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13 - Management of cancer of the stomach

Published online by Cambridge University Press:  05 November 2015

Sarah Gwynne
Singleton Hospital, Swansea, UK
Mick Button
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Tom Crosby
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Louise Hanna
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Velindre Cancer Centre, Velindre Hospital, Cardiff
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There has been a steady decline in the incidence of gastric cancer in most countries in the world in the last 50 years. However, gastric cancer remains a major health problem: it is the 13th most common malignancy in the UK, the 7th most common cause of cancer-related death in the UK, and ranks second worldwide. The decline in incidence in the UK has not been in all anatomical locations. The previously most common, distal type, has become less common, but there has been an increase in cancers affecting the gastro-oesophageal junction and cardia, particularly among young Caucasians, reflecting changes in aetiological factors.

The only current curative treatment is surgery, but in the UK most patients present late, with locally advanced or metastatic disease. Only 25–40% of cases are amenable to potentially curative surgery and, even in these, local recurrence may occur in up to 50% and the 5-year survival is 30–40%. Because of this and because response rates to combination chemotherapy are 40–50% in patients with advanced disease, adjuvant therapy is increasingly being used. Perioperative chemotherapy is used most commonly in the UK, while postoperative chemoradiotherapy is more commonly used as standard treatment in the USA.

Each year the outcomes for patients with oesophagogastric cancer are audited in the National Oesophagogastric Audit (, accessed August 2014).

Types of tumour

The types of tumour affecting the stomach are shown in Table 13.1. Adenocarcinoma accounts for 95% of all malignant tumours.


The stomach begins at the gastro-oesophageal junction and ends at the pylorus and is anatomically defined in three parts: the proximal fundus (cardia), the body and the distal pylorus (antrum). Anteriorly it is covered by the peritoneum of the greater sac, posteriorly by the peritoneum of the lesser sac. Proximally it abuts the diaphragm on the left and the left lobe of the liver on the right. Other adjacent organs (and therefore potential sites of direct invasion) are the spleen, the left adrenal gland, the superior portion of the left kidney, the pancreas and the transverse colon.

Publisher: Cambridge University Press
Print publication year: 2015

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Ajani, J. A. (2005). Evolving chemotherapy for advanced gastric cancer. The Oncol., 10 (Suppl. 3), 49–58.Google ScholarPubMed
Bang, Y-J., Van Cutsem, E., Feyereislova, A., et al. (2010). Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet, 376, 687–697.CrossRefGoogle ScholarPubMed
Borrman, R. (1926). Geschwulste des magens und duodenums. In Handbuch der Speziellen Pathogischen Antomie und Histologie, ed. Henske, F. and Lubarsch, O.. Berlin: Julius Springer, IV-L864-71.Google Scholar
Cook, N., Marshall, A., Blazeby, J., et al. (2013). Cougar-02: a randomised phase 3 study of docetaxel versus active symptom control in patients with relapsed oesophago-gastric adenocarcinoma. J. Clin. Oncol., 31 (Suppl, abstract 4023).Google Scholar
Correa, P. (1995). Helicobacter pylori and gastric carcinogenesis. Am. J. Surg. Path., 19 (Suppl. 1), S37–43.Google ScholarPubMed
Cunningham., D., Allum, W. H., Stenning, S. P., et al. (2006). Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N. Engl. J. Med., 355, 76–77.CrossRefGoogle ScholarPubMed
Cunningham, D., Starling, N., Rao, S., et al. (2008). Capecitabine and oxaliplatin for advanced esophagogastric cancer. N. Engl. J. Med., 358, 36–46.CrossRefGoogle ScholarPubMed
Earle, C. C. and Maroun, J. A. (1999). Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomized trials. Eur. J. Cancer, 35, 1059–1064.CrossRefGoogle Scholar
Glimelius, B., Ekstrom, K., Hoffman, K., et al. (1997). Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann. Oncol., 8, 163–168.CrossRefGoogle ScholarPubMed
Gunderson, L. L. and Sosin, H. (1992). Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int. J. Rad. Oncol. Biol. Phys., 8, 1–11.Google Scholar
Hallisey, M. T., Dunn, J. A., Ward, L. C., et al. (1994). The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five year follow-up. Lancet, 343, 1309–1312.CrossRefGoogle Scholar
Hermans, J., Bonenkamp, J. J., Boon, M. C., et al. (1993). Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomised trials. J. Clin. Oncol., 11, 1441–1447.CrossRefGoogle Scholar
Jansen, E., Boot, H., Verheij, M., et al. (2005). Optimal locoregional treatment in gastric cancer. J. Clin. Oncol., 23, 4509–4517.CrossRefGoogle ScholarPubMed
Japanese Gastric Cancer Association. (1998). Japanese classification of gastric carcinoma – 2nd English edition. Gastric Cancer, 1, 10–24.
Kao, G., Whittington, R. and Coia, L. (1992). Anatomy of the coeliac axis and superior mesenteric artery and its significance in radiation therapy. Int. J. Rad. Oncol. Biol. Phys., 25, 131.CrossRefGoogle Scholar
Kwee, R. M. and Kwee, T. C. (2007). Imaging in local staging of gastric cancers systematic review. J. Clin. Oncol., 25, 2107–2116.CrossRefGoogle Scholar
Lim, L., Michael, M.Mann, G. B., et al. (2005). Adjuvant therapy in gastric cancer. J. Clin. Oncol., 23, 6220–6232.CrossRefGoogle ScholarPubMed
Macdonald, J.S., Smalley, S.R., Benedetti, J., et al. (2001). Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastro-oesophageal junction. N. Engl. J. Med., 345, 725–730.CrossRefGoogle ScholarPubMed
McCulloch, P., Nita, M. E., Kazi, H., et al. (2003). Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. The Cochrane Database Syst. Rev., 18, no. CD001964.Google Scholar
Memon, M., Khan, S., Yunus, R., et al. (2008). Meta-analysis of laparascopic and open distal gastrectomy for gastric carcinoma. Surg. Endosc., 22, 1781–1789.CrossRefGoogle Scholar
Moiseyenko, V., Ajani, J., Tjulandin, S., et al. (2005). Final results of a randomised phase III trial (TAX 325) comparing docetaxel (T) combined with cisplatin (C) and 5-fluorouracil (F) to CF in patients with metastatic gastric adenocarcinoma. J. Clin. Oncol., 23, 308s.CrossRefGoogle Scholar
Murad, A. M., Santiago, F. F., Petroianu, A., et al. (1993). Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer, 72, 37–41.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Pyrhonen, S., Kuitunen, T., Nyandoto, P., et al. (1995). Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br. J. Cancer, 71, 587–591.CrossRefGoogle ScholarPubMed
Shimada, K. and Ajani, J. A. (1999). Adjuvant therapy for gastric carcinoma patients in the last 15 years: a review of Western and Oriental trials. Cancer, 86, 1657–1668.3.0.CO;2-J>CrossRefGoogle Scholar
Smalley, S., Gunderson, L., Tepper, J., et al. (2002). Gastric surgical adjuvant radiotherapy consensus report: rationale and treatment implication. Int. J. Radiat. Oncol. Biol. Phys., 52, 283–293.CrossRefGoogle Scholar
Thuss-Patience, P., Deist, T., Hinke, A., et al. (2009). Irinotecan versus best supportive care (BSC) as second line therapy in gastric cancer: a randomised phase 3 study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). J. Clin. Oncol., 27(15 Suppl.; abstract 4520).Google Scholar
UICC. (2009). TNM Classification of Malignant Tumours, ed. Sobin, L. H., Gospodarowicz, M. K. and Wittekind, Ch., 7th edn. Chichester: Wiley-Blackwell.
Waddell, T. S., Chau, I., Barbachano, Y., et al. (2012). A randomized multicenter trial of epirubicin, oxaliplatin, and capecitabine (EOC) plus panitumumab in advanced esophagogastric cancer (REAL3). J. Clin. Oncol., 30 (Suppl.; abstract LBA4000).CrossRefGoogle Scholar
Ychou, M., Boige, V., Pignon, J. P., et al. (2011). Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J. Clin. Oncol., 29, 1715.CrossRefGoogle ScholarPubMed

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