Treatment of gastric cancer

Although many foreign hospitals have started neoadjuvant chemotherapy before surgery, the main treatment for gastric cancer in China is still surgery. However, in 2007, the treatment principle has changed significantly. Before 2007, the treatment principle was surgery plus chemotherapy. Since 2007, the new trend has been chemotherapy + surgery + chemotherapy + biological treatment or traditional Chinese medicine treatment.

(1) Treatment of early gastric cancer: Early gastric cancer here refers to those with small and shallow lesions under gastroscopy and no metastasis to the lymph nodes around the stomach found by ultrasound. This diagnosis is confirmed after surgery. Generally, systemic chemotherapy or radiotherapy is not required. However, because it is impossible to completely prevent intraperitoneal dissemination caused by the operation during surgery, the author recommends intraperitoneal chemotherapy during surgery. Practice has proven that this measure can reduce the recurrence rate. The focus of early gastric cancer is postoperative follow-up observation, especially regular postoperative marker monitoring. Once an increase is found, effective treatment should be taken as soon as possible, or Chinese medicine that helps improve immunity can be taken.

(2) Treatment of mid-stage gastric cancer: mid-stage gastric cancer refers to patients with large lesions under gastroscopy and infiltration depth reaching the submucosal layer or muscular layer. There are many such patients, and as long as the treatment measures are appropriate, it is very likely to be effective, so it is a focus of treatment and comprehensive treatment should be adopted. It includes: first giving 1 to 2 courses of chemotherapy. Traditional commonly used chemotherapy regimens include FAM (composed of fluorouracil, doxorubicin and mitomycin. In recent years, doxorubicin has been withdrawn from the market and epirubicin is often used instead), FAMTX (composed of fluorouracil, doxorubicin, methotrexate), EAP (composed of etoposide and cisplatin), and paclitaxel or docetaxel also have certain efficacy. Recently, as targeted therapy drugs have been added to the chemotherapy combination regimen, new effective treatment options include: FUP (consisting of cisplatin and fluorouracil), PTX+DDP+5-FU (consisting of rituximab, i.e., Rituxan, plus cisplatin and fluorouracil), FOLFOX (consisting of oxaliplatin, fluorouracil, and folinic acid), XELOX (consisting of Rituxan and Xeloda), IF (consisting of irinotecan, i.e., Capto, folinic acid, and fluorouracil), etc.

(3) Treatment of advanced gastric cancer: Advanced gastric cancer refers to gastric cancer with a fixed mass in the upper abdomen, or gastric cancer patients whose B-ultrasound and CT scans indicate that surgical resection is impossible, but does not include patients with pyloric obstruction, because the latter still need a gastrojejunostomy to ensure food intake. The treatment principle of advanced gastric cancer is mainly chemotherapy, combined with Chinese medicine and biological treatment. However, surgery still has a certain significance, because although the lesion cannot be removed, if the tumor load can be reduced as much as possible, the sensitivity to chemotherapy can be enhanced: for patients who have been effectively treated with chemotherapy and meet the conditions for resection, surgical resection can still be performed. Regarding cases where a mass is felt in the upper abdomen, the experience of Japanese scholars is that 25% of patients with upper abdominal masses can still be completely removed by naked eyes after laparotomy. Therefore, patients with upper abdominal masses should not give up, but should actively use all means such as chemotherapy to reduce the mass and further strive for surgical resection.