Gastric carcinoma is a malignant (cancerous) tumor in the stomach. The disease can also spread to other parts of the body, such as the lungs or lymph nodes. If the cancer has not spread when diagnosed, it is called stage I GC. If it has spread, the cancer is stage IV GC.
About 90% of all GCs are sporadic, with around 10% of cases showing a familial aggregation [21]. Due to increased standards of hygiene, conscious nutrition, Helicobacter pylori eradication and other factors, the incidence rates for GC have fallen within recent decades. Nonetheless, a high risk of GC still exists. This is why mass screening with photofluorography – with a sensitivity of 70-90% and a specificity of 80-90% – remains an important approach for primary prevention. The same applies to chemoprevention, as well as the use of endoscopic surveillance programs in patients with a higher risk of developing GC.
Diagnosis
The first step is to check for signs of a gastric tumor, such as abdominal pain and a large, firm lump in the abdomen. If these are not present, the doctor may order tests to help find out if the person has a cancerous tumor. This may include blood tests, an electrocardiogram or a CT scan of the abdomen.
If the diagnosis is a malignant tumor, the doctor will decide on a treatment plan. The most common treatment is surgery to remove the cancerous tissue from the stomach. Surgery is often done together with chemotherapy and/or radiation therapy. In some cases, doctors give these treatments before surgery (neoadjuvant chemoradiation therapy). This helps kill more cancer cells and shrink the tumor to make it easier to remove during surgery.
Some people have a type of tumor in the stomach that does not grow or spread. This is called early gastric cancer or non-invasive GC. It is sometimes known as gastric adenocarcinoma, or GAC.
In stage 0, cancer has formed in the mucosa (innermost layer) of the stomach wall but has not spread into the submucosa or muscle layers. It is also called carcinoma in situ.
In stages IA and IB, cancer has grown into the submucosa of the stomach wall. In stages III and IV, cancer has spread to other organs in the abdomen or to nearby lymph nodes.
New types of treatment are being tested in clinical trials. For example, some doctors are using hyperthermic intraperitoneal chemotherapy (HIPEC) to treat recurrent or persistent gastric cancer. This uses heated chemotherapy drugs inserted into the abdominal cavity to kill cancer cells that remain after surgery. Some doctors are also using radiation techniques to target the area where the cancer has recurred, such as intensity-modulated radiation therapy or stereotactic body radiation therapy.
Treatment of advanced GC is challenging because it usually has an aggressive biology, with high recurrence and metastasis rates. However, new improvements in treatment landscape based on genomic classification and immuno-oncology with checkpoint inhibition and immune stimulation have been shown to improve survival [12]. Therefore, the standard of care for patients with GC has evolved into a multidisciplinary management approach and personalized medicine.
