Gastric%20cancer Treatment

Treatment

Surgical Intervention

Surgery with lymph node dissection is the primary treatment option in early stage/resectable gastric cancer
- Though majority still relapse following resection, it is potentially curative
- For ≥stage 1B combined modality approaches are standard

Standard goal is complete resection with negative margins
- Extent of resection is determined by preoperative stage of the cancer

Gastrectomy with D1 or a modified D2 lymph node dissection with a goal of examining at least 16 lymph nodes for patients with localized resectable cancer

Endoscopic Therapies

Endoscopic resection is necessary to accurately stage early-stage cancers (T1a or T1b)
For the treatment of patients with early stage (Tis or T1a) gastric cancer, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been used as an alternative to surgery

ESD is the treatment of choice for most gastric superficial neoplasmic lesions
EMR or ESD of focal nodules (≤2 cm) performed during early-stage cancer can provide more information on the degree of differentiation, presence of lymphovascular invasion and depth of invasion, and can be potentially therapeutic

It has been shown that en-bloc excision by ESD is more effective than EMR in curing early gastric cancer
For lesions >5 cm in diameter, complete resection rates were significantly better for ESD while in lesions <5 cm in diameter, there were no difference between EMR and ESD rates regardless of location
T4 tumors require en bloc resection of involved structures
Indications for EMR or ESD includes:
- Carcinoma in situ
- Lesions ≤2 cm in diameter
- Well or moderately differentiated lesions
- Confined to the mucosa
- With clear lateral and deep margins
- Not ulcerated
- Without lymph node metastases or lymphovascular invasion

Gastrectomy

Distal, subtotal or total gastrectomy is recommended for T1b-T3 tumors

Subtotal Gastrectomy

A procedure that involves removal of a section of the stomach, and may include part of the esophagus or 1st part of the duodenum; the remaining section of the stomach is then reattached
Preferred approach for distal gastric cancers
May be carried out if a macroscopic proximal margin of 5 cm can be achieved between the tumor and esophagogastric junction
Eating is much easier after surgery

Total Gastrectomy

A procedure involving the surgical removal of the stomach as a whole, including adjacent lymph nodes and omentum, as well as part of the esophagus that is attached to the small intestines
Preferred gastrectomy for patients with stage IB-III gastric cancer
Proximal gastrectomy and total gastrectomy are both indicated for proximal gastric cancers and are typically associated with postoperative nutritional impairment
- A margin of 8 cm is recommended for diffuse type cancers

Lymph Node Dissection

It is the removal of regional lymph nodes
It should be included in gastric resection
Classification depends on the extent of lymph nodes removed during gastrectomy:
- D0 refers to incomplete resection of N1 lymph nodes
- D1 involves gastrectomy and the removal of the involved proximal or distal part of the stomach or the entire stomach, including the greater and lesser omental lymph nodes
- D2 involves D1 with additional removal of the anterior leaf of the transverse mesocolon and all the nodes along the corresponding arteries

Laparoscopic Surgery

An alternative to open surgery due to potential benefits of:
- Less blood loss
- Reduced postoperative pain or morbidity
- Reduced recovery time
- Early return to normal bowel function
- Reduced hospital stay

Not recommended for T4b or N2 bulky gastric cancer
Although there are concerns about long-term outcomes and the possibility for reduced nodal harvest

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.