Gastric Cancer

Excerpt

Gastric cancer is the fourth leading cause of cancer deaths worldwide and the fifth most frequently diagnosed cancer. The incidence of gastric cancer shows significant geographic variation and has declined over the past 3 decades. Risk factors include dietary habits, genetic syndromes, Helicobacter pylori infection, and age. High-risk populations may benefit from screening programs, although such programs are uncommon in Western countries. Gastric cancer primarily arises in 2 histologic forms: intestinal and diffuse-type cancers. Gastric cancers are more common in the distal stomach (antrum and body), but proximal gastric cancers are increasing in frequency.

Often, gastric cancer is advanced at diagnosis due to the late onset of symptoms. Endoscopy is the diagnostic test of choice, allowing for visual inspection, tissue sampling, and resection of early tumors. Gastrectomy remains the mainstay of curative treatment, with the extent of gastric resection tailored to tumor location and size. A comprehensive lymphadenectomy is also recommended. Patient outcomes improve with perioperative chemotherapy and potentially with radiotherapy.

Recently, targeted agents and immunotherapy have significantly improved outcomes in patients with actionable mutations. Despite these advancements, the overall prognosis for gastric cancer remains poor, especially in less developed regions. Gastroesophageal junction (GEJ) tumors have separate staging, treatment, and prognosis. Please see StatPearls' companion resource, "Esophageal Cancer," for more information on these malignancies.