Carcinoma of the Stomach

Abstract

Overview Gastric cancer is the second most common cause of cancer‐related death worldwide and risk factors include autoimmune gastritis, chronic Helicobacter pylori infection, obesity, and other causes. Some countries with higher incidence have established screening programs but methodology and eligibility remain controversial. Despite knowledge of risk factors and screening for high‐risk populations, identification of earlier stage potentially curable disease remains a challenge. Multiple genetic mutations are involved in gastric cancer pathogenesis, and mutations in the cellular adhesion protein CDH1 result in familial diffuse gastric cancer. Certain patterns of metastatic disease have been associated with particular molecular alterations. Increasing understanding of molecular pathways involved in gastric cancer has led to efficacious use of targeted biologic therapies with cytotoxic chemotherapy in the advanced setting, such as use of trastuzumab in patients with gastric cancer and HER2/neu overexpression. Surgical resection is the primary potentially curative therapy in those without metastatic disease. Type of resection and extent of lymphadenectomy are not consistent, and standards for best practice are needed. Chemotherapy and radiation play an important role in the adjuvant setting and, therefore, decisions regarding choice and timing of these therapies require accurate staging by thorough evaluation with endoscopy, cross‐sectional imaging and, in some cases, endoscopic ultrasound or positron emission tomography. Palliative interventions and therapy are often important, both for patients with symptoms in the metastatic setting and after recurrence as cure is not achieved in either situation. Results of recent clinical trials are encouraging, and there have been multiple positive phase III trials in the adjuvant and metastatic setting during the past 10 years. Despite this, most people diagnosed with gastric cancer will die from it eventually, so much more research is needed.