Management of Gastric Cancer

Gastric cancer is the fifth most common cancer and the second most common cause of cancer death worldwide. More than 50% of the patients have advanced disease at diagnosis and in this case the disease has a poor outcome. The staging of gastric cancers is based on endoscopic ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography, in addition to the laparoscopic staging. Many improvements in the surgical techniques have been seen in the last decade. Laparoscopic surgery is an emerging approach which offers important advantages: less blood loss, reduced postoperative pain, accelerated recovery, early return to normal bowel function and reduced hospital stay. D1 lymphadenectomy, with a goal of examining 15 or greater lymph nodes is a standard. D2 dissection is considered as a standard in several institutions especially in eastern Asia. Perioperative chemotherapy and adjuvant concurrent radiochemotherapy are recognized as standards treatments. Palliative chemotherapy is the mainstay treatment of advanced stages of the disease (metastatic and non-operable tumors). Despite these treatment advances, the prognosis of gastric cancer remains poor with a 5-year survival ranging from 10 to 15% in all stages combined.