Although the occurrence of stomach cancer is declining in the United States, the only body organs giving rise to a greater number of cancer deaths are the lung, colon-rectum, and breast. An estimated 20,000 Americans will develop stomach cancer this year and 17,000 will die of it. Persistent indigestion, ulcer symptoms, and anemia are common signals, but often do not prompt attention until the disease is well advanced.

The usual method of treatment is surgical removal of the cancer and its regional metastases. However, of every 100 persons found by a leading medical center to have stomach cancer, 80 undergo exploratory surgery and 44 actually have an operable tumor. It is estimated that only about 9 percent of all patients with stomach cancer survive 5 years or longer.

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Although the incidence of stomach cancer is declining, it is still an important cause of cancer deaths in the United States.

Stomach cancer is classified according to the cell type as carcinoma, lymphoma, or leiomyosarcoma. Only cancers of the lymphoma class are ordinarily treated successfully by radiotherapy; supervoltage radiotherapy or cobalt therapy is then the usual method.

Drugs may have some value as treatment. Illustrative studies include one in which 5 of 18 (27 percent) patients treated with nitrogen mustard achieved an average remission of 5 1/2 months. Objective remissions were obtained in 15 of 49 (34 percent) patients treated in another study with 5-FU.

In March 1968 a report was published on a study at 27 hospitals of patients receiving thioTEPA shortly after completion of gastric surgery. Of 616 patients who survived at least 30 days after surgery, 301 (49 percent) were treated with the drug. Patients whose cancer appeared to have been thoroughly removed at surgery and who had no evidence of involvement of the regional lymph nodes, had significantly higher survival rates for the first three years after surgery if they received thioTEPA than if they did not. No significant improvement was noted, however, in patients whose cancer had not been fully removable or had spread to lymph nodes.

Mitomycin C has been reported useful in stomach cancer, particularly by Japanese investigators. More experience in its use is needed in this country to permit an adequate evaluation.