The current management of gastric cancer

Gastric cancer remains a serious public health problem in many regions of the world. The failure to improve results following surgical resection and adjuvant therapy in the West has led to an increased interest in the Japanese approach to the management of gastric cancer. The detailed staging system proposed in Japan permits a more rational, type-oriented therapy and a better anatomic planning of the operation. However, experience in the West indicates that radical operations have not yielded the excellent results reported from Japan, neither in terms of morbidity and mortality nor in 5-year survival. It is possible that early diagnosis, the variable virulence of the diverse types of tumors, and other not well-defined factors have importance in determining the striking differences in results reported from Japan and from the Western countries. The surgeon must weigh the potential increased morbidity and mortality of radical surgery vs. its potential benefits in terms of locoregional control of the disease. Intraoperative radiotherapy may permit better local and regional control of disease; it must be further evaluated. Endoscopic ablation of early gastric cancer may be increasingly utilized in the future through improved selection of patients. DNA ploidy studies may reveal patients at variable risk, so that more rational individualized therapy can be implemented. Increased detection of early cancers through more aggressive endoscopic examination of populations at high risk, and improved systemic therapy, are the most immediate desirable goals in the management of this very serious, highly lethal disease.