3. Gastric Cancer

  1. Janusz Jankowski MB ChB, MSc, MD, PhD, FRCP, FACG, AGAF2,3,4 and
  2. Ernest Hawk MD, MPH5
  1. Branislav Bystricky and
  2. David Cunningham

Published Online: 15 NOV 2012

DOI: 10.1002/9781118423318.ch3

Handbook of Gastrointestinal Cancer

Handbook of Gastrointestinal Cancer

How to Cite

Bystricky, B. and Cunningham, D. (2012) Gastric Cancer, in Handbook of Gastrointestinal Cancer (eds J. Jankowski and E. Hawk), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118423318.ch3

Editor Information

  1. 2

    Sir James Black Professor of Gastrointestinal Biology and Trials, Centre for Digestive Diseases, Barts and Th e London School of Medicine and Dentistry, London, UK

  2. 3

    Consultant Gastroenterologist, University Hospitals of Leicester, Leicester, UK

  3. 4

    James Black Senior Fellow, University of Oxford, Oxford, UK

  4. 5

    Vice President and Division Head, Division of Cancer Prevention & Population Sciences, Boone Pickens Distinguished Chair for Early Prevention of Cancer, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Author Information

  1. Royal Marsden Hospital, London and Surrey, UK

Publication History

  1. Published Online: 15 NOV 2012
  2. Published Print: 12 JUL 2012

ISBN Information

Print ISBN: 9780470656242

Online ISBN: 9781118423318



  • Gastric cancer;
  • epidemiology;
  • diagnosis;
  • prevention;
  • chemotherapy;
  • radiotherapy;
  • epirubicin;
  • cisplatin;
  • oxaliplatin;
  • 5-flourouracil;
  • trastuzumab


The incidence of gastric carcinoma has decreased over the past 30 years and although there has been an improvement in survival, the 5-year overall survival still remains below 25%. Upper GI endoscopy remains the gold standard in the diagnosis of gastric cancer, and patients aged 55 years and above with unexplained, persistentrecent onset of dyspepsia should be referred urgently for endoscopic evaluation. For medically fit patients with resectable disease treated in specialized centers with access to adequate postoperative care, D2 lymph node dissection without resection of adjacent organs is now the accepted standard of care in the West. Perioperative chemotherapy using epirubicin, cisplatin, and fluoropyrimidine significantly improved 5-year overall survival by 13.3% when compared with surgery alone in the UK MRC MAGIC trial. In addition, a significant improvement in overall survival has been demonstrated with adjuvant oral S-1 chemotherapy in Japanese patients and with postoperative chemoradiotherapy that is widely used in North America. In the metastatic setting, multiagent palliative chemotherapy confers a survival benefit and based on the results of the REAL-2 trial, the combination of epirubicin, oxaliplatin, and capecitabine is one of the most commonly used regimens. The ToGA trial demonstrated a significant overall survival benefit with the addition of trastuzumab, a monoclonal antibody to the HER-2 receptor, in combination with chemotherapy in patients with metastatic disease whose tumors overexpress HER-2.