Quiros R M, Desai D C
St. Luke's Hospital and Health Network, Bethlehem, PA, USA.
Minerva Gastroenterol Dietol. 2011 Mar;57(1):53-68.
Gastric cancer is a global phenomenon and is the second leading cause of cancer-related deaths worldwide. The highest rates of gastric cancer are seen in Asia and parts of Eastern Europe. In Western countries, the incidence of gastric cancer has declined over the last several decades. At the same time, the distribution of gastric tumors has shifted towards more proximal location in Western patients compared to their Asian counterparts. The most common risk factors include dietary factors, smoking, acid hyposecretory conditions, and H. pylori infection. Clinical diagnosis is made by obtaining a good history and physical exam, complemented by endoscopy and imaging studies. Patients often have advanced disease at time of diagnosis. In the absence of metastases, and provided that the patient is medically fit, surgery is the mainstay of treatment. The extent of gastric resection, including the extent of lymph node dissection, varies by region, with more extensive operations being done in Asia, particularly Japan. Because of the propensity of gastric cancer to recur both locally and distantly, additional therapies including chemotherapy and radiation therapy are recommended along with surgery. These can be administered pre-, peri-, or postoperatively based on institutional practices. As with surgical technique, how and when these additional treatments are offered depends largely on regional practice. In the setting of unresectable, or metastatic disease, palliative options including endoscopic and surgical interventions, radiotherapy, and chemotherapy are available.
胃癌是一种全球现象，是全球癌症相关死亡的第二大主要原因。胃癌发病率最高的地区是亚洲和东欧部分地区。在西方国家，过去几十年来胃癌发病率有所下降。与此同时，与亚洲患者相比，西方患者胃肿瘤的分布已向更靠近近端的位置转移。最常见的风险因素包括饮食因素、吸烟、胃酸分泌不足状况和幽门螺杆菌感染。临床诊断通过获取详细病史和进行体格检查，并辅以内镜检查和影像学检查来做出。患者在诊断时往往已患有晚期疾病。在没有转移且患者身体状况适合的情况下，手术是主要治疗方法。胃切除的范围，包括淋巴结清扫的范围，因地区而异，亚洲尤其是日本进行的手术更为广泛。由于胃癌有局部和远处复发的倾向，除手术外还建议采用包括化疗和放疗在内的其他治疗方法。这些治疗可根据医疗机构的做法在术前、术中或术后进行。与手术技术一样，这些额外治疗的提供方式和时间很大程度上取决于地区惯例。在无法切除或转移性疾病的情况下，可采用包括内镜和手术干预、放疗和化疗在内的姑息治疗方案。
