Locally advanced gastric adenocarcinoma

diagnosis and treatment

Abstract

Gastric adenocarcinoma is by far the most common cancer of the stomach, representing approximately 95% of all malignant tumors of this organ. Therefore, the term gastric cancer is commonly used as a synonym for gastric adenocarcinoma; and we will do so from this moment on in the present story. Gastric cancer is subdivided into early and advanced. The first is defined as one that does not infiltrate beyond the submucosal layer, regardless of whether there is lymph node involvement (may exist in 3 to 20% of cases; 3 to 5% for exclusively mucosal tumors). The importance of this subdivision is given by the important difference in onco logical prognosis, since early gastric cancer has a good prognosis overall, with a survival rate to 5 years from 80 to 95%. Unfortunately, in the West, including our country, more than 90% of adenocarcinomas Gastric diseases are diagnosed in an advanced stage, leading to a worse prognosis and requiring treatment strategies multimodal. In accordance with this reality, we have decided to refer exclusively to diagnosis and treatment of advanced gastric cancer, since it is by far the situation that the surgeon most frequently faces and all the oncology team in its usual practice in our country. Within advanced gastric cancers, at the time of diagnosis, approximately 50% present with incurable disease, especially due to extensive systemic or peritoneal metastatic spread. Less frequently it happens because they are unresectable tumors. These situations imply a poor prognosis, liable to treatment palliative, which can be very varied, multidisciplinary, adapted to each patient. In this story we will refer to resectable, non-metastatic advanced gastric cancer, in which the cancer team can act in a allegedly curative, since it is the situation in which surgery plays a preponderant role and where there have been the main controversies and advances in recent decades for these tumors.