Gastric cancers

Question 1

Treatment for gastric cancers

Answer 1

Curative treatment is radical surgery.
Europe uses perioperative chemotherapy as well
America uses perioperative chemoradiotherapy.

Early stages
- Endoscopic mucosal or submucosal dissection

Locally advanced

• Subtotal gastrectomy if it is a distal, intestinal type, otherwise a total gastrectomy for all other types and locations.
• Also needs a D2 lymphadenectomy, minimum 25 perigastric lymph nodes.
• May also give neoadjuvant chemotherapy and

If distant metastasis is present, no surgery.

Stomach is replaced with a jejunal loop.

Question 2

What immunotherapy is sometimes used for gastric cancers

Answer 2

Traztuzumab/Herceptin.

Gastric cancers need to be tested for HER-2 positivity.

Sometimes anti PDL1-R antibodies as well.

Question 3

What chemoradiotherapy is used for gastric cancers

Answer 3

5-FU and platinum agents, plus radiation.

Radiation therapy is also used as palliation for gastric tumor bleeding.