Gastric Adenocarcinoma: A Multimodal Approach

Abstract

Despite its declining incidence, gastric cancer (GC) remains a leading cause of cancer-related deaths worldwide. A multimodal approach to GC is critical to ensure optimal patient outcomes. Pretherapy fine resolution contrast-enhanced cross-sectional imaging, endoscopic ultrasound and staging laparoscopy play an important role in patients with newly diagnosed ostensibly operable GC to avoid unnecessary non-therapeutic laparotomies. Currently, margin negative gastrectomy and adequate lymphadenectomy performed at high volume hospitals remain the backbone of GC treatment. Importantly, adequate GC surgery should be integrated in the setting of a multimodal treatment approach. Treatment for advanced GC continues to expand with the emergence of additional lines of systemic and targeted therapies.

Keywords: chemotherapy; gastrectomy; gastric adenocarcinoma; gastric cancer; multidisciplinary approach; multimodal therapy; oncology; radiotherapy.

Figure 1

A large, friable, actively oozing fundic mass with extension into the cardia, found in a 69-year-old gentleman who underwent esophagogastroduodenoscopy (EGD) for anemia and melena. Pathology was consistent with gastric adenocarcinoma.

Figure 2

Correlative endoscopic ultrasound image revealing the muscularis propria (white arrows), serosa (black arrows), and an area in which the mass invades these layers (red oval). The mucosal and submucosal layers are obliterated by the mass and difficult to identify in this image.

Figure 3

Intravenous and oral contrast-enhanced computed tomography (CT) in four different patients with gastric adenocarcinoma. (A) Diffuse gastric wall thickening with loss of normal rugal fold pattern (arrow). (B) Focal, circumferential narrowing of the antrum with marked wall thickening that has irregular spiculation into the perigastric fat (arrow). Small perigastric lymph node is present (arrowhead). (C) Coronal reconstruction shows an intraluminal polypoid carcinoma (arrow) with heterogeneous enhancement and a soft tissue component that infiltrates the lesser omentum. (D) Sagittal reconstruction shows a carcinoma that is producing focal wall thickening (arrow) along the inferior body of the stomach.

Figure 4

Intravenous and oral contrast material-enhanced computed tomography (CT) showing an adenocarcinoma producing irregular wall thickening of the proximal body of the stomach (arrow) with adjacent omental spread of tumor (arrowheads).