Gastric adenocarcinoma

Abstract

Gastric cancers, with gastric adenocarcinoma (GAC) as the most common histological type, impose a considerable global health burden. Although the screening strategies for early detection have been shown to be successful in Japan and South Korea, they are either not implemented or not feasible in most of the world, leading to late diagnosis in most patients. Helicobacter pylori infection contributes to the development of many endemic GACs, and pre-emptive eradication or early treatment of this bacterial infection might provide effective primary prevention. GACs are phenotypically and genotypically heterogeneous. Localized (clinical stage I) GAC is best treated either endoscopically or with limited surgical resection, but clinical stage II or stage III tumours require multidisciplinary adjunctive approaches in addition to surgery. Although GAC is highly treatable in its early stages, advanced (clinical stage IV) GAC has a median survival of just ∼9-10 months. However, detailed molecular and immune profiling of GAC is yielding promise; early studies with immune checkpoint inhibitors suggest that GAC is amenable to immune modulation. Molecular studies have yielded a vast quantity of new information for potential exploitation. Nevertheless, advances against GACs have lagged compared with other tumours of similar incidence, and more research is necessary to overcome the obstacles to prolong survival.

Management of Helicobacter pylori Infection: What Should the Surgeon Know

“…H. pylori infection leads to chronic active gastritis in all infected individuals, while the clinical outcome of the infection is unpredictable, ranging from an uncomplicated, clinically unapparent course to most severe complications. In the case of gastric cancer, it is mostly an incurable disease at the time of diagnosis [6]. Similar to other chronic infections such as syphilis or tuberculosis, which may remain clinically silent before eventually presenting with clinical symptoms, the outcome of H. pylori infection cannot be predicted for the individual infected and complications, even gastric cancer, are preventable by H. pylori eradication [7].…”

Update on targeted therapy and immune therapy for gastric cancer, 2018

“…Although several clinical trials have attempted to improve prognosis in GC patients [46] and their survival rate has been improving in recent years, unresectable or metastatic AGC has been untreatable, and median survival at this stage remains poor [47] . Therefore, research into more effective therapeutic targets, biological mechanisms, and treatments for AGC is essential.…”

Management of metastatic esophagogastric junction adenocarcinoma

“…PANGEA is a phase II trial that gastroesophageal tumors are classified into the following six categories (HER2+, MET+, FGFR2+, VEGFR2+, MSI-H, and EGFR+), and then paired specific targeted therapies (trastuzumab, TBD, anti-EGFR antibody ABT-806, TBD2, ramucirumab, and nivolmab) are assigned according to the biomarkers, along with standard chemotherapy [32] . VIKTORY is a screening trial without drug intervention for metastatic GC patients who failed or progressed on first-line chemotherapy, using cancer panel/nanostring CNV and immunohistochemistry [33] . These efforts may create new algorithms in upper gastrointestinal cancers.…”