Gastric Cancer

The therapeutic method of gastric cancer is mostly performed by surgical operations. However, surgical operations should not be performed in case intraabdominal dissemination, rectal shelf and virchow node are manually felt, the same as distantmetastasis.

1. Endoscopic Therapy
It is largely divided into local coagulation and endogastrectomy. In the case of local coagulation, laser therapies such as endoscopic YAG laser, photodynamic therapy and local laser hypertheramia (42-45 degree) are used as well as absolute alcohol, 5-FU and OK-432 are locally injected. In the case of endogastrectomy (EMR), snare polypectomy, strip biopsy, EMR-C (transparent cap), EMR-L (rubber band) and EMR-P (electrotome) and hot biopsy are mostly used.

2. Indicant of Endoscopic Therapy
Lymph node metastasis or distantmetastasis should not be being in the abdomen in order that endoscopy may be performed, and carcinoma should be laid at the endoscope’s length as well as infiltration should be shallow. It was reported that mcosal cancer accounts for 2 to 6 percent and submucosal cancer accounts for 20 to 25 percent and the rate of lymph node metastasis reaches 10 to 15 percent. It was reported that lymph node metastasis can be excluded in the protrudent differentiated cancer of which major axis is less than 20mm, the depressed differentiated cancer that has no ulcer and has the major axis of 10mm and downward, the local gastric cancer generated on a gastric adenoma and the gastric-like cancer of which major axis is less than 20mm. Such things can be the targets of endoscopic therapy. In the case of the patients whose general conditions are not normal, who are aged, who get multiple cancers and who refuse to undergo surgical operations, it may be comparative indicant. The 515 patients diagnosed with early gastric cancer (1990 ? 1996) were analyzed in Seoul Central Hospital. In result, lymph node metastasis was not observed in the mucosal cancer that has the major axis of 20mm and downward and has no ulcer, irrespective of cell differentiation. Also, lymph node metastasis was not observed in protrudent early cancer. According to Takekoshi, the five-year survival and ten-year survival rate of the patients who underwent endoscopic operations before 1991 were 86% and 72% respectively. Also, there were no patients who died due to relapse of cancer during 14 years’ follow-up study. The result is behind laparotomy (90~95% and 80~85%), but it is not bad at all in consideration of the age of patients and their systemic diseases.

3. Surgical Operation
Surgical operations are also divided into laparoscopic resection and laparotomy. Laparoscopic resection can be finished within a short time, and patients can be rapidly recovered after the operation. However, laparoscopic resection can be performed in case lymph node metastasis is not observed in the abdomen. Further, it has been scarcely applied to early cancer because endoscopic therapy has been advanced. Laparotomy was succeeded for the first time by Billroth in 1881, and afterwards it has been used most widely. As it dissects lymph nodes, postoperative diagnosis and staging can be correctly derived. It has been regarded as the optimum therapeutic method and as the unique method to heighten survival rate, irrespective of lymph node metastasis. The five-year survival rate of Korean patients reaches only 30 to 40 percent, despite radical operations, because their cancers are mostly detected at the tertiary stage. As early gastric cancer has been increased, recently it accounts for 30 percent and upward. However, the value is remarkably lower than Japan of which early cancer reaches 50 to 60 percent. Prevention and early detection are critical to heighten survival rate.

4. Cancer Chemotherapy
Cancer cannot be completely recovered only by cancer chemotherapy, but it is effective to remedy minute metastasis or residual cancer and to prevent relapse. Also, it is used to palliate carcinoma in case a surgical operation cannot be performed. The cases where cancer chemotherapy came to good reaches 10 to 20 percent in the West, and reaches about 30 percent in Korea. Furthermore, the cases where lifespan was stringed out were very small.
5. Radiotherapy: Ordinarily, radiotherapy shows high effect to gastric cancer. In the case of the cancer generated at the esophagus-stomach copula, preoperative treatment can be performed restrictively.

from: http://www.hidoc.co.kr/