Gastric%20cancer Management

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

GP symposium 2019: Updates on the Use of Probiotics in Clinical Practice

Dr. Gwee Kok Ann, Dr. Warren Lee, Dr. Mark Tang, Dr. Lim Sanghyun, 24 Apr 2019

Modulation of gut microbiota with probiotics has been studied in a wide range of clinical settings, in the hope of achieving health benefits in the host. Under the auspices of the Asian GI Faculty, four experts discussed the role of probiotics in clinical practice at the recent IMPACT (Improving Medical Practice through Advancement in Clinical Treatment) GP symposium in Singapore sponsored by DCH Auriga.

Long COVID: What we have learned so far

Prof. Ghassan Dbaibo, 27 Apr 2023

The WHO defines long COVID as a condition that occurs 3 months from COVID-19 onset, whose symptoms last ≥2 months and cannot be attributed to an alternative diagnosis. In an interview with MIMS Doctor, Professor Ghassan Dbaibo of the Center for Infectious Diseases, American University of Beirut, Beirut, Lebanon, describes the evolving attitudes towards long COVID among healthcare professionals (HCPs), some unexpected predisposing factors, potential biological mechanisms behind prolonged symptom duration and shares data on vaccination’s protective effects against long COVID.

Updates in the Management of Gastric Cancer

Prof Yasuhiro Kodera, Prof Winnie Yeo, 23 Jul 2019

Globally, gastric cancer is the third leading cause of cancer death.¹ Its primary treatment is gastrectomy with adjuvant chemotherapy or chemoradiotherapy to improve survival. Although neoadjuvant chemotherapy or adjuvant chemoradiation is preferred in Western countries, postoperative adjuvant chemotherapy is still the mainstream therapeutic strategy in Asia.² At a recent symposium in Hong Kong, experts discussed updates in the treatment and management of gastric cancer, with a focus on the use of S-1 (TS-ONE^®; Taiho Pharma Singapore), a combination of tegafur, gimeracil, and oteracil potassium.