Stomach cancer, also known as gastric cancer, may be treated with surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Often, a combination of treatments is used to treat gastric cancer.
Descriptions of the common types of treatments used for stomach cancer are listed below.
Surgical treatment involves the removal of the tumour and some surrounding healthy tissue during an operation. The type of surgery used depends on the stage of the cancer.
Radiation therapy is a stomach cancer treatment involving the use of high-energy rays to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Patients with gastric cancer usually receive external beam therapy (EBRT) which focuses radiation on the cancer. Other special types of radiation therapy, such three-dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) are also used in treating gastric cancer. These newer approaches aim the radiation at the cancer from several angles. This helps to focus the radiation on the cancer and limit the damage to nearby normal tissues.
Radiation therapy may be used before the surgery to shrink the size of the tumour and after the surgery to destroy any remaining cancer cells. It may also be used to alleviate cancer related symptoms of pain or bleeding in patients with advanced gastric cancer.
Chemotherapy treatment involves the use of medications to destroy cancer cells, usually by stopping the cancer cells from growing, dividing, or multiplying.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive one (1) drug at a time, or a combination of different drugs given at the same time.
The goal of chemotherapy is to destroy cancer cells before or after surgery, slow the tumour’s growth, or alleviate cancer-related symptoms. Chemotherapy may be administered in combination with radiation therapy in certain cases. Most chemotherapy treatments for stomach cancer are based on combinations of the following drugs:
Other drugs used may include:
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells with limited damage to healthy cells.
To tailor the most effective treatment for each patient, the doctor may order some tests to identify the genes, proteins, and other factors in a patient’s tumour. Targeted therapy for stomach cancer includes:
Immunotherapy is designed to boost the body’s natural defenses to fight the cancer. Checkpoint inhibitor is a form of immunotherapy used to treat stomach cancer.
Surgery for stomach cancer is complex and may have complications. Like all cancer treatments, surgery has benefits, risks, and side effects. After surgery, it is common to have some pain from the surgery’s effect on the body. Most patients will have at least some pain after the operation, which can usually be helped with pain medication, if needed.
Side effects after surgery may include nausea, heartburn, abdominal pain and diarrhea. Fatigue is also common after surgery. Many people are very tired after major surgery, especially when it involves the abdomen in the case of gastric cancer. Fatigue usually goes away gradually two to four weeks after surgery.
The possible side effects of radiation therapy depend on where the radiation is targeted. The common side effects of this stomach cancer treatment include:
The side effects of chemotherapy as a stomach cancer treatment commonly include the following:
Depending on the targeted drugs used for this stomach cancer treatment, the common side effects of targeted therapy may include:
The side effects of immunotherapy as stomach cancer treatment may include:
If you suspect that you or your loved one have stomach cancer, it is advisable to get the support you need as soon as possible. Early detection and diagnosis of stomach cancer is key to treating the disease.
Regardless of what stage your stomach cancer may be, you should schedule an appointment to see an oncologist specialising in stomach cancer as soon as possible. With the speed of developments in gastric cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of gastric cancer, as well as earlier stages of the disease.
Senior Consultant, Medical Oncologist
https://oncocare.sg/specialists/dr-akhil-chopra/
MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology) –
American Board Certified (Med Oncology)
Before joining OncoCare Cancer Centre at Mount Elizabeth Hospital, Singapore, Dr Akhil Chopra was a Senior Consultant in Medical Oncology at Johns Hopkins Singapore, Tan Tock Seng Hospital and Adjunct Associate Professor at Lee Kong Chian School of Medicine.
Dr Chopra has experience treating multiple cancer types including breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as Sarcomas and chronic leukaemia’s/multiple myeloma. Besides his clinical and research work, he has been involved in teaching medical students from the Lee Kong Chian School of Medicine as well as medical residents and students from Johns Hopkins University, Baltimore in USA.
MEDICAL PROFILE
Cancer Specialities: breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers
Senior Consultant, Medical Oncologist
MBBCH, BAO (Ireland) – MRCP (United Kingdom) – FRCP (Edinburgh) – FRCP (Medical Oncology)
Dr Benjamin Chuah, Senior Consultant Medical Oncologist at OncoCare Cancer Centre, was previously Consultant in the Department of Haematology-Oncology, National Cancer Institute Singapore, National University Hospital.
Graduating in medicine from Trinity College Dublin in 1998 where he was awarded the Professor Prize in Physic (Surgery) and the Arthur Ball Prize (2nd Place), Dr Chuah returned to Singapore and obtained his Membership of the Royal College of Physicians of the United Kingdom in 2002.
Prior to entering private practice, Dr Benjamin Chuah (patients often address him as Dr Ben Chuah) was actively involved in both post-graduate teaching and research. He was the Director for Postgraduate Medical Education (Medical Oncology) and was a Core Faculty for the Residency Program (Internal Medicine). For his efforts, he was awarded the National University Hospital Postgraduate Teaching Excellence Award in 2011. He was also involved in clinical and translational research for many years and was the principal or co-investigator in international trials involving the use of novel and targeted therapy drugs for colorectal and pancreatic cancer. He was awarded the NUH Innovative Grant for research in warfarin pharmacogenomics and was also honoured with the inaugural Kobayashi Foundation Award for work done on serial changes in the expression of breast cancer-related proteins in response to neoadjuvant chemotherapy. His research work has lead to several 1st author publications in high impact medical and oncology journals including Gastroenterology, GUT and Annals of Oncology.
Dr Ben Chuah’s subspecialty interest is in Gastrointestinal Cancers including oesophageal, stomach, biliary tract, pancreatic, liver (hepatocellular carcinoma), neuroendocrine cancers and colorectal cancers. As a clinical cancer specialist and researcher, his research work includes small cell gallbladder cancer with paraneoplastic hyponatremia, exploring the lack of somatic mutations in VEGFR-2 tyrosine kinase domain in hepatocellular carcinoma, renal cell carcinoma (kidney cancer) with bony metastases and use of the chemotherapy drug, docetaxel (Taxotere) with or without ketoconazole in breast cancer. He has published on screening in colorectal cancer and was involved in a randomized, phase 2 study of ganitumab or conatumumab in combination with FOLFIRI (5-FU, leucovorin, irinotecan) for second-line treatment of mutant KRAS metastatic colorectal cancer.
MBBS (Singapore) – MRCP (United Kingdom)
Dr Thomas Soh is a Senior Consultant Medical Oncologist at OncoCare Cancer Centre. He is also an accredited medical practitioner by the Office of the Public Guardian, to assist patients with making a Lasting Power of Attorney (LPA).
He was previously Consultant at the Department of Haematology Oncology at National University Hospital (NUH) and Visiting Consultant at Ng Teng Fong General Hospital.
He graduated from National University of Singapore in 2003 and received his Membership of the Royal College of Physician (United Kingdom) in 2007. He later completed his advance specialist training in Medical Oncology in 2012.
He was heavily involved in both undergraduate and postgraduate education, and was core faculty for the both the Internal Medicine Residency program and the Oncology Senior Residency program in the National University Hospital from 2012 to 2016. He was recognised for his mentorship and a good teacher to junior doctors and medical students, with the Teaching Excellence Award in 2014, from National University Cancer Institute (NCIS), as well as the Best Tutor Award in 2015 for undergraduate teaching by the University Medical Cluster, NUH.
Dr Soh believes in the delivery of quality healthcare, and was the lead and co-lead in several healthcare improvement projects. He had received multiple awards for his involvement in the Clinical Practice Improvement Programmes that he had implemented in NUH. From 2013-2015, he contributed a leading role being the Honorary Secretary of the Executive Committee, Singapore Society of Oncology.
Dr Soh is actively involved in both research and education in cancer medicine. He had received funding for his work from the National Medical Research Council, Singapore, being awarded the Clinical Investigator Salary Support Program (CISSP) award 3 times. He had researched on drug response and toxicity in treating cancer, understanding how chemotherapy and targeted medications is absorbed and cleared in the body in relation to the pharmacokinetics and pharmacodynamics. He had published on genetic variants affecting chemotherapy in Asian breast cancer patients. His research publication in colorectal cancer involves working with cell free DNA, chemotherapy drugs Regorafenib, FOLFIRI regimen (irinotecan, 5-fluorouracil and folinic acid).
He was the principal investigator in several multi-centre gastrointestinal cancer clinical trials and his research work has lead to more than 10 publications in high impact medical and oncology journals. He was the Principal Investigator for studies of circulating tumour cells, and was also doing trials in hepatocellular cancer (hepatoma) with drugs such as Sorafenib, Lenvatinib, Carbozantinib. The colorectal cancer trials involved drugs such as Cetuximab (Erbitux) with FOLFOX (Oxaliplatin, 5-fluorouracil and folinic acid), FOLFIRI regimens, Aflibercept and Y90 (Therasphere). In advanced pancreatic cancer, he was principal investigator for studies using Gemcitabine, Masitinib, and Abraxane. These experiences stand him in good stead to care for cancer patients and he is recognised for his dedication and expertise in these areas.
Dr Soh’s subspecialty interest is in Gastrointestinal (oesophageal, gastric, colon and rectal cancer) and Hepatobiliary Cancer (liver, pancreas, bile duct and gallbladder cancers). He is also a cancer specialist who looks after patients with neuroendocrine cancers. He speaks fluent English, Mandarin, Malay, Bahasa as well as Hokkien and has looked after many Indonesian and Malay patients. He has looked after many international patients, including Vietnamese, Myanmar, Banglahdeshi and Cambodian patients as well, with the help of interpreters.
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology) – MHsc (Duke, USA)
Dr Wong Nan Soon is a Senior Consultant Medical Oncologist with more than 15 years of experience in the diagnosis and management of a wide range of cancers.
His subspecialty interests are in the field of breast cancer and gastrointestinal cancers (which include colon cancer, stomach cancer, rectal cancer, anal cancer, biliary cancer, pancreatic cancer, liver cancer, GI stromal cancers (GIST) and neuroendocrine cancers).
In addition, he is also well versed in the treatment of a wide variety of cancers which include lung cancers, kidney cancers, uterine, cervical and ovarian cancers.
He graduated from the Faculty of Medicine, National University of Singapore in 1994 and obtained the degrees of Master’s in Internal Medicine and Membership of the Royal College of Physicians of the United Kingdom in 2000.
In 2003, he completed advanced specialty training in general medical oncology.
This was followed by a 1 year clinical fellowship sub-specializing in breast medical oncology in Sunnybrook and Women’s Health Science Centre, Toronto, Canada where he trained under world renowned breast oncologists including Professor Kathleen Pritchard.
He was promoted to the position of consultant in 2006 and subsequently rose to the position of senior consultant and chief of breast team in the department of medical oncology, National Cancer Centre Singapore in 2009.
In 2009, he was awarded the prestigious Singapore National Medical Research Council overseas research fellowship to develop expertise in phase I clinical trials at Duke University, North Carolina, USA. During this year, he broadened his subspecialty interest to encompass gastrointestinal cancers, training under Professor Herbert Hurwitz. He also underwent further training in biostatistics and clinical research methodology, graduating with a master’s degree in health science research.
With this knowledge and experience in novel drug combinations, he is able to offer cutting edge medical treatment for both early stage cancers and also drug resistant difficult to treat advanced cancers.
Senior Medical Oncologist
MBBS (S’pore), Grad Dip (GRM), MRCP (UK), M Med (Internal Med)
Dr Angela Pang is a Senior Medical Oncologist at OncoCare Cancer Centre and also a visiting consultant at the National University Cancer Institute of Singapore (NCIS).
Prior to this, she was a Consultant with the Haematology-Oncology Department of National University Cancer Institute of Singapore (NCIS), National University Hospital (NUH) and Visiting Consultant at Ng Teng Fong General Hospital (NTFGH).
She had obtained her undergraduate degree from the School of Medicine, National University of Singapore (NUS). Thereafter, she obtained her postgraduate qualifications – Masters in Medicine (Internal Medicine) from NUS, and her Membership of the Royal College of Physicians (UK). Subsequently, she went on to complete her advanced specialist training in Medical Oncology in the National University Hospital (NUH), Singapore and was awarded the NCIS research scholarship for her Sarcoma research fellowship with Professor Robert G Maki in the Tisch Cancer Institute, Mount Sinai Hospital, New York.
With a specific interest in the optimisation of care in elderly cancer patients, Dr Pang further pursued a Graduate Diploma in Geriatric Medicine with the Yong Loo Lin School of Medicine (YLLSOM). In order to integrate her expertise in both geriatrics and oncology, she also trained in Geriatric Oncology with Dr Beatriz Korc and Dr Stuart Lichtman in the Memorial Sloan Kettering Cancer Center, New York.
Dr Pang’s main clinical interests are in bone/soft tissue sarcomas, gastrointestinal cancers (including stomach cancer) and geriatric oncology. She was the co-lead for the Musculoskeletal oncology service in NCIS, and had set up of the multi-disciplinary Geriatric Oncology service in NCIS and NTFGH.
She was also a principal investigator for several international multi-centre cancer clinical trials and also a recipient of several grants. Her research work has been published in peer reviewed journals including the Journal of Clinical Oncology (JCO), Journal of American Society of Medicine (JAMA) Oncology, Nature Communications, Clinical Cancer Research, British Medical Journal (BMJ) GUT, Oncogene, Oncotarget and others.
She is a member of several professional bodies, including the American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), International Society of Geriatric Oncology (SIOG) and the Connective Tissue Oncology Society (CTOS).
Dr Pang was also actively involved in both undergraduate and post graduate educations at the YLLSOM and NUH respectively. She has been awarded for teaching excellence and was previously appointed as Assistant Professor for Faculty of Medicine, YLLSOM and had served as core faculty of the undergraduate education (Medical Oncology) and Senior Residency (Medical Oncology) of NUH.
Dr Pang is fluent in English, Mandarin and Hokkien. She is able to converse in simple Malay/Bahasa. She has taken care of patients from many regional and overseas regions including Malaysia, Indonesia, Vietnam, Myanmar, China, Bangladesh, Sri Lanka, India, Canada and Mongolia.
Medical Profile
Bibliography
1) Cancer physicians’ attitude towards treatment of the elderly cancer patient in a developed Asian country. Angela Pang, Shirlynn Ho and Soo-Chin Lee, BMC Geriatr. 2013 Apr 16;13:35. doi: 10.1186/1471-2318-13-35.
2) Hepatitis B virus reactivation risk varies with different chemotherapy regimes commonly used in solid tumours. Ling WH, Soe PP, Pang AS, Lee SC.Br J Cancer. 2013 May 28;108(10):1931-5. doi: 10.1038/bjc.2013.225. Epub 2013 May 7.
3) Lymphadenopathy and airway obstruction. Li A, Khoo KL, Tan CL, Pang A, Lee P. Am J Respir Crit Care Med. 2015 Jan 1;191(1): e1-3. doi: 10.1164/rccm.201409-1622IM.
4) Contemporary Therapy for Advanced Soft-Tissue Sarcomas in Adults: A Review. Angela Pang, Mariana Carbini, Robert G. Maki. JAMA Oncol. 2016;2(7):941-947.
5) Phase Ib/II randomized, open-label study of doxorubicin and cyclophosphamide with or without low-dose, short-course sunitinib in the pre-operative treatment of breast cancer. Andrea L.A. Wong, Raghav Sundar, Ting-Ting Wang, Thian-C Ng, Bo Zhang, Sing-Huang Tan, Thomas I.P. Soh, Angela S.L. Pang, Chee-Seng Tan, Samuel G.W. Ow, Lingzhi Wang, Jannet Mogro, Jingshan Ho, Anand D. Jeyasekharan, Yiqing Huang, Choon-Hua Thng, Ching-Wan Chan, Mikael Hartman, Philip Iau, Shaik A. Buhari, Boon-Cher Goh, Soo-Chin Lee Oncotarget. 2016 Sep 27; 7(39): 64089–6409
6) Carcinosarcomas and Related Cancers: Tumors Caught in the Act of Epithelial-Mesenchymal Transition. Angela Pang, Mariana Carbini, Andre L. Moreira, Robert G. Maki. Journal of Clinical Oncology 2018 36:2, 210-216
7) Longitudinal monitoring reveals dynamic changes in circulating tumor cells (CTCs) and CTC-associated miRNAs in response to chemotherapy in metastatic colorectal cancer patients. Karen Tan, Sai Mun Leong, Zizheng Kee, Patrick Vincent Caramat, James Teo, Michael Vito Martin Blanco, Evelyn S.C. Koay, Wai Kit Cheong, Thomas I-Peng Soh, Wei Peng Yong, Angela Pang. Cancer Letters, Volume 423, 1 – 8
8) Bromodomain and extraterminal proteins foster the core transcriptional regulatory programs and confer vulnerability in liposarcoma.
Chen Y, Xu L, Mayakonda A, Huang ML, Kanojia D, Tan TZ, Dakle P, Lin RY, Ke XY, Said JW, Chen J, Gery S, Ding LW, Jiang YY, Pang A, Puhaindran ME, Goh BC, Koeffler HP.Nat Commun. 2019 Mar 22;10(1):1353. doi: 10.1038/s41467-019-09257-z.
9) The treatment landscape of advanced angiosarcoma in Asia-A multi-national collaboration from the Asian Sarcoma Consortium.
Chen TW, Pang A, Puhaindran ME, Maw MM, Loong HH, Sriuranpong V, Chang CC, Mingmalairak S, Hirose T, Endo M, Kawai A, Farid M, Tan SH, Goh WL, Quek R, Chan JCH, Leung AKC, Ngan RKC.Cancer Sci. 2021 Mar;112(3):1095-1104. doi: 10.1111/cas.14793. Epub 2021 Feb 7.
10) Outcomes of a phase II study of intraperitoneal paclitaxel plus systemic capecitabine and oxaliplatin (XELOX) for gastric cancer with peritoneal metastases.
Daryl Chia, Raghav Sundar, Guo Wei Kim, Jiajun Ang, Jeffrey Lum, Min En Nga, Chee Cheng Ean, Hon Lyn Tan, Jingshan Ho, Natalie Ngoi, Matilda Lee, Vaishnavi Muthu, Gloria Chan, Angela Pang, Yvonne Ang, Joan Choo, Joline Si Jing Lim, Asim Shabbir, Wei-Peng Yong, and Jimmy Bok Yan So. Journal of Clinical Oncology 2021 39:3_suppl, 165-165
11) MNK1 and MNK2 enforce expression of E2F1, FOXM1 and WEE1 to drive soft tissue sarcoma Ke XY, Chen Y, Tham VY, Lin RY, Dakle P, Nacro K, Puhaindran ME, Houghton P, Pang A, Lee VK, Ding LW, Gery S, Hill J, Chen L, Xu L, Koeffler HP.Oncogene. 2021 Mar;40(10):1851-1867. doi: 10.1038/s41388-021-01661-4.
12) Targeting Glycolysis in Macrophages Confers Protection Against Pancreatic Ductal Adenocarcinoma.
Penny HL, Sieow JL, Gun SY, Lau MC, Lee B, Tan J, Phua C, Toh F, Nga Y, Yeap WH, Janela B, Kumar D, Chen H, Yeong J, Kenkel JA, Pang A, Lim D, Toh HC, Hon TLK, Johnson CI, Khameneh HJ, Mortellaro A, Engleman EG, Rotzschke O, Ginhoux F, Abastado JP, Chen J, Wong SC. Int J Mol Sci. 2021 Jun 14;22(12):6350. doi: 10.3390/ijms22126350. PMID: 34198548; PMCID: PMC8231859.
13) Stereotactic radiosurgery in alveolar soft part sarcoma brain metastases: Case series and literature review.
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Definition of Gastric Cancer
The stomach is located in the upper abdomen and plays a central role in digesting food. When food is swallowed, it is pushed down the muscular tube called the esophagus, which connects the throat with the stomach. Then, the food enters the stomach. The stomach mixes the food and releases gastric juices that help break down and digest the food. The food then moves into the small intestine for further digestion.
Stomach cancer, also called gastric cancer, begins when healthy cells in the stomach become abnormal and grow out of control into a tumour. A tumour can be cancerous or benign. A cancerous tumour is malignant, meaning it can grow and spread to other parts of the body. Cancer can begin in any part of the stomach. It can also spread to nearby lymph nodes and other parts of the body, such as the liver, peritoneum, lungs and bones.
Most gastric cancers arise from the glandular cells lining the inside of the stomach and are known as adenocarcinoma. Other types of cancerous tumours that form in the stomach include lymphoma, gastrointestinal stromal tumour (GIST), and neuroendocrine tumours, but these are rare.
In Singapore, gastric cancer is the seventh (7th) most common cancer in men and the ninth (9th) most common cancer in women. Yearly, more than 300 lives are lost to gastric cancer, however when detected early, gastric cancer is potentially curable.
Globally, stomach (gastric) cancer is the fifth (5th) most common cancers contributing to more than one (1) million cases per year and 5.7% of all cancer diagnosis.
The most common symptoms of Stomach Cancer are:
Gastric cancer is usually not found at an early stage because it often does not cause specific symptoms. When symptoms do occur, they may be vague and may include those listed below.
Symptoms of advanced gastric cancer may include:
Screening is used to look for cancer before you have any symptoms or signs.
Stomach (gastric) cancer is usually found when a patient goes to the doctor because of signs or symptoms they are having. If gastric cancer is suspected, exams and tests will be needed to find out for sure. If cancer is found, other tests might then be needed to learn more about it.
Gastric Cancer screening tests include:
Upper endoscopy, or also called oesophagogastroduodenoscopy (OGD) is the test most often done if the doctor suspects a patient to have gastric cancer.
During this test, the doctor passes an endoscope, which is a thin, flexible, lighted tube with a small video camera on the end, down the patient’s throat. This lets the doctor see the inner lining of the esophagus, stomach, and first part of the small intestine. If abnormal areas are seen, biopsy samples can be removed using instruments passed through the endoscope. The tissue samples are sent to a lab, where they are looked at with a microscope to see if they contain cancer.
Doctors use many tests to find or diagnose stomach cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread.
The doctor may consider these factors when choosing a diagnostic test:
Tests to diagnose Stomach Cancer include:
The following factors may raise a person’s risk of developing stomach (gastric) cancer:
The type of stomach cancer a patient has tells what type of cell it started in. These are the several types of cancers that can occur in the stomach:
Staging is a way of describing where the cancer is located, or if it has spread and whether it is affecting other parts of the body. The tests and scans used to diagnose the patient’s cancer will give some information about:
This is also called carcinoma in situ. The cancer is found only on the surface of the epithelium. The cancer has not grown into any other layers of the stomach. This stage is considered an early cancer (Tis, N0, M0).
Stage IV: Stage IV gastric cancer describes a cancer of any size that has spread to distant parts of the body in addition to the area around the stomach (any T, any N, M1).
This TMN system is commonly used for cancer staging. Results from surgery, diagnostic tests and scans are used to answer these questions:
The results are combined to determine the stage of stomach cancer of each patient and to plan the best treatment.
Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the how far the tumour has grown into the stomach wall.
Stage may also be divided into smaller groups that help describe the tumour in even more detail. Specific tumour stage information is listed below:
The “N” in the TNM staging system refers to the number of regional lymph nodes involved by the stomach cancer.
The “M” in the TNM system describes whether the stomach cancer has spread to other parts of the body, called distant metastases.
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