Chapter 4

Gastric Neoplasms

Sami M. Shimi

Abstract

Neoplasms of the stomach may be benign or malignant. Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer-related death worldwide. Gastric carcinogenesis is probably a multi-step process based on a model referred to as the Correa Cascade. It progresses mainly from H. pylori induced chronic gastritis. Diagnosis is by endoscopy and biopsy. CT and laparoscopy are required for adequate staging. Endoscopic mucosal resection or surgery, are the standard treatment options for Tis, T1 early gastric cancer. No further treatment is necessary if there is no residual or nodal disease. Subtotal or total gastrectomy with regional lymphadenectomy is the standard surgical treatment for early stage gastric cancer with lymph node metastases. In many parts of the world, multi-modality treatment using chemotherapy or chemoradiotherapy (either following surgery or combined pre-operative and post-operative administration) is the preferred treatment strategy. In very advanced cases, a number of clinical trials have produced evidence that chemotherapy improves survival in comparison to best supportive care in selected patients. Gastro-intestinal stromal tumours are responsible for 2.2% of malignant gastric tumours without any gender preference. They have a much better prognosis than adenocarcinoma of the stomach. The incidence of gastric neuroendocrine tumours is constantly rising. The majority of gastric NETs have a benign course and asymptomatic behaviour. Primary gastric lymphoma originates from the gastric wall or from the adjacent lymph nodes. The primary treatment is oncological.

Total Pages: 140-191 (52)

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