Gastric cancer: A neoplastic enigma

Abstract

Effective therapy for gastric cancer remains elusive, and thus surgeons, oncologists, and radiotherapists are continually confounded. Multiple attempts to improve survival in gastric cancer patients have failed, including extended lymphadenectomy (by American surgeons), single-or multipleagent chemotherapy, and combined-modality therapy (multiple-agent chemotherapy combined with radiation therapy). Such studies have been plagued by the high volume of inadequate antitumor responses or by lethal toxicity. At present, chemotherapy remains the best hope for effective adjuvant therapy, but new routes of drug delivery that will decrease systemic toxicity must be developed. Since gastric cancer recurs locoregionally and infrequently metastasizes to distant sites until very late in its course, theory suggests intraperitoneal (IP) chemotherapy applied to locoregional sites should decrease recurrence without significant systemic toxicity. Such treatments have been effective in other malignancies that commonly occur IP, such as ovarian cancer. Intracavitary chemotherapy protocols for gastric cancer are under development and will soon produce data on treatment efficacy. Such studies offer a theoretic basis for improved survival from gastric cancer; however, only well-controlled treatment trials will confirm if theory can be translated into clinical reality.

Early Gastric Cancer in the Young: Clinicopathological Study

“…Although its incidence has decreased during the last three decades, gastric cancer is still one of the major causes of death due to malignant disease in Japan. [1][2][3][4][5][6][7][8][9][10][11] In recent years, much interest has been shown in the diagnosis and management of early gastric cancer, which has a very high cure rate compared with that of advanced stage disease. [12][13][14][15][16][17] Early gastric cancer was defined by the Japanese Gastroenterological Endoscopy Society in the early 1960s as carcinoma limited to the gastric mucosa and submucosa, regardless of the presence or absence of lymph node metastases.…”

“…Although its incidence has decreased during the last three decades, gastric cancer is still one of the major causes of death due to malignant disease in Japan 1 –11 . In recent years, much interest has been shown in the diagnosis and management of early gastric cancer, which has a very high cure rate compared with that of advanced stage disease 12 –17 .…”

Perioperative therapy in gastric cancer

“…In stage II and stage III, 5-year survival rate after R0 resection is only 45% and 25%, respectively. Th erefore, even resectable gastric cancer should be viewed as a disseminated disease [2,4]. Th e poor prognosis and the high recurrence rate are the rationale for developing adjuvant or neoadjuvant treatment strategies.…”

“…Th e 5-year survival of patients suff ering from gastric cancer is low with a rate below 20%. Most of the patients (70-80%) are diagnosed in an advanced or metastatic stage and are therefore inoperable [2]. In this setting, palliative chemotherapy prolongs survival and improves quality of life [3].…”

Adjuvant therapy in resectable gastric cancer

“…For the majority of the patients the diagnosis means a strong likelihood of death. The 5-year survival rates were only 7% to 10% and there has been relatively little improvement in this outlook over the past 30 years (Kern, 1989).…”