Stomach cancer is a common cancer of the digestive system. Most of the cases are diagnosed for people over 70 years old. The incidence of stomach cancer is reduced due to better control of risk factors, in particular the eradication of Helicobacter pylori, which halves the risk of gastric cancer. Other risk factors for developing gastric adenocarcinoma are autoimmune atrophic gastritis (Birmer’s disease), heredity, ethnicity, alcohol consumption, and smoking.
For diagnosis - a chest, abdominal, and / or PET scan is performed using 18 FDG. Stomach fibroscopy and echo-endoscopy are performed at the initial assessment stage. A tumor biopsy allows you to make a diagnosis and provides information about overexpression of HER2, this is necessary to offer targeted therapy. An antral biopsy is also performed to check for Helicobacter pylori infection. Tumor markers CA 19-9 and ACE are also analyzed. Stomach cancer is divided into cancer of the cardia (or gastroesophageal junction) and non-cardia (the so-called "distal" cancer).
Cancer of the gastroesophageal or cardiac junction is considered in the presence of oncology of the lower esophagus (most often adenocarcinoma), this pathology can produce gastric reflux (endobrachiosophagus). The proposed treatment is radio-chemotherapy or chemotherapy followed by surgery (for young people) if the tumor is localized. In case of surgical contraindication, for example, due to age or considering the anamnesis, radiation therapy in combination with exclusive chemotherapy is proposed. In case of cancer of the distal stomach, perioperative chemotherapy is proposed (according to the protocol: 4 FLOT cycles before and after surgery (5 FU, oxaliplatin, docetaxel). The operation, as a rule, partial or complete gastrectomy is carried out depending on the size and location, as well as depending on if the lymph nodes are affected.