Gastric cancer - An overview

Abstract

Gastric cancer remains the second leading cause of cancer-related deaths worldwide. Apart from dietary factors, Helicobacter pylori is currently considered as one of the most important risk factors. The incidence of gastric cancer in Hong Kong is not high enough to justify population screening with upper endoscopy. Clinical features, however, can be quite non- specific. Patients may be asymptomatic, especially during early stage of the disease. Upper endoscopy should be considered in patients presenting with recent onset of ulcer-like symptoms, weight loss, symptoms of obstruction, bleeding or anaemia, especially if they are elderly. By the time clinical features of metastases are apparent, the disease would be beyond cure. In recent years, endoscopic ultrasonography and staging laparoscopy have greatly enhanced the pre-operative staging accuracy. Such information will be important if neoadjuvant chemotherapy is contemplated for advanced disease. At present, surgery remains the mainstay of potentially curative treatment. Post-operative adjuvant chemotherapy is not recommended unless on a proper trial basis. Early results of pre-operative neoadjuvant chemotherapy are encouraging but further studies are required to confirm its efficacy. For unresectable gastric cancer, various treatment options are available and selection has to be individualised.