Position PaperExpert opinion on management of gastric and gastro-oesophageal junction adenocarcinoma on behalf of the European Organisation for Research and Treatment of Cancer (EORTC) - gastrointestinal cancer group
Introduction
Gastric cancer is a significant global problem. Recent figures indicate that 1.4 million new cases of gastro-oesophageal and gastric cancer are diagnosed annually and 1.1 million deaths are attributed to the disease.1 While the rate of fundus and distal gastric cancers (often associated with Helicobacter pylori infection) has declined over past decades, the incidence of adenocarcinoma for the gastric cardia and gastro-oesophageal (GE) junction continues to rise. Areas with a particularly high incidence of gastric cancer include parts of Asia, Eastern Europe and South America with enormous differences between populations in the pathologic distribution and overall survival as shown by Maruyama et al.2
As with other malignancies, treatment for gastric cancer depends on the initial stage of the disease. Where possible, surgery is the cornerstone of treatment with curative intent, but recurrences frequently occur. Multiple clinical studies have therefore looked at whether adjuvant (and/or neo-adjuvant) chemotherapy can improve patient outcomes.
The European Organisation for Research and Treatment of Cancer (EORTC) Gastric Cancer Working Party took place at Nice (France) on 10 November 2006. Seven experts took part in the meeting and elaborated this review for gastric and (GE junction) adenocarcinoma management, as regards to literature or international meeting data using evidence-based medicine principles.
Section snippets
Diagnosis of gastric/GE junction adenocarcinoma
Diagnosis should be made from a gastroscopic or surgical biopsy and the histology given according to the World Health Organisation criteria. Particular attention is to be paid to familial history of gastrointestinal polyposis and/or gastrointestinal cancer [e.g. Hereditary Non Polyposis Colon Cancer (HNPCC)3 or Hereditary Diffuse Gastric Cancer due to a mutation of the gene coding for E-Cadherin].
Staging and risk assessment
Initial staging consists of clinical examination including Virchow’s lymph nodes and digital rectal examination, blood counts, liver and renal function tests, chest X-ray and (spiral) Computed Tomography (CT) scan of the abdomen and chest (if GE-junction cancer). Endoscopic ultrasound and laparoscopy may help to optimally determine resectability.
Further staging can include laparoscopy with peritoneal lavage for cytology to rule out peritoneal metastases, especially in case of T3–4 and/or
Treatment plan
Multi-disciplinary treatment planning is mandatory.
Conflict of interest statement
An unrestricted educational grant was provided by Sanofi-Aventis to the EORTC-GI group.
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