Management Of Gastric Cancer

Gastric cancer has been one of the great malignant scourges affecting man kind for as long as medical records have been kept. Until operative resection pioneered by Bilroth and others became available, no effective treatment was feasible and death from cancer was virtually inevitable. Even with resection by total gastrectomy, the chances of tumor eradication remained small. Over recent years, however, the situation has been changing. Some changes have resulted from better understanding of the disease, early detec tion, and better management techniques with applied clinical research, but the reasons for other changes are poorly understood. For example, the incidence of gastric cancer is decreasing, especially in westernized societies, where it has fallen from one of the most common cancers to no longer being in the top five causes of cancer death. Still it remains the number one killer of adult males in Japan and Korea. Whether the reduced incidence in western societies is a result of dietary changes or methods of food preservation, or some other reason, is as yet uncertain. Improvements in outcome have been reported from mass screening and early detection; more refined techniques of establishing early diagnosis, tumor type, and tumor extent; more radical surgical resection; and resection at earlier stages of disease.

Although there has been a slow but steady decrease in incidence, gastric cancer remains the second leading cause of cancer death worldwide. Several aspects of the oncological and surgical management are still controversial and so gastric cancer represents a challenge for the surgeon. This book aims to delineate the state of the art in the surgical and oncological treatment of gastric cancer, describing the new TNM staging system, the extent of visceral resection and lymphadenectomy focusing on the different open and minimally invasive surgical techniques and discussing intraoperative chemohyperthermia and neoadjuvant and adjuvant treatment. Operative endoscopy and endoscopic ultrasonography are also discussed, as these now have an important role in both diagnostic work-up and palliative care of gastric cancer patients. Only a multidisciplinary approach involving the surgeon, gastroenterologist, and oncologist can produce the comprehensive and integrated overview that today constitutes a winning strategy for the optimization of results.What we hope we have achieved is a flexible, up-to-date, exhaustive publication, rich in illustrations and consistent with evidence-based medicine.

Advances in Surgical Pathology: Gastric Cancer provides a concise, updated review of the pathological characteristics of gastric cancer, with an emphasis on exploring practical issues and recent developments. The book features current and emerging concepts in the field of gastric cancer, a disease whose management requires a multidisciplinary approach in which pathology plays a key role. Its six sections cover the essential histopathology of gastric cancer as well as related topics such as imaging evaluation, molecular diagnosis, and personalized treatment, among other areas of interest. Individual chapters written by international experts in the fields of pathology, gastrointestinal medical oncology, cancer epidemiology, and gastrointestinal radiology, address the fundamental issues surrounding gastric cancer, including its epidemiology, basic diagnostic features, differential diagnoses, pitfalls and complications, and treatments. Endoscopic evaluation and histology correlation are emphasized. The screening, clinical management, and treatment of gastric cancer are summarized in related book sections. Recent findings regarding the roles of immunohistochemistry and molecular testing in the diagnosis, prognosis, and personalized treatment of gastric cancer are also reviewed. The book also includes current knowledge regarding the molecular alteration of gastric cancer carcinogenesis and its impact on patient care.

Included here is a discussion of the pathophysiological aspects and risks of laparoscopic staging (such as trocar metastases) on the basis of international experience.

The overall prognosis for patients with gastric cancer remains poor as tumors are often diagnosed at an advanced stage, despite new developments and technical advances in endoscopic diagnosis and therapy. This publication brings together leading experts in the fields of basic research and clinical management of gastric cancer, to share their expertise with the clinical community. State-of-the-art reviews discuss the pathogenesis of and the most important risk factors for the development of gastric cancer, potential benefits of chemoprevention and Helicobacter pylori eradication. Moreover, new diagnostic modalities and surgical therapy, including the potential benefits of neoadjuvant and adjuvant therapies, are presented. As most patients require palliative therapy because of locally advanced or metastasized cancers, several reviews are dedicated to advances in the chemotherapy of advanced gastric cancers and peritoneal metastasis. Finally, future approaches towards a molecular diagnosis and therapy are described. Those involved in the management of gastric cancer patients will find the information presented in this publication of utmost help and will benefit greatly for their daily routine.

This issue of Surgical Oncology Clinics of North America, Guest Edited by Neal Wilkinson, MD, is devoted to the Management of Gastric Cancer. Articles in this issue will focus on Epidemiology; Genetics and Prophylactic Surgery; Endoscopic Diagnosis & Staging; Gastric Stromal Tumors (GIST); Management of Early Stage Gastric Cancer; Endoscopic Mucosal Resection (EMR); Tailored Lymphadenectomy; Laparoscopic Resection Gastric Cancer - Western Experience; Gastric Cancer - Eastern Experience; Update of Gastric Cancer Clinical Trials; Preoperative and Postoperative Chemotherapy for Gastric Cancer; and Phase I and II Clinical Trials.