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MANAGEMENT OF GASTRIC CANCER Edited by Nabil Ismaili Management of Gastric Cancer Edited by Nabil Ismaili Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Davor Vidic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Sebastian Kaulitzki, 2010. Used under license from Shutterstock.com First published June, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Management of Gastric Cancer, Edited by Nabil Ismaili p. cm. ISBN 978-953-307-344-6 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Gastric Cancer Staging 1 Chapter 1 The Role of Computed Tomography in the Imaging of Gastric Carcinoma 3 Marco Moschetta, Amato Antonio Stabile Ianora, Federico Cazzato, Arnaldo Scardapane and Giuseppe Angelelli Chapter 2 MR Imaging of Gastric Carcinoma Il Young Kim Chapter 3 PET Imaging in Gastric Carcinoma 37 Kiyohisa Kamimura and Masayuki Nakajo Chapter 4 Novel Biomedical Imaging Approach for Detection of Sentinel Nodes in an Orthotopic Xenograft Rat Model of Human Gastric Carcinoma Akihito Tsubota, Tomoki Koyama, Yoshihisa Namiki, Norio Tada and Hiroshi Takahashi Part 2 Surgery 19 55 71 Chapter 5 Laparoscopic Surgery for Gastric Cancer 73 Kyo Young Song and Jung Ho Shim Chapter 6 Lymph Node Dissection 87 Bulent Cavit Yuksel, Okan Murat Akturk and Ilyas Hakan Ozel Part 3 Chapter 7 Chemotherapy 117 Prospective Study of Triple Combination Chemotherapy Consisting of Paclitaxel, S-1, and 24-Hour Infusion of Cisplatin (PSC) for Inoperable Highly Advanced Gastric Cancer Kenji Ina, Ryuichi Furuta, Takae Kataoka, Satoshi Kayukawa and Hiroaki Iwase 119 VI Contents Part 4 Chapter 8 A Rare Gastric Carcinoma 127 A Rare Gastric Carcinoma - Neuroendocrine Tumors Petar Svorcan, Jelena Djordjevic and Branko Maksimovic 129 Preface Gastric cancer is the fifth most common cancer and the second most common cause of cancer death worldwide. The highest incidence was seen in Korea and Japan because of early diagnosis by screening policy. Environmental risk factors include Helicobacter pylori infection, high salt intake, smoking and genetic factors. Two major classifications are currently used and the Japanese classification is the most commonly used. More than 50% of the patients have advanced disease at diagnosis and in this case the disease has a poor outcome. The diagnosis is confirmed by endoscopy and the histological examination of the biopsy specimen. Adenocarcinoma is the most common histological type. The staging of gastric cancers is based on endoscopic ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography, in addition to the laparoscopic staging. In localized disease, the surgery remains the mainstay treatment of this malignancy. Many improvements in the surgical techniques have been seen in the last decade. Laparoscopic surgery is an emerging approach which offers important advantages: less blood loss, reduced postoperative pain, accelerated recovery, early return to normal bowel function and reduced hospital stay. However, laparoscopic surgery as a treatment approach to gastric cancer requires further investigations as the extent of lymph node dissection remains controversial. D1 lymphadenectomy, with a goal of examining 15 or greater lymph nodes is a standard. D2 dissection is considered as a standard in several institutions especially in eastern Asia. Perioperative chemotherapy is considered as a therapeutic standard for stage 2 disease. Concurrent radiochemotherapy is also recognized as a standard after surgery for patients at high risk of relapse. Palliative chemotherapy is the mainstay treatment of advanced stages of the disease (metastatic and non‐operable tumors). Several randomized studies have the aim to improve the efficacy and the safety of chemotherapy treatments. The best knowledge in molecular biology has led to the development of new targeted therapies that have improved the results in efficacy and safety. Despite these treatment advances, the prognosis of gastric cancer remains poor with a 5‐year survival ranging from 10 to 15% in all stages combined. X Preface This book provides a real insight into the staging and treatment of patients with this illness that is very relevant to clinicians worldwide. In addition, a chapter has been reserved to a rare type of gastric carcinoma. Nabil Ismaili, MD Department of Medical Oncology Regional Cancer Center Agadir, Morocco