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Chapter-25 Gastric Cancer

BOOK TITLE: Surgical Oncology: Fundamentals, Evidence-based Approaches and New Technology

Author
1. Polanco Patricio M
2. Hughes Steven
ISBN
9789350250518
DOI
10.5005/jp/books/11193_24
Edition
1/e
Publishing Year
2011
Pages
19
Author Affiliations
1. University of Pittsburgh, USA, University of Texas Southwestern, Dallas, Texas, USA
2. University of Pittsburgh, USA
Chapter keywords

Abstract

Gastric cancer is one of the most common causes of cancer mortality worldwide. Although its incidence has declined in developed countries, it remains a major cause of cancer-related death in the United States of America. This chapter will cover gastric cancer epidemiology, clinical presentation, diagnostic modalities, staging algorithms and surgical and other therapeutic approaches. Palliative options will also be reviewed. Our discussion will be divided into discrete sections that correspond to the three major histologic subtypes of gastric neoplasms: adenocarcinomas, lymphomas and gastrointestinal stromal tumors. We will devote the majority of our discussion to gastric adenocarcinomas as this lesion represents more than 95% of neoplasms arising in the stomach. The incidence of gastric cancer varies widely by location, indicating an important role of environmental factors in the pathogenesis of the disease. Infection with H. pylori induces a 6-fold increased risk of developing gastric cancer and it is estimated to be responsible for 63% of gastric cancer cases worldwide. Due to this high risk of developing gastric cancer, genetic counseling and prophylactic gastrectomy are indicated in asymptomatic carriers of cdh1 mutation. Preoperative evaluation of a patient with suspected gastric cancer should include a PET-CT and an endoscopic ultrasound. In patients with early gastric adenocarcinoma, a gastric resection with a macroscopically negative margin of 5 cm and an en bloc resection of the adjacent lymph nodes (D1, regional lymphadenectomy) is the standard of care. The extent of regional lymphadenectomy is a topic of significant controversy. A decrease in the risk of recurrence with extended lymphadenectomy (D2/3) has been documented, but no long-term survival benefit was realized due to the higher operative mortality. Extended resections carry significant morbidity and mortality and should be performed only in high volume centers, if at all. MALT lymphoma is strongly associated with H. pylori infection and treatment of early stage mucosa associated lymphatic tissue is eradication of the bacteria. The biological behavior of gastrointestinal stromal tumors can be difficult to interpret, thus all GISTs must be considered to harbor malignant potential. Based on large retrospective studies, tumor size, site of origin and mitotic count are reliable markers of malignant potential.

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