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Abstract
<p class="first" id="d1374785e119">Gastric cancer is the fifth most common cancer
and the third most common cause of
cancer death globally. Risk factors for the condition include Helicobacter pylori
infection, age, high salt intake, and diets low in fruit and vegetables. Gastric cancer
is diagnosed histologically after endoscopic biopsy and staged using CT, endoscopic
ultrasound, PET, and laparoscopy. It is a molecularly and phenotypically highly heterogeneous
disease. The main treatment for early gastric cancer is endoscopic resection. Non-early
operable gastric cancer is treated with surgery, which should include D2 lymphadenectomy
(including lymph node stations in the perigastric mesentery and along the celiac arterial
branches). Perioperative or adjuvant chemotherapy improves survival in patients with
stage 1B or higher cancers. Advanced gastric cancer is treated with sequential lines
of chemotherapy, starting with a platinum and fluoropyrimidine doublet in the first
line; median survival is less than 1 year. Targeted therapies licensed to treat gastric
cancer include trastuzumab (HER2-positive patients first line), ramucirumab (anti-angiogenic
second line), and nivolumab or pembrolizumab (anti-PD-1 third line).
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