Table of contents
- 1. Introduction
- 2. Staging
- 3. Treatment
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Introduction
- See Esophageal Malignancies in GI section
- Histology (same treatment, doesn't matter)
- Gastric
- Virtually all are adenocarcinomas
- Esophagus
- 95% adenocarcinomas
- 5% squamous
- Gastric
Staging
- TNM
- Stage 1 - Superficial Lesion (does not penetrate esophagus/stomach wall)
- Stage 2 - Full-thickness lesion
- Stage 3 - Locoregional LN's
- Stage 4 - Distal Metastatic
Treatment
- Locoregional disease (AJCC Stage I-III) --> surgery
- Recurrence rates high, surgical cure is low
- Neoadjuvant chemotherapy
- Improves outcomes (modestly, but statistically significant)
- Pre-Op Radiation
- Supported (less robust data)
- Post-Op Chemoradiation
- Combination used
- Metastatic Disease
- Usually palliative
- Some modest activity from chemo agents:
- Combination cisplatin-based regimen (single agents aren't as effective)
- HER2 Growth Factor
- Expressed in 20% gastric and 30% gastroesophageal
- Trastuzumab added to chemo therapy
Comments