Advanced gastric cancer

Advanced gastric cancer refers to stomach cancer that has spread beyond the primary site to adjacent tissues, lymph nodes, or distant organs. It is often associated with a poor prognosis due to the difficulty of achieving a complete surgical cure and the high likelihood of metastasis.

Key Aspects of Advanced Gastric Cancer

Staging

Advanced gastric cancer typically refers to stages III and IV:

  • Stage III: Cancer has spread to deeper layers of the stomach wall and nearby lymph nodes but has not yet reached distant organs.
  • Stage IV: Cancer has spread to distant organs such as the liver, lungs, or peritoneum (the lining of the abdominal cavity).

Symptoms

Common symptoms of advanced gastric cancer include:

  • Persistent stomach pain or discomfort
  • Unintentional weight loss
  • Nausea and vomiting, sometimes with blood
  • Difficulty swallowing
  • Loss of appetite
  • Fatigue
  • Gastrointestinal bleeding, leading to anemia

Diagnosis

Diagnosis typically involves a combination of the following:

  • Endoscopy: Allows direct visualization and biopsy of the gastric mucosa.
  • Imaging Studies: CT scans, MRI, PET scans, and X-rays to assess the extent of disease spread.
  • Biopsy: Histological examination to confirm malignancy and determine the type and grade of cancer.
  • Laboratory Tests: Blood tests, including tumor markers like CEA and CA 19-9, can provide additional information about the disease.

Treatment Options

Treatment of advanced gastric cancer usually involves a multimodal approach:

  1. Surgery:
  • Subtotal or Total Gastrectomy: Removal of part or all of the stomach, often with lymph node dissection.
  • Palliative Surgery: To relieve symptoms like obstruction or bleeding when a cure is not possible.
  1. Chemotherapy:
  • Used to shrink tumors before surgery (neoadjuvant) or to eliminate residual cancer cells after surgery (adjuvant).
  • Common regimens include combinations of drugs such as fluorouracil (5-FU), cisplatin, capecitabine, oxaliplatin, and irinotecan.
  1. Radiotherapy:
  • Often combined with chemotherapy (chemoradiation) to improve outcomes in locally advanced cases.
  1. Targeted Therapy:
  • Agents like trastuzumab (for HER2-positive tumors) and ramucirumab (VEGF receptor inhibitor) can be used.
  1. Immunotherapy:
  • Checkpoint inhibitors like pembrolizumab for patients with specific genetic markers or high levels of PD-L1 expression.
  1. Palliative Care:
  • Focuses on symptom management and quality of life for patients with terminal disease. This may include pain relief, nutritional support, and psychological support.

Prognosis

The prognosis for advanced gastric cancer is generally poor, especially for stage IV disease, with a median survival time typically less than a year. However, early and aggressive treatment can improve outcomes for some patients.

Conclusion

Advanced gastric cancer is a challenging condition requiring a comprehensive treatment strategy tailored to the individual patient’s disease stage, molecular characteristics, and overall health status. Multidisciplinary care involving surgeons, oncologists, radiologists, and palliative care specialists is essential for optimal management.