gastric%20cancer
GASTRIC CANCER
Gastric cancer is the cancer originating in the esophagus, esophagogastric junction and stomach.
Most of gastric cancers are adenocarcinomas, subdivided according to histological appearances into diffuse (undifferentiated) and intestinal (well differentiated) types.
It is the 4th most common cancer and the 2nd most common cause of cancer-related deaths worldwide.
Most common sites of gastric cancer are the proximal lesser curvature, cardia and esophagogastric junction.

Gastric%20cancer Management

Follow Up

  • A regular follow-up may allow investigation and treatment of symptoms, psychological support and early detection of recurrence, though there is no evidence that it improves survival outcomes
  • Response to systemic treatments should normally be assessed with interval computed tomography (CT) imaging of chest, abdomen and pelvis
  • In the advanced disease setting, identification of patients for second-line chemotherapy and clinical trials requires regular follow-up to detect symptoms of disease progression before significant clinical deterioration
  • The type of pathological response and histologic tumor regression after neoadjuvant therapy has been shown to be a predictor of survival
  • Follow-up should include a complete history and physical examination every 3-6 months for 1-2 years, every 6-12 months for 3-5 years and annually thereafter
  • Patients who have undergone surgical resection should be monitored and treated as indicated for vitamin B12 and iron deficiency
  • Endoscopic surveillance requires multiple (4-6) biopsies of any visualized abnormalities after definitive treatment of gastric cancer
    • Strictures found on endoscopy should be biopsied
    • Endoscopic ultrasound-guided fine needle aspiration is recommended if areas of wall thickening or suspicious lymph nodes are noted
  • Patients with Tis and successfully treated with endoscopic resection should undergo EGD every 6 months for 1 year then annually for 3 years
  • Patients with pathologic stage I who underwent surgical resection for T1a, T1b, N0-1 or endoscopic resection for T1a should undergo EGD every 6 months for 1 year then annually for 5 years with subsequent follow-ups based on symptoms or radiologic findings
  • Patients with pathologic stage II/III or postneoadjuvant stage I-III who underwent neoadjuvant therapy with or without adjuvant therapy should have CT scans of the chest, abdomen and pelvis every 6-12 months for the first 2 years, then annually up to 5 years with subsequent follow-ups based on risk factors and comorbidities
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
4 days ago
Daily intake of cow’s milk formula in early life helps prevent the development of cow’s milk allergy later on without competing with breastfeeding, a recent study has found.