Gastric tumours

Gastric tumours are mostly adenocarcinomas, although it is important to diagnose gastrointestinal stromal tumours (GISTs) and gastric lymphoma since novel therapeutic interventions have dramatically changed the survival of patients with these rarer tumours. The major aetiological factor worldwide remains chronic Helicobacter pylori infection which affects up to 80% of the population in the developing world and is acquired in childhood. The decreasing incidence of H. pylori may be the major factor for the declining incidence of gastric adenocarcinoma. There has also been a move from predominantly antral tumours to oesophagogastric junctional and cardia tumours. The mainstay of therapy remains radical surgical excision, now combined with neo-adjuvant chemotherapy. The increasing detection of early gastric cancer has allowed the development of novel endoscopic techniques for local removal and control. The most important chemopreventative strategy is the eradication of Helicobacter infection. Gastric lymphoma is also strongly associated with H. pylori, and control of early disease may be possible following eradication. Gastrointestinal stromal tumours (GISTs) are highly responsive to c-kit tyrosine kinase inhibitors. They may present with massive disease and metastatic disease, but early diagnosis allows treatment and often a dramatic response with prolonged survival.