Gastric cancer – still many questions to be solved

Summary

Gastric cancer is the fourth most common malignant tumour and the second-most common cause of cancer-related death worldwide. Multidisciplinary care and stage-specific treatment lead to improvements of this very aggressive disease. Accurate staging should include high-resolution computed tomography. Localised disease should also be staged with endoscopic ultrasound. In mucosal gastric cancer, endoscopic resection can replace surgical resection if specific criteria are present. In cancer infiltrating the submucosal layer or beyond, surgical resection including resection of the D2 lymph nodes is regarded as standard of care. In the stages II and III, perioperative chemotherapy has been studied with positive results. In the metastatic setting, treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can maintain a better quality of life. Combination chemotherapy including a platinum compound and a fluoropyrimidine is the current standard. 22% of gastric cancers exhibit overexpression of the growth factor receptor Her2. Trastuzumab is a monoclonal antibody directed against Her2 and has shown to prolong survival when combined with cisplatin and fluoropyrimidines in the treatment of Her2-positive gastric cancer. The current role of other biologically targeted therapies like anti-EGFR directed treatment still needs to be established.