Prognosis and survival for stomach cancer: What to know

Overall outlook

According to a 2024 article, over half of stomach cancer cases can be cured if the cancer has not spread to other areas of the body.

However, most of the time, a doctor does not diagnose stomach cancer until it has spread, which can mean that the outlook is often less favorable. About 10% to 20% of stomach cancers diagnosed in the United States are considered early stage.

Overall, 37.9% of people with stomach cancer survive 5 years or longer, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.

Seeking early care for stomach cancer symptoms, such as bloody vomiting, stomach pain, or frequent gastrointestinal problems, may help a person get the treatment they need to improve their outlook.

Factors that affect the outlook

Cancer is unpredictable, and so are treatment results. Some people survive very advanced cancers, while others with early cancers see their cancers metastasize and spread. No formula can conclusively determine a person’s outlook.

That said, a few important factors can help doctors predict the outlook, including:

Type and stage of stomach cancer

Tumors that test positive for Epstein-Barr virus tend to have a better outlook because they respond well to treatment.

Well-differentiated intestinal cancer also has a better outlook than diffuse cancer, which is more aggressive and likely to spread.

Also, early stage cancers that have not spread to other body areas have a better outlook. The portion of the stomach where the cancer is located can also influence outlook.

Treatment decisions and response

Several treatments are available for stomach cancer, including:

• chemotherapy
• targeted therapies
• surgery
• radiation

A person’s outlook may be more favorable if they can have surgery. It is the only definitive cure for those without stomach cancer that has spread to distant parts of the body.

Some people — particularly those with advanced cancer — may not want to continue treatment, especially if it is painful, time consuming, or causes side effects that are hard to manage. They may instead choose palliative care or hospice.

Typically, a person’s response to treatment influences their outlook. For example, people who develop severe side effects and whose cancers do not shrink tend to have a worse outlook than those who tolerate treatment well while experiencing improvements in their tumors.

Overall health

A person’s overall health can affect their outlook. This is because a person’s overall health status can determine the following:

• whether it is safe to have surgery
• how well they can tolerate treatment
• how sick the cancer might make them

Individual characteristics

Other factors, including age, can impact outlook. For example, older people with gastric cancer are likely to have an increased risk of surgical complications and a less favorable outlook.

The relationship between sex and race in the outlook of stomach cancer is more complex. Further research into how they impact outlook would be beneficial.

Access to care and treatment

Having access to quality, early treatment may determine outlook, especially in people for whom financial or other barriers delay a diagnosis.

Survival by TNM stages

Doctors determine the cancer stage by taking a sample of the tissue from the site of the suspected cancer and performing a biopsy. They may also take imaging scans of the body to assess for cancer cells.

Stomach cancer staging is a measure of how far the cancer has spread. The TNM system uses three key pieces of information to stage stomach cancer, including:

• T: the extent of the tumor
• N: spread to nearby lymph nodes
• M: metastasis — or spread to distant parts of the body

Below are survival rates based on the TNM stages:

Stage 0

Known also as carcinoma in situ, stage 0 cancer has the highest cure rate. This cancer has invaded only the epithelial tissue, not the deeper tissue of the stomach, and has not spread.

More than 90% of people will likely survive 5 years or longer with surgical intervention.

Stage I

Type I is localized cancer. Type IA means the cancer is only in the stomach tissue, while type IB means it has spread to one or two local lymph nodes.

With curative surgery, this rate rises to 93.6% for type IA. With neoadjuvant therapies instead of surgery, 5-year survival is 76.5%. Neoadjuvant approaches refer to treatments that shrink the tumor, for example, chemotherapy or radiation.

Stage II

Stage II means that the cancer has spread to several lymph nodes. Doctors further divide the cancer into subtypes based on specific characteristics.

Type IIA, which has the lowest spread, has the best outlook with curative surgery, with a 5-year survival rate of 81.8%. With neoadjuvant therapies alone, 5-year survival for type II is 46.3%.

Stage III

Stage III cancer has spread to nearby regions or many local lymph nodes.

With curative surgery, the survival rate is 54.2%. However, with neoadjuvant therapies alone, 5-year survival is 18.3%.

Stage IV

Stage IV has the least favorable outlook, likely because the cancer has spread to other organs, such as the brain or lungs.

Surgery cannot cure it. However, other treatments may prolong a person’s life. Even with treatment, however, the 5-year survival rate is low.

Summary

In the early stages, stomach cancer responds well to treatment and is often even curable. However, most cancers go undiagnosed until the later stages, when treatment and cure become less likely.

As a result, the overall outlook for stomach cancer is not favorable, with a 5-year survival for all combined types of just 37.9%.

Every cancer is different, and survival rates are constantly shifting thanks to new treatments. Moreover, each cancer is different, and every person living with cancer has different risk factors.

The most reliable source of information about a person’s outlook is an oncologist familiar with their situation.