Gastric Cancer

Gastric cancer (GC) continues to be an important issue in the world of oncology. The diagnosis of GC portends a poor prognosis with reported overall 5-year survival rates between 20% and 25% across all stages in most industrialized nations. Worldwide, most countries are experiencing a steady decline in the incidence of GC. Contrary to this observation, the projected incidence for India is on increasing trend. All patients suspected to have GC should undergo an endoscopic evaluation with a biopsy to confirm the tissue diagnosis. Appropriate stage is determined with a contrast-enhanced CT scan of thorax, abdomen and pelvis. Endoscopic ultrasound evaluation of assessing primary tumor and staging laparoscopy are selectively performed for specific indications. Early gastric cancers (T1a and selected T1b tumors) can be managed by endoscopic resection techniques (EMR/ESD) or upfront surgery (local resection/gastrectomy). Patients with advanced T stage and/or with suspected lymph node-positive disease are best suited to undergo perioperative chemotherapy with a radical D2 gastrectomy, after excluding the possibility of metastatic disease. Other approaches include upfront D2 gastrectomy followed by adjuvant chemotherapy or adjuvant chemoradiotherapy. Patients with metastatic disease are offered chemotherapy with palliative intent if the performance status is suitable. Patients with poor general condition are offered best supportive care only.