Prevention and Treatment of Gastric Cancer

Dear Colleagues,

Gastric cancer is the 5th most common cancer and the 4th leading cause of cancer-associated death worldwide. Its five-year survival is as low as 21.6% in the UK due to late diagnosis and a limited number of effective treatments. Additionally, 43% of patients have stage IV disease when diagnosed. The symptoms of early gastric cancer are vague and non-specific, including dyspepsia. Typical ‘red flags’, signs that prompt patients to see their doctor, such as a palpable upper abdominal mass, dysphagia, vomiting and weight loss, are more consistent with advanced and even metastatic disease. Therefore, the early diagnostic testing and risk stratification of patients more susceptible to gastric cancer may help identify the disease at an earlier stage, potentially increasing the chances of recovery. Although there are no interventions currently employed to prevent gastric cancer, lifestyle measures may reduce its risk. These include reducing excess alcohol consumption, not smoking, and bringing one’s BMI to within a healthy range. Patients with early disease (T1a) may undergo endoscopic resection. More advanced but curative cases may undergo radical surgical resection and D2 lymphadenectomy with perioperative chemotherapy. Breakthroughs in the immune profiling of tumours, such as mismatch repair deficiency and microsatellite instability, enable patients to potentially benefit from immunotherapy. This may be given concurrently with chemotherapy to improve the overall and recurrence-free survival. Further research on its early diagnosis, risk stratification and systemic therapies are required in order to improve the outcomes of this disease.

Dr. Sacheen Kumar
Guest Editor

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