The diagnosis and management of gastric cancer
A partir d'une revue de la littérature publiée durant les 10 dernières années, cet article fait le point sur le diagnostic et la prise en charge thérapeutique d'un cancer de l'estomac
Summary points : The incidence of gastric cancer is highest in eastern Asia, eastern Europe, and South America, and it affects twice as many men as women. Risk factors for gastric cancer include Helicobacter pylori infection, cigarette smoking, high alcohol intake, excess dietary salt, lack of refrigeration, inadequate fruit and vegetable consumption, and pernicious anaemia. Patients present with weight loss and abdominal pain, although those with proximal or gastro-oesophageal junction tumours may present with dysphagia. Upper gastrointestinal endoscopy with biopsy is used to confirm the diagnosis; precise tumour stage is defined by more sophisticated radiological investigations. Multidisciplinary approach to treatment: early gastric cancer is treated with surgery alone, whereas advanced disease is usually managed with chemotherapy before and after surgery, or postoperative chemoradiation. Metastatic disease is managed with chemotherapy or chemoradiation as well as supportive care measures Age standardised mortality rates for gastric cancer are 14.3 per 100 000 in men and 6.9 per 100 000 in women worldwide.1 Incidence shows clear regional and sex variations—rates are highest in eastern Asia, eastern Europe, and South America and lowest in northern and southern Africa.1 Early diagnosis is crucial because of the possibility of early metastasis to the liver, pancreas, omentum, oesophagus, bile ducts, and regional and distant lymph nodes.2 Using evidence from large randomised controlled trials, meta-analyses, cohort studies, and case-control studies this review aims to outline preventive strategies, highlight the presenting features of gastric cancer, and guide generalists in early diagnosis, referral, and treatment. Sources and selection criteria : We searched PubMed to identify peer reviewed original articles, meta-analyses, and reviews. Search terms were gastric cancer, cancer of the stomach, gastric adenocarcinoma, gastro-oesophageal cancer, gastric neoplasm, and neoplasm of the stomach. We considered only those papers that were written in English, published within the past 10 years, and which described studies that had adequate scientific validity.