Local palliation for advanced gastric cancer
- Johanna Bendell, MD
Johanna Bendell, MD
- GI Oncology Research
- Sarah Cannon Research Institute
The majority of patients with gastric cancer will require palliative treatment at some point in the course of their disease. Approximately 50 percent of patients already have advanced incurable disease at the time of initial presentation, and even those who undergo potentially curative resection have high rates of distant as well as local recurrence. (See "Surgical management of invasive gastric cancer", section on 'Prognosis'.)
Palliative treatments for advanced gastric cancer can be either local or systemic. While cytotoxic chemotherapy is the most effective treatment modality for patients with metastatic disease, it is frequently inadequate for palliation of local symptoms, such as nausea, pain, obstruction, perforation, or bleeding from a locally advanced or locally recurrent primary tumor, which require multidisciplinary management using endoscopic, surgical, radiotherapeutic, or other approaches. (See "Systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer".)
This topic review will focus on local palliative treatments for patients with locally advanced unresectable or metastatic gastric cancer. Chemotherapy for locally advanced unresectable or metastatic esophageal and gastric cancer is discussed elsewhere, as is endoscopic palliation for dysphagia in patients with locally advanced or recurrent esophageal cancer and primary surgical treatment. (See "Systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer" and "Endoscopic palliation of esophageal cancer" and "Surgical management of invasive gastric cancer" and "Surgical management of resectable esophageal and esophagogastric junction cancers".)
THERAPEUTIC OPTIONS FOR LOCAL PALLIATION
Therapeutic options to control symptoms of local disease progression, such as nausea, pain, bleeding, and obstruction, include palliative surgical resection, surgical bypass (gastrojejunostomy), radiation therapy (RT), and endoscopic techniques. All forms of palliative therapy must take into account the overall prognosis of the patient in order to avoid excessive morbidity and mortality or lengthy hospital stays in those with a limited life span.
Palliative resection — We recommend against palliative gastrectomy in most patients with advanced gastric cancer who are receiving systemic therapy. Palliative gastrectomy should be reserved for extreme, highly symptomatic cases where less invasive methods cannot be used.
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