-5 years prior to diagnosis. Gastric X-ray had been performed in 184 cases during the year preceding diagnosis. In 44 cases (24%) the examination gave no suspicion of cancer. One hundred and thirty-five patients were operated upon. Tumour resection was possible in 73, of which 12 (16%) died postoperatively. The crude 5-year survival rate after diagnosis was a mere 7% in the entire series and 19% after tumour resection. Only 14 patients were alive at the end of 1980, 13 after radical surgery. Eleven early gastric cancers (4.7%) were diagnosed, 9 prior to death. We conclude, that the symptoms of gastric cancer were regularly misinterpreted, that the diagnostic tools were dull and that the prognosis is still poor. Prompt recognition of the symptoms and liberal indications of gastroscopy might allow diagnosis at an earlier stage and thus, hopefully, an improved prognosis.