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Current status of endoscopic submucosal dissection for the management of early gastric cancer: A Korean perspective  [cached]
Hoon Jai Chun,Bora Keum,Ji Hyun Kim,Sang Young Seol
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i21.2592
Abstract: The early diagnosis of gastric cancer allows patients and physicians to pursue the option of endoscopic resection, which is significantly less invasive than conventional surgical resection. In Korea, the use of endoscopic submucosal dissection (ESD) has been increasing, and many reports on ESD have been published. In addition, Korean gastroenterologists from several hospitals performing ESD have conducted formal meetings to discuss useful information regarding ESD. Here, we discuss the Korean experience with ESD, including outcomes and prospects of endoscopic treatments.
EUS in the management of gastric cancer
Ioannis S. Papanikolaou,Maria Triantafyllou,Konstantinos Triantafyllou,Thomas Rosch
Annals of Gastroenterology , 2011,
Abstract: In this review we summarize latest data on the role of endoscopic ultrasonography (EUS) in the diagnosis and management of gastric carcinoma. Since its initial introduction in clinical practice, EUS has been considered a valuable tool for the diagnosis and locoregional staging of gastric cancer and a method of inarguable value for the assessment of gastric wall involvement and presence of infiltrated paragastric lymph nodes. Moreover, another application of EUS, i.e. its role in the assessment of early gastric cancer has come into focus, especially nowadays in the era of endoscopic mucosal resection and endoscopic submucosal dissection. These topics, together with other aspects of EUS in gastric cancer are discussed. On the other hand, despite its indisputable value, EUS for gastric cancer evaluation is “threatened” nowadays by other modern cross-sectional imaging methods (including trans-abdominal ultrasound, CT, MRI and PET), whose quality has lately improved. A brief comparison between the available imaging methods, attempts to show that their role ismore complementary than competitive. Keywords endoscopic ultrasonography, EUS, gastric cancer, locoregional staging, TNM Ann Gastroenterol 2011; 24 (1): 9-15
Gastric Cancer: Current Status of Diagnosis and Treatment  [PDF]
Tsunehiro Takahashi,Yoshiro Saikawa,Yuko Kitagawa
Cancers , 2013, DOI: 10.3390/cancers5010048
Abstract: Gastric cancer is the second leading cause of death from malignant disease worldwide and most frequently discovered in advanced stages. Because curative surgery is regarded as the only option for cure, early detection of resectable gastric cancer is extremely important for good patient outcomes. Therefore, noninvasive diagnostic modalities such as evolutionary endoscopy and positron emission tomography are utilized as screening tools for gastric cancer. To date, early gastric cancer is being treated using minimally invasive methods such as endoscopic treatment and laparoscopic surgery, while in advanced cancer it is necessary to consider multimodality treatment including chemotherapy, radiotherapy, and surgery. Because of the results of large clinical trials, surgery with extended lymphadenectomy could not be recommended as a standard therapy for advanced gastric cancer. Recent clinical trials had shown survival benefits of adjuvant chemotherapy after curative resection compared with surgery alone. In addition, recent advances of molecular targeted agents would play an important role as one of the modalities for advanced gastric cancer. In this review, we summarize the current status of diagnostic technology and treatment for gastric cancer.
The Current State of Diagnosis and Treatment for Early Gastric Cancer  [PDF]
Tomoyuki Yada,Chizu Yokoi,Naomi Uemura
Diagnostic and Therapeutic Endoscopy , 2013, DOI: 10.1155/2013/241320
Abstract: The prognosis for gastric cancer depends on its stage; so, detection in the early stage of disease is important, when complete and curative removal is possible. Accurate diagnosis can be facilitated by a sound understanding of the basic findings of white light endoscopy of early gastric cancer, and diagnosis can be refined further by the combined use of other imaging modalities such as image-enhanced endoscopy including chromoendoscopy and endoscopic ultrasonography. Minimally invasive endoscopic treatment has come to be the preferred therapeutic approach for early gastric cancer. In addition to conventional endoscopic mucosal resection, a new technique known as endoscopic submucosal dissection (ESD) has spread rapidly worldwide. Indeed, strategies for ESD have been established, devices developed, its indications expanded, and its safety and long-term results extensively reported. Some unique combination therapies involving endoscopy and surgical treatment have also been reported. It is anticipated that the number of patients undergoing endoscopic therapy will continue to increase, and the ongoing developments in endoscopic treatment are expected not only to improve gastric cancer prognosis but also to maintain good quality of life after treatment. 1. Introduction Despite both the incidence and mortality rates of gastric cancer showing decreasing trends, gastric cancer remains one of the most common causes of death by cancer worldwide [1, 2]. There are significant regional differences in gastric cancer onset, with East Asian countries, including Japan and Korea, known to have a particularly high incidence rate compared to the Western countries. In Japan, following the introduction of a mass screening program that utilizes double-contrast barium radiography for early the detection of gastric cancer and alongside developments in endoscopic equipment and improved diagnostic capability, gastric cancer is now being detected more often in the asymptomatic stages [3]. As a result, approximately 50% of the cases of gastric cancer currently treated in Japan are early stage disease [4]. In contrast, in Western countries, gastric cancer is often detected at an advanced stage and prognosis remains poor. Prognosis depends on the stage at which it is detected, and complete excision of the cancer is the only curative option. The excellent postoperative results for early gastric cancer, with a 5-year survival rate of over 90% in both Western countries and Japan, indicate just how important it is to detect the cancer at the earliest possible stage [5, 6]. Moreover, with
Immunohistochemical Biomarkers in Gastric Cancer Research and Management  [PDF]
Elena Lastraioli,Maria Raffaella Romoli,Annarosa Arcangeli
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/868645
Abstract: Gastric cancer still represents a major health problem, despite a decrease in its incidence in the last years. Due to the social impact of gastric cancer (GC), there is a need for novel biomarkers in order to stratify patients into appropriate screening, surveillance, or treatment programs. Although histopathology remains the most reliable and less expensive method, numerous efforts have been made searching for novel biomarkers. In recent years, several molecules have been identified and tested for their clinical relevance in GC management. In this paper, we will focus on a well-known GC marker, whose determination is mandatory in GC, HER2, a marker whose correlation with prognosis is still controversial (VEGF-A) and a quite novel, unconventional marker, the ether-à-go-go-related gene 1 (hERG1). All these proteins can be easily detected with immunohistochemistry, a technique widely used both in diagnostic and research laboratories that represents a link between surgical and molecular pathology, basic science, and clinical medicine. 1. Gastric Cancer Gastric cancer (GC) still represents a major health problem, despite a decrease in its incidence in the last years [1]. According to the most recent estimates, GC accounts for 8% of the total cancer cases and for 10% of the deaths for all cancers [2]. GC is characterized by a clear geographical distribution, with over 70% of the cases occurring in developing countries. This is partly due to dietary habits as well as Helicobacter pylori infection prevalence. Indeed, the reasons accounting for the decreased GC incidence in most countries are related to changes in dietary habits, amelioration of food preservation, reduction in H. pylori chronic infection [3–5] as well as reduction in smoking [1]. The majority of stomach tumors are sporadic, while only a small percentage have a familial component, with an autosomal pattern of inheritance. GC is a multifactorial disease characterized by both genetic and environmental components. In sporadic cancers of the stomach, the environmental component seems to be predominant. Conversely, the genetic component plays a major role in familial cancers. About 90% of GCs are classified as adenocarcinomas, whilst the remaining 10% is represented by non-Hodgkin lymphomas, leiomyosarcomas, squamous cell carcinomas, and undifferentiated carcinomas. In this paper, we will mainly refer to adenocarcinomas, addressing them as simply “GCs.” According to the Lauren’s classification, two subtypes of GC can be distinguished basing on their different histology: the intestinal (I-GC) and
Gastric cardia cancer and precursor lesions- current dilemmas
Jovanovic I.,Mouzas I.
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Over the last two decades a marked increase in the incidence of adenocarcinoma of the gastroesophageal junction has been observed. This carcinoma can develop, either from short segment Barrett s esophagus or metaplastic gastric epithelium in the cardia. Much confusion exists regarding the malignant potential of such short segments of intestinal metaplasia, at or above the esophagogastric junction. Furthermore, it is currently unclear whether intestinal metaplasia at the esophagogastric junction and in the distal esophagus, represent a continuum of the same underlying disease process, i.e., gastroesophageal reflux, or constitute different entities with a different pathogenesis. Such a difference may not be crucial since all patients with cancer would undergo surgical procedure, but the identification of precursor lesions is merited since different therapeutic and surveillance protocol can be established. Biopsies below the Z line might show specialized epithelium in some patients and the question is whether this is another form of short segment Barrett s esophagus or whether it is related to a generalized atrophic process of the stomach. Epidemiological data and classic parameters for the diagnosis of gastroesophageal reflux disease do not currently support a causal role of gastroesophageal reflux in the pathogenesis of specialized intestinal metaplasia of the gastric cardia. Results from recent studies still leave us with a dilemma concerning the role of reflux disease and Helicobacter pylori infection in the development of carditis and consecutive intestinal metaplasia. It appears that such discrepancies often originate from different biopsy sampling protocols. At present, there are no accepted criteria concerning the position of gastric cardia. Anatomic and histological landmarks do not always coincide. A promising tool for future investigation may be the different expression of cytokeratins in metaplastic epithelium arising from the esophageal, as opposed to the gastric mucosa. This article reviews the results of the recent studies and presents dilemmas relating to the burning issue of gastric cardia cancer.
Endoscopic management of gastric dysplasia: Cutting edge technology needs a new paradigm  [cached]
Seong Woo Jeon
World Journal of Gastrointestinal Endoscopy , 2010,
Abstract: There has been tremendous progress in endoscopic techniques for the management of premalignant or malignant gastric lesions. Gastric cancer remains the second most common cause of cancer related mortality worldwide. This means that there is a need for early detection and diagnosis of premalignant lesions or early cancer in clinical practice. Despite substantial development of endoscopic resection techniques, the management of gastric premalignant lesions is controversial because of the lack of consensus and accurate risk stratification. Future study of various aspects would clarify these issues but in the meantime we should reconsider the current algorithm approach for the management of gastric low grade dysplasia.
Clinical management of gastric cancer: results of a multicentre survey
Xiaolong Zhang, Nanjing Li, Wen Wei, Wenxiu Yao, Ke Xie, Jiankun Hu, Lida Shen, Weizheng Ji, You Lu, Feng Wen, Yu Jiang, Feng Xu, Hong Feng, Feng Bi, Qiu Li, The Western Cooperative Gastrointestinal Oncology Group of China
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-369
Abstract: A questionnaire asking the treatment options for gastric cancer cases was sent to 394 Chinese oncology specialists, including surgical oncologists, medical oncologists, and radiation oncologists working in hospitals joined in The Western Cooperative Gastrointestinal Oncology Group of China. The questionnaire involved a series of clinical scenarios regarding the interpretation of surgery, neoadjuvant, adjuvant, and advanced treatment planning of gastric cancer.Analysis of 358 respondents (91%) showed variations between each specialization and from the recommended guidelines in the management approaches to specific clinical scenarios. The majority of specialists admitted that less than 50% of patients received multidisciplinary evaluation before treatment. The participants gave different responses to questions involving adjuvant, neoadjuvant, and advanced settings, compared to the recommended guidelines.These results highlight the heterogeneity of the treatment of gastric cancer. Surgical oncologists, medical oncologists, and radiation oncologists are not adhering to the recommended guidelines.Despite the downward trend for cancer incidence and mortality in most countries, gastric cancer has become the second leading cause of cancer-related deaths worldwide with an annual rate of 700,000 deaths [1]. Almost two-thirds of the cases occur in developing countries, with 42% occurring in China alone, where gastric cancer remains the most deadly cancer among both sexes [2].Surgical resection, chemotherapy and radiotherapy are mainstay of treatment for patients with gastric cancer [3-5]. However, several questions concerning the treatment of gastric cancer remain. First, the type of resection and the role of extensive lymphadenectomy have been the subjects of international debate. Second, is there an ideal setting or regimen that predicts whether chemotherapy and/or radiotherapy should be provided before and/or after surgery as (neo) adjuvant treatment in patients with locali
Comparative study of laparoscopic vs open gastrectomy in gastric cancer management  [cached]
Giuseppe S Sica,Edoardo Iaculli,Livia Biancone,Sara Di Carlo
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i41.4662
Abstract: AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit. METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality. RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series. CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer.
Comparative study of laparoscopic vs open gastrectomy in gastric cancer management  [cached]
Giuseppe S Sica,Edoardo Iaculli,Livia Biancone,Sara Di Carlo
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i41.4602
Abstract: AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit. METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality. RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series. CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer.
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