la terapia del cancro dello stomaco - gastrolearning®

Gastric CancerGastrolearning 26/5/2014

F.FarinatiS.LonardiA.Marchet

Padova

Gastric CancerF.Farinati

Epidemiology, precancerous changes, Early Gastric

Cancer

Gastric cancer mortali

ty

Gastric cancer: epidemiology

Almost one million new cases of stomach cancer estimated to have occurred in 2012 (952,000 cases, 7% of the total), the fifth most common malignancy in the world, after the lung, breast, colorectum and prostate.

Globocan IARC 2012

Third leading cause of cancer death in both sexes worldwide (723,000 deaths, 9% of the total). Highest estimated mortality rates in Eastern Asia (24 per 100,000 in men, 9.8 per 100,000 in women), lowest in Northern America (2.8 and 1.5, respectively). High mortality rates are also present in Central and Eastern Europe, and in Central and South America.

Hereditary diffuse gastric cancer (HDGC).

Vogelaar et al. Hereditary Cancer in Clinical Practice 2012, 10:18

The role of diet in gastric cancer: still an open question.

Berretta M et al. Front Biosci (Landmark Ed). 2012 Jan 1;17:1640-7.

• Fruit and vegetables • Salt and salted food • Vitamins and mineral • Alcohol • Nitrate, nitrite and nitrosamines

High dietary salt intake exacerbates Helicobacter pylori-induced gastric carcinogenesis.

Gaddy JA et al 2013 Infect Immun.

Natural history of H. pylori infection

Gastritis

Atrophy

Days

Weeks

Sipponen et al.1993

Duodenal ulcer

Gastric ulcer

Years

Months

Risk

15%

1%NeoplasiaDecades

H. pylori and Cancer Collaborative Group, 2001

Association between Helicobacter pylori infection and non-cardia gastric cancer

The Correa’ s Cascade

Inoue, Cancer. Lett. 2000, RR 2.2 at 5 years in moderate atrophy

You, Int J Cancer 1999 RR = 1

Chronic atrophic gastritis: Cancer risk

Low risk

Gastric atrophy: OLGA staging

M.Rugge et al

Dysplasia (Intra Epithelial neoplasia – IEN

Non Invasive Neoplasia - NIN)

Cancers detected during the follow-up

Early GC

22 = 88%

Advanced GC

3 = 12%

Pathological Stage (pTNM) assessed in 25 patients

30 Gastric Cancers detected among 129

patients

Follow-up > 12 months

Follow-up < 12 months

19 11

Follow-up :mandatory !!!!

Gastric epithelial dysplasia (NIN-IEN)

CAG

DYSPL

Cancer

EGC

ChemotherapyPalliative surgeryRadiation

Progress in the treatment of AGC: median overall survival

BSC1

5FU monotherapy1

Docetaxel-Cisplatin-5FU 2

Capecitabine-Cisplatin (XP)3

5FU-LV-Oxaliplatin (FLO)4

EOX5

Trastuzumab-CT6

4 months

7 months

9.2 months

10.5 months

10.7 months

11.2 months

13.8 months

1.Wagner JCO 03; 2 Van Cutsem ASCO 09; 3. Kang Ann Oncol 09; 4. Al Batran JCO 09; 5. Cunningham NEJM 07; 6. Van Cutsem ASCO 09.

Adapted from Cervantes Gastrointestinal Cancer Symposium Barcellona 2009

O.S.

Gastric Cancer

Early Gastric Cancer

Strip biopsy EMR

Endoscopic Submucosal Dissection ESD