Gastric tumours

The majority of gastric tumours are adenocarcinomas. Rarer types include gastrointestinal stromal tumours (GISTs), carcinoids and lymphomas. Gastric adenocarcinoma is a common cancer worldwide with the highest rates in the Far East. In the UK the majority of patients with gastric adenocarcinoma present with advanced, incurable disease. Accurate disease staging is essential to identify those patients suitable for curative treatment. Staging involves the use of endoscopy, CT, PET–CT, endoscopic ultrasound, staging laparoscopy and bone scintigraphy. A fitness assessment is an essential part of the staging process. Early gastric adenocarcinoma may be treated with endoscopic mucosal resection. The mainstay of curative treatment is surgery commonly in the form of subtotal or total gastrectomy. Patients with locally advanced tumours should be considered for peri-operative chemotherapy. In the West this is according to the MAGIC trial. The overall prognosis from gastric adenocarcinoma is poor. In patients who undergo surgery, 5-year survival rates of 45% can be achieved. Gastric GISTs are managed according to the risk of malignant behaviour. The majority of carcinoids and lymphomas are managed non-operatively.