Gastric cancer displays significant global variation in incidence; the highest rates are seen in Eastern Asia, Eastern Europe and South America, with lower rates in North America and Western Europe. Patients in Asian countries are frequently diagnosed with gastric cancer at an earlier stage than in non-Asian countries. In Japan and Korea, where the incidence of gastric cancer is much higher than in Western countries, screening for gastric cancer is routine.

Risk Factors:

R isk factors for gastric cancer include male gender (incidence is twice as high), Helicobacter pylori infection, tobacco use, atrophic gastritis, partial gastrectomy and Ménétrier’s disease.

Distal or antral gastric cancers that are associated with H. pylori infection, alcohol use, high-salt diet, processed meat and low fruit and vegetable intake are more common in East Asia.

Tumours of the proximal stomach (cardia) are associated with obesity, and tumours of the gastroesophageal junction are associated with reflux and Barrett’s oesophagus and are more common in non Asian countries.

Ninety per cent(90%) of gastric cancers are adenocarcinomas. The other types of gastric malignancies such as gastrointestinal stromal tumours (GISTs), lymphomas and neuroendocrine tumours are rarer.

Surgical Resection:

Surgical resection of gastric cancer, specifically at early stages, is potentially curative. However, the majority of patients still relapse following resection, and therefore, combined modality therapies are standard for ≥ Stage IB disease.

Laparoscopic surgery has the potential benefit of decreased postoperative morbidity and reduced recovery time. Although concerns existed regarding the possibility of a inadequate lymph nodal clearance with a laparoscopic approach.

Trials from the Far East have reported equivalent results to open surgery for distal gastrectomy. Laparoscopic surgery is becoming one of the recommended options for patients with early gastric cancer.

Adjuvant Treatment:

Recommendation: For patients with ≥Stage IB gastric cancer who have undergone surgery without administration of preoperative chemotherapy (e.g. due to understaging before the initial decision for upfront surgery), postoperative chemoradiotherapy (CRT) or adjuvant chemotherapy is recommended. For patients having undergone preoperative chemotherapy, the addition of postoperative radiotherapy (RT) has no added benefit.