Recent developments and innovations in gastric cancer

Gastric cancer has an important place in the worldwide incidence of cancer and cancer-related deaths. It can metastasize to the lymph nodes in the early stages, and lymph node metastasis is an important prognostic factor. Surgery is a very important part of gastric cancer treatment. A D2 lymphadenectomy is the standard surgical treatment for c T1N+ and T2-T4 cancers, which are potentially curable. Recently, the TNM classification system was reorganized, and the margins for gastrectomy and lymphadenectomy were revised. Endoscopic, laparoscopic and robotic treatments of gastric cancer have progressed rapidly with development of surgical instruments and techniques, especially in Eastern countries. Different endoscopic resection techniques have been identified, and these can be divided into two main categories: endoscopic mucosal resection and endoscopic submucosal dissection. Minimally invasive surgery has been reported to be safe and effective for early gastric cancer, and it can be successfully applied to advanced gastric cancer with increasing experience. Cytoreductive surgery and hypertherm?c intraper?toneal chemotherapy were developed as a combined treatment modality from the results of experimental and clinical studies. Also, hyperthermia increases the antitumor activity and penetration of chemotherapeutics. Trastuzumab which is a monoclonal antibody interacts with human epidermal growth factor(HER) 2 and is related to gastric carcinoma. The anti-tumor mechanism of trastuzumab is not clearly known, but mechanisms such as interruption of the HER2-mediated cell signaling pathways and cell cycle progression have been reported previously. H. pylori is involved in 90% of all gastric malignancies and Japanese guidelines strongly recommend that all H. pylori infections should be eradicated regardless of the associated disease. In this review, we present innovations discussed in recent studies.

Acute abdomen caused by nontraumatic hemoperitoneum is the first manifestation of gastric low grade stromal tumor

BACKGROUND:Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract in adults.We treated surgically a man with acute abdomen caused by non-traumatic hemoperitoneum and diagnosed by low grade gastric GIST.METHODS:A 51-year-old Caucasian man came to the hospital for abdominal pain for 3 hours.He had no history of abdominal trauma.On admission,he was conscious and alert,and he had hypotension(80/50 mmHg) and moderate tachycardia.Abdominal ultrasonography showed the presence of free peritoneal fluid.Abdominal magnetic resonance imaging(MRI) showed diffuse intraabdominal hemorrhage and solid mass lesion at the greater curvature of the stomach.At an emergency laparotomy,a pedunculated,fragile mass of 5x6 cm originating from the posterior wall of the stomach was seen.The tumor was resected.Histopathologically a gastrointestinal stromal tumor was detected.RESULTS:The patient had an uneventful postoperative course and was discharged on the sixth postoperative day.Follow-up showed no recurrence of the tumor 8 months after surgery.CONCLUSION:Intraabdominal bleeding is a rare presentation of gastrointestinal stromal tumors.The diagnosis of the tumor should be based on whether sudden abdominal pain occurs in patients with an intraabdominal mass.

Esophagogastric malignancies detected in a tertiary surgical center endoscopy unit from Turkey: a descriptive study

Background:The most common symptoms of upper gastrointestinal(UGI)diseases are epigastric pain and heartburn,nausea and vomiting,regurgitation and dysphagia.Endoscopic examination is the most reliable method for assessing UGI evaluation.Methods:Malignant tumors detected in UGI endoscopies performed between Dec 31,2015 and Jan 1,2011were included in our study.Age,gender,indication for endoscopy,tumor site,tumor type,stage of disease and type of treatment data were recorded.Results:According to the analysis of five-year patient data;39(1.17%)of 3,309 cases had malignancy in the UGI endoscopy.The average age of malignancy detected cases were 63.4 years(range,33–88 years).In the malignancy positive group;35(1%)cases had gastric and 4(0.12%)cases had esophagus tumors.According to the gastric localization of tumors,12 of cases were distal,10 were proximal,7 were middle and 4 were linitis plastica.Two of the cases had previous gastric surgery and the gastric malignancy of these cases was localized at the gastrojejunostomy site.The most frequent symptoms were abdominal pain,anemia,dyspepsia,bleeding,weight loss,obstruction and dysphagia in patients with gastric cancer.Two(5.7%)of the cases had previous gastrectomies because of benign causes.Malignant tumors were detected in the remnant tissue of these cases.The percentage of over 50-year-old patients was 89.7%in UGI malignancy detected patients.Three percent of gastric cancers were stage I,18%of them were stage II,25%of them were stage III and 53%of the cases were stage IV.Seventy-five percent of esophageal cancer cases had systemic metastases.Conclusions:Malignity is rarely detected among the patients from general surgery outpatient clinic,on whom UGI endoscopy is performed.But it is not different from the literature.Most of the malignancies are at advanced stage.In older age patients,endoscopy should be recommended even there are nonspecific symptoms.In the presence of alarm symptoms,UGI endoscopy should be recommended without considering the age.