Gastric Cancer

Abstract

Gastric cancer is the third leading cause of cancer mortality among the elderly. Seventy one percent of over a million new gastric cancer cases globally in 2018 were aged over 60 years. The incidence and mortality rates of gastric cancer has been declining worldwide. Unfortunately, most gastric cancers diagnosed after the onset of typical symptoms are advanced, less amenable to curative treatments and have lower survival. The delivering optimal cancer therapy to old patients is challenging and textbook outcomes are rarely achieved because of multiple comorbidities and polypharmacy. The treatment plan for an elderly patient with gastric cancer is best decided by a multidisciplinary team (MDT). For those shortlisted for surgery, a diagnostic laparoscopy is needed to exclude serosal involvement and peritoneal metastasis. Shared treatment decisions are based on the stage of cancer, overall fitness, and personal preferences of the elderly patient. Surgery performed for curative intent by open or minimally invasive methods must achieve clear (R0) margins and adequate lymph nodes dissection (D2 resection). Perioperative chemotherapy or postoperative adjuvant chemotherapy can be offered to select group of patients who are fit and willing to undergo prolonged treatments. Patients with metastatic cancer can expect improvement of overall survival time and quality of life with two lines of cytotoxic chemotherapy. Malnutrition is a common, and feeding protocols are important. Select subgroup of patients can benefit from Immunotherapy or targeted therapy. Adequate supportive care and palliative care are important part of managing gastric cancer. Gastric cancer screening is recommended in high-incidence regions. Old age should not be seen as a roadblock for using optimal combination treatments and each patient should be managed individually with shared decisions.