• For stomach cancer in the United States, the expected incidence in 2012 was 21,320 cases and 10,540 deaths.
  • These cancers are usually adenocarcinomas.
  • In the United States, the site of origin is shifting as more proximal lesions are diagnosed.
  • Prognostic factors relate to tumour extent and include nodal involvement and extension beyond the gastric wall.
  • Ploidy may be an independent prognostic factor.
  • Staging should always include history and physical examination, complete blood cell count, liver chemistries, chest x-ray film, endoscopy with biopsy, ultrasound (determine degree of direct tumour extensions), and computed tomography (CT) of the abdomen (define extragastric disease).
  • Additional studies that may help define extent of disease include upper gastrointestinal imaging, CT of the chest (for gastroesophageal junction [GEJ] lesions), laparoscopy (to rule out peritoneal seeding or early liver metastases), and positron emission tomography.
  • Surgical resection is the primary therapy of resectable gastric and GEJ cancers.
  • Cure rates of 80% or higher are achieved only with early lesions (patients with nodes negative, confined to mucosa or submucosa), which are uncommon in the United States.
  • Role for extended node dissection has not been found in randomized trials.
  • Adjuvant therapy (chemotherapy, irradiation) is indicated on the basis of patterns of relapse and survival results with surgery alone (high rates of local-regional relapse and distant metastases).
  • Adjuvant chemotherapy has a modest, significant benefit and has become the standard in Asia.
  • Irradiation alone reduced local-regional relapse and improved overall survival (OS) in a Beijing trial of 370 patients testing preoperative irradiation versus surgery alone (5-year OS 30% vs. 20%, = 0.009).
  • The U.S. intergroup phase III trial of 556 patients found a survival benefit for combined-modality postoperative irradiation plus chemotherapy versus surgery alone (3-year relapse-free survival 48% vs. 31%, = 0.001; 3-year OS 50% vs. 41%, = 0.005).
  • A British phase III trial of 503 patients demonstrated a survival advantage for perioperative ECF chemotherapy (epirubicin, cisplatin, 5-fluorouracil [5-FU]) when compared with surgery alone (5-year OS 36% vs. 23%, = 0.009).
  • A French phase III trial of 224 patients demonstrated a survival advantage for perioperative cisplatin and 5-FU compared with surgery alone (5-year OS 38% vs. 24%, P= 0.02).
  • The POET trial of 120 patients with GEJ lesions tested preoperative chemotherapy versus chemoradiotherapy (CRT); outcomes trends favoured preoperative CRT over chemotherapy alone for both OS ( = 0.07) and local control ( = 0.06).
  • Combined external beam radiation therapy (EBRT) plus chemotherapy or intraoperative radiation therapy (IORT) produced long-term survival in 10% to 20% of patients in most randomized and nonrandomized trials.
  • Neoadjuvant chemotherapy studies reveal possible increase in resection rates but high incidence of local-regional relapse (consider addition of IORT alone or with EBRT and concurrent chemotherapy to neoadjuvant chemotherapy regimens).
  • Palliative resection of gastric component of disease may be indicated.
  • European phase III trials demonstrate a trend toward improved quality and duration of life with palliative chemotherapy versus supportive care.
  • Multiple-drug chemotherapy regimens have response rates of 30% to 50%, and provide some improvement in OS, including the two- and three-drug regimens ECF, EOX (epirubicin, oxaliplatin, capecitabine), and DCF (docetaxel, cisplatin, 5-FU).
  • A phase III trial of 594 patients showed a significant improvement in OS with the addition of trastuzumab to chemotherapy in patients with HER-2-positive tumours (median OS 13.8 vs. 11.1 months, = 0.0046)

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About Genomic Medicine UK

Genomic Medicine UK is the home of comprehensive genomic testing in London. Our consultant medical doctors work tirelessly to provide the highest standards of medical laboratory testing for personalised medical treatments, genomic risk assessments for common diseases and genomic risk assessment for cancers at an affordable cost for everybody. We use state-of-the-art modern technologies of next-generation sequencing and DNA chip microarray to provide all of our patients and partner doctors with a reliable, evidence-based, thorough and valuable medical service.

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