New possibilities for the treatment of gastric cancer

Abstract

Most cases of gastric cancer in Europe are detected in the advanced stages. The recommendations concerning diagnostic and therapeutic procedures currently in effect were presented during the 1 st St. Gallen EORTC Gastrointestinal Cancer Conference in St. Gallen, in March 2012. The indispensable diagnostic tests are endoscopy with histopathological assessment of endoscopic biopsies, and CT scan of the abdomen and the chest. In the case of locally advanced gastric cancer the basis of treatment is a resection procedure. The type of surgery performed depends on the size of tumour (cT) and the state of lymph nodes (cN). In tumours cT2-4a and/or cN+ a total or subtotal gastrectomy is an obligatory step. Clinical studies carried out recently have confirmed that patients with locally advanced tumours-depth of invasion T2, T3, T4 and/or N+, without the presence of distant metastases-should be eligible to receive neoadjuvant chemotherapy. Adjuvant therapy following surgical resection after the resection surgery consists in the continuation of chemotherapy or application of radiotherapy. Postoperative chemotherapy prolongs the 5-year survival rate by 13-14%, and the use of adjuvant radiochemotherapy increases the percentage of overall survival by 11%. Streszczenie Rak żołądka w większości przypadków wykrywany jest w Europie w stadiach zaawansowanych. Aktualnie obowiązujące zalecenia dotyczące postępowania diagnostyczno-terapeutycznego zostały przedstawione podczas pierwszej konferencji EORTC w St. Gallen w marcu 2012 r. Koniecznymi badaniami diagnostycznymi są endoskopia z oceną histopatologiczną wycinków oraz tomografia komputerowa jamy brzusznej i klatki piersiowej. Podstawą leczenia w przypadkach miejscowo zaawansowanego raka żołądka jest zabieg resekcyjny. Rodzaj operacji zależy od wielkości guza (cT) oraz stanu węzłów chłonnych (cN). W guzach cT2-4a i/lub cN+ obowiązuje całkowita lub prawie całkowita resekcja żołądka. W przeprowadzonych w ostatnich latach badaniach klinicznych dowiedziono, że pacjentów z miejscowo zaawansowanymi nowotworami-głębokie T2, T3, T4 i/lub N+, bez przerzutów odległych należy kwalifikować do neoadjuwantowej chemioterapii. Leczenie uzupełniające po zabiegu resekcyjnym polega na kontynuowaniu chemioterapii lub zastosowaniu radiochemioterapii. Chemioterapia okołooperacyjna zwiększa odsetek 5-letnich przeżyć o 13-14%, a zastosowanie radiochemioterapii uzupełniającej zwiększa odsetek przeżyć całkowitych o 11%.

Assessment of the risk of colorectal cancer in Poland on the basis of the analysis of epidemiological indicators

“…Considering the fact that lifestyle plays an important role in carcinogenesis and the natural history of the disease, and prognoses are related to society's ASR/100 000 awareness in cancer prevention [8, 11-13, 18, 19], a significant role is also played by tumour diagnostics carried out at early stages of tumour development [18][19][20]. Improvement in the epidemiological situation requires wide-scale interventions in these regions.…”

The Influence of Splenectomy Performed Simultaneously with Gastrectomy on Postoperative Complications in Patients with Gastric Cancer Undergoing Surgery with the Intention to Treat

“…The first group received chemotherapy based on etoposide, cisplatin and 5-fluorouracil in the perioperative period, while the second group underwent surgery only. The 5-year survival rate in the group that received perioperative chemotherapy was 36.3%, while in the group that received surgical treatment only: 23% (5).…”

“…This is not only due to different cancer biology and advancement stage at the time of diagnosis, but also the scope of lymphadenectomy. In Japan, the preferred type is D2 lymphadenectomy, in selected cases D3 lymphadenectomy, while in the USA D1 lymphadenectomy is recommended (5).…”

Good distant outcome of treatment of a patient with advanced gastric cancer

“…The best diagnostic methods remain endo-ultrasonography (EUS) and gastroscopy, which enable the collection of specimens for histopathological testing in order to make a diagnosis [5].…”