Chapter 2 - Gastric cancer

Abstract

Gastric cancer is the fifth most common cancer, and the third commonest cause of cancer-related death. In Western countries, there has been an increase in proximally located gastric cancer. In Japan, distally located tumors predominate. Risk factors for the development of gastric cancer include Helicobacter pylori infection (associated with distal gastric cancer), gastric polyps, chronic exposure to nitrosamines, smoking, pernicious anemia, and previous gastric surgery and family history. Symptomatology is associated with advanced lesions. Patients may complain of abdominal pain; this is vague and mild initially, progressing to severe pain. Anorexia decreased caloric intake and weight loss are common. Proximal cancers may present with dysphagia; pseudo-achalasia may result from tumor invading the myenteric Auerbach plexus. Gastric outlet obstruction in large tumors, distal tumors or linitis plastica present with nausea and vomiting. Gastrectomy is the mainstay of treatment of gastric cancer. The main objective is a R0 resection, with gross margins >5 cm and negative frozen-section margins. Distal lesions may be treated with a subtotal gastrectomy, more proximal lesions with a total gastrectomy. D2 lymphadenectomy is considered the standard of care in most institutions with experience. Combined modality therapy is considered in patients who have tumors that are T2 or greater. Perioperative chemotherapy is used frequently.