Treatment and Prognosis



Surgery offers the only chance for cure of gastric cancer, but it is a rare chance (Fig. 41-1). After the diagnosis is established, staging must be car­ried out to determine insofar as possible if there is distant spread or local spread (beyond the wall of the stomach but confined to adjacent nodes) or whether the tumor seems to be confined to the stomach. This staging is usually carried out by biopsy of suspected nodes, liver function tests, and scans, ultrasonography, and increasingly CT of the abdomen. Occasionally laparoscopy and bi­opsy are indicated. If distal spread is found, sur­gery should be confined to palliative procedures,usually for obstruction. If the tumor is localized, subtotal gastrectomy is usually carried out for tu­mors of the distal or middle third and total gas­trectomy for the proximal third. In either case ex­tensive resection of regional lymphatics is indicated. The results of surgical treatment are summarized in Figure 41—1.

Irradiation of gastric carcinoma is generally un­satisfactory and has been palliative at best. A number of chemotherapeutic programs have been tried with very modest effects, if any, on survival. A current program that combines 5-fluorouracil, mitomycin-C, and doxorubicin shows some promise for both palliation and increase in sur­vival.

No method of preventing gastric carcinoma is known. Careful surveillance of patients at in­creased risk, especially with pernicious anemia, known atrophic gastritis, and following subtotal gastrectomy, may be indicated.