Gastric cancer is a difficult malignancy to treat. A combined approach of surgery, chemotherapy and radiation can be challenging for patients to tolerate and the survival rates are poor. Dr. Vadim Gushchin, director of gastrointestinal oncology at the Institute for Cancer Care at Mercy Medical Center, discusses the little-known but dangerous disease.
* The incidence of gastric cancer in the United States is relatively low. However, this is not good news for more than 20,000 patients who will be diagnosed with this disease in 2009. Diagnostic studies aimed at early cancer detection or screening studies are not effective in tumors with relatively low incidence. As a result, gastric cancer is often not discovered (via an upper endoscopy and biopsy) until it is advanced.
* Genetic predisposition accounts only for a minority of gastric cancer cases. The dramatic decrease in gastric cancers in the U.S. over the past 100 years is attributed to better food refrigeration and preparation techniques (e.g. avoiding nitrates and smoking in food preservation).
* New immigrants from Asia, South America and Eastern Europe appear to be at the highest risk for developing gastric cancer. The disease is less prevalent in subsequent generations.
* Unfortunately, there are no proven strategies to prevent this disease. At present, research is focused on effective treatments that not only prolong survival, but also preserve the patients' quality of life during and after the treatment.
* Surgery for gastric cancer became a "lost art," and studies have shown that surgical treatment of gastric cancer in the U.S. is mostly inadequate.
* Treatment results for gastric cancer in Japan and other Asian countries have been better than those in the Western world. In part, this is explained by a superior surgical technique of Asian surgeons. Many Western surgeons who have adopted the Japanese approach in treating gastric cancer have significantly improved their patients' outcomes.
Today, the most promising strategy is combining meticulous surgery (followed by thorough pathological testing of the tumor and lymph nodes) and chemotherapy before and after surgery.
All treatment decisions should be done by a multidisciplinary team of surgical, medical and radiation oncologists after accurate staging of the tumor and prior to treatment.
