Diagnosis and treatment of gastric cancer.

Despite a decreased incidence, gastric cancer remains a leading cause of death worldwide. The only potentially curative modality for localised gastric cancer is surgery. However, overall 5-year survival does not exceed 40%. Although extensive surgery seems to increase survival in Japanese patients, this has not yet been demonstrated in Western patients. The pattern of recurrence of gastric cancer would suggest that both local and systemic treatment are required to improve survival. To date, there is no evidence that adjuvant treatment is effective. Some trials investigating preoperative chemotherapy with various combinations of etoposide, fluorouracil, cisplatin and doxorubicin in locally advanced disease suggest that a reduction in the bulk of the localised tumour may increase the curative resection rate. Advanced disease remains poorly controlled. The most effective treatments appear to be a combination of fluorouracil, methotrexate and doxorubicin (FAMTX), and of fluorouracil and cisplatin. Response rates range from 25 to 50%, and median survival from 6 to 13 months. New agents and new therapeutic approaches are required to improve the poor prognosis of gastric cancer patients.