Introduction

E. Strong (ed.). Gastric cancer. Principles and practice. Springer (2015)


Gastric cancer, an uncommon but highly virulent malignancy in the USA, was diagnosed in 22,220 patients in 2014, with 10,990 deaths [1]. In comparison to its relative rarity in the USA, gastric cancer is endemic in parts of East Asia, which account for more than half of the approximately 1 million cases that develop per year globally [2]. Despite the much higher incidence, East Asian patients with gastric cancer do appear to have better prognosis [3].

In the USA, the incidence of gastric cancer has decreased significantly in the past 50 years but the location of the primary tumor has also changed. Distal gastric cancer, which previously predominated, has become uncommon, while the incidence of tumors of the gastric cardia and gastroesophageal junction (GEJ) have increased 4–10% per year among US men since 1976 [4, 5].

Changing epidemiologic factors account for the increasing incidence of proximal tumors. Chronic infection with Helicobacter pylori has been implicated in the development of gastric cancer on the basis of epidemiological evidence [6]. A decline in H. pylori infection in the USA has led to an overall decrease in the number of gastric cancer cases. On the other hand, proximal and GEJ tumors are now more common because of an increased incidence of gastroesophageal reflux disease [7] and obesity [8].

For locally advanced gastric cancer, surgery remains the most important component of curative therapy. Numerous studies have evaluated preand postoperative strategies for locally advanced disease, including chemotherapy or chemoradiation. As a whole, these studies show that some treatment in addition to surgery clearly improves outcomes. As an important clarification and consistent with guidelines from the National Comprehensive Cancer Network, our practice pattern is to apply the conclusions of these studies only to Siewert Type III GE junction and gastric adenocarcinomas [9]. Siewert Type I tumors arise from the distal esophagus and infiltrate the GEJ from above while Type III tumors are gastric cardia tumors that infiltrate the GEJ from below; Type II tumors are true tumors of the GEJ. Preoperative chemoradiation is a validated option for lower esophageal and Siewert Type I/II GEJ adenocarcinomas [10] but this approach and these diseases are not the focus of this review.

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