Friday, 9 December 2016

Gastric cancer diagnosis and treatment

Gastric cancer diagnosis and treatment
The goal of obtaining laboratory studies is to assist in determining optimal therapy. Potentially useful tests in patients with suspected gastric cancer include the following:
·         CBC: May be helpful to identify anemia, which may be caused by bleeding, liver dysfunction, or poor nutrition
·         Liver function tests
·         Electrolyte panels
·         Tumor markers such as CEA and CA 19-9: Elevated CEA in 45-50% of cases; elevated CA 19-9 in about 20% of cases
Imaging studies that aid in the diagnosis of gastric cancer in patients in whom the disease is suggested clinically include the following:
·         Esophagogastroduodenoscopy (EGD): To evaluate gastric wall and lymph node involvement
·         Double-contrast upper GI series and barium swallows: May be helpful in delineating the extent of disease when obstructive symptoms are present or when bulky proximal tumors prevent passage of the endoscope to examine the stomach distal to an obstruction
·         Chest radiography: To evaluate for metastatic lesions
·         CT scanning or MRI of the chest, abdomen, and pelvis: To assess the local disease process and evaluate potential areas of spread
·         Endoscopic ultrasonography (EUS): Staging tool for more precise preoperative assessment of the tumor stage
Biopsy of any ulcerated lesion should include at least six specimens taken from around the lesion because of variable malignant transformation. In selected cases, endoscopic ultrasonography may be helpful in assessing depth of penetration of the tumor or involvement of adjacent structures.
Treatment
Surgery
Surgery remains the mainstay treatment for localised gastric adenocarcinoma (confined to the stomach). The exact procedure performed is determined by the size and location of the tumour as well as the ability to achieve surgical margins clear of disease. The surgical approach in gastric cancer depends on the location, size, and locally invasive characteristics of the tumor.
Types of surgical intervention in gastric cancer include the following:
·         Total gastrectomy, if required for negative margins
·         Esophagogastrectomy for tumors of the cardia and gastroesophageal junction
·         Subtotal gastrectomy for tumors of the distal stomach
·         Lymph node dissection
Chemotherapy
Chemotherapy has been shown to increase survival and the time it takes the disease to progress, compared to best supportive care alone. An improved quality of life with chemotherapy compared to best supportive care has also been demonstrated. Antineoplastic agents and combinations of agents used in managing gastric cancer include the following:
·         Platinum-based combination chemotherapy
·         Trastuzumab
·         Ramucirumab

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