Stomach or gastric cancer is frequently diagnosed in our field. Its impact has changed in the last 20 years, and has increased specially in patients younger than 40 years old, but the tumor has also shown changes in its location in the stomach..
The incidence of cancer in the distal half of the stomach has decreased since the 1930s. Nonetheless, in the last two decades the number of cases of cardia and gastroesophageal union cancers has increased.
The local extension of the illness is diagnosed with an oral panendoscope and echoendoscopy, and its possible dissemination is diagnosed with a thoracic-abdominal CAT and a PET-CT.
The prognosis for patients with stomach cancer depends on the extension of the tumor and includes the engagement of the ganglia as well as the extension of the tumor beyond the gastric wall. This information must be gathered before the surgical procedure and permits establishing the operability criteria and/or resectability, but also knowing if a neoadjuvant treatment is necessary (preoperative chemotherapy).
Radical surgery is the standard therapy with a healing intention The tumoral injuries with tumors in the gastric mucosa and submucosa without lymphatic affectation must be treated exclusively with surgery. In case of a complete affectation of the gastric wall and the presence of a lymphatic tumoral affectation, it will be necessary to proceed with postoperative chemoradiotherapy. The surgical technique will be conditioned to the location of the tumor. A total or partial gastrectomy with exeresis of the locoregional glandular groups is the chosen procedure. The total gastrectomy is the chosen procedure for patients suffering from signet ring cell carcinoma. In very specific cases of early gastric carcinoma, the resection of the mucosa with endoscopy is a very important and innovative therapeutic option. In case of inoperable injuries, a good palliative option is placing endoscopic intraluminal prosthesis.
When postoperative radiotherapy is indicated, the chosen procedure is the Intensity modulated radiation therapy (IMTR). Thus, it is possible to limit the radiation received by surrounding organs, and therefore the secondary effects can be reduced sometimes.
In spite of all these therapeutic options, the rate of therapeutic failure increases because of the tumor itself and the regional lymph glands, or due to hematogenous or peritoneal dissemination. This is why it is advisable that those patients suffering from gastric carcinoma should be first assessed and then treated in institutions that offer an integral treatment with the agreement of the different specialists that take part in the procedure.
Por ello resulta muy aconsejable que los pacientes afectos de carcinoma gástrico deban ser inicialmente valorados y posteriormente tratados en instituciones que permitan ofrecer un tratamiento integrado y consensuado por los diferentes especialistas que participan en su tratamiento.