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. 2009 Aug 8;374(9688):477-90.
doi: 10.1016/S0140-6736(09)60617-6. Epub 2009 Jul 20.

Gastric cancer

Henk H Hartgrink  1 , Edwin P M Jansen, Nicole C T van Grieken, Cornelis J H van de Velde
Affiliations

Gastric cancer

Henk H Hartgrink et al. Lancet. .

Abstract

Gastric cancer is the second most frequent cause of cancer death worldwide, although much geographical variation in incidence exists. Prevention and personalised treatment are regarded as the best options to reduce gastric cancer mortality rates. Prevention strategies should be based on specific risk profiles, including Helicobacter pylori genotype, host gene polymorphisms, presence of precursor lesions, and environmental factors. Although adequate surgery remains the cornerstone of gastric cancer treatment, this single modality treatment seems to have reached its maximum achievable effect for local control and survival. Minimally invasive techniques can be used for treatment of early gastric cancers. Achievement of locoregional control for advanced disease remains very difficult. Extended resections that are standard practice in some Asian countries have not been shown to be as effective in other developed countries. We present an update of the incidence, causes, pathology, and treatment of gastric cancer, consisting of surgery, new strategies with neoadjuvant and adjuvant chemotherapy or radiotherapy, or both, novel treatment strategies using gene signatures, and the effect of caseload on patient outcomes.

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Conflict of interest statement

Conflicts of interest

We declare that we have no conflicts of interest.

Figures

Figure 1
Figure 1
Correa sequence precursor gastric lesions Sequence shows increasing risk for development of intestinal-type gastric carcinoma. (A) Normal mucosa. (B) Chronic gastritis. (C) Mucosal atrophy. (D) Intestinal metaplasia. (E) Dysplasia. (F) Intestinal-type carcinoma.
Figure 2
Figure 2
Survival in patients with positive or negative resection lines Data adapted from Songun and co-workers.
Figure 3
Figure 3
Lymph-node stations surrounding stomach 1=right cardial nodes. 2=left cardial nodes. 3=nodes along lesser curvature. 4 s and 4 d=nodes along greater curvature. 5=suprapyloric nodes. 6=infrapyloric nodes. 7=nodes along left gastric artery. 8=nodes along common hepatic artery. 9=nodes around celiac axis. 10=nodes at splenic hilus. 11=nodes along splenic artery. 12=nodes in hepatoduodenal ligament. 13=nodes at posterior aspect of pancreas head. 14=nodes at root of mesenterium. 15=nodes in mesocolon of transverse colon. 16=para-aortic nodes.
Figure 4
Figure 4
Overall survival based on Maruyama Index (MI) analysis Overall survival for 648 patients with MI<5 and MI>5 status. Patients from Dutch D1–D2 trial cases (p<0·0001).
Figure 5
Figure 5
Typical intensity modulated radiotherapy (IMRT) beam setup IMRT beam setup for postoperative gastric cancer treatment. Blue=liver. Red=clinical target volume. Yellow=right kidney. Green=left kidney.
Figure 6
Figure 6
Radiotherapy and IMRT planning for gastric cancer IMRT=intensity modulated radiotherapy. Red line=clinical target volume. Green line=right kidney. Purple line=left kidney. Improved sparing of kidneys and optimum coverage of clinical target volume is possible with present radiotherapy techniques. (A) Result of a two-dimensional anterior-posterior posterior-anterior (APPA) radiotherapy plan. (B) Result of an IMRT plan.
See this image and copyright information in PMC

Comment in

  • Gastric cancer.
    Fujita T. Fujita T. Lancet. 2009 Nov 7;374(9701):1593-4; author reply 1594-5. doi: 10.1016/S0140-6736(09)61946-2. Lancet. 2009. PMID: 19897122 No abstract available.
  • Gastric cancer.
    Fernández-Fernández FJ, Sesma P. Fernández-Fernández FJ, et al. Lancet. 2009 Nov 7;374(9701):1594; author reply 1594-5. doi: 10.1016/S0140-6736(09)61947-4. Lancet. 2009. PMID: 19897123 No abstract available.

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