In order to assist the oncologists in making major clinical decisions encountered in managing their gastric cancer patients, the Indian Council of Medical Research (ICMR) has issued a 'consensus document' for the management of gastric cancer, which is found to be the second most common cause of cancer-related deaths amongst men and women in India.
This consensus document has been developed by national experts in the field and does not in any way bind a clinician to follow this guideline verbatim. The document represents the experts ‘current thinking' on the topic based on available evidence. One can use an alternate mode of therapy based on discussions with the patient and institution, national or international guidelines. The mention of pharmaceutical drugs for therapy does not constitute endorsement or recommendation for use but is a guidance for clinicians in complex decision-making.
This consensus document may be used as framework for more focused and planned research programmes to carry forward the process. The aim of the guidelines is to assist oncologists in making major clinical decisions encountered in managing their patients, well realizing the fact that some patients may require treatment strategies other than that suggested in these guidelines.
According to the draft consensus document issued by the ICMR, the histological confirmation is mandatory prior to commencing definitive treatment and all patients should be staged with TNM staging system and risk-assessed at diagnosis. A baseline contrast-enhanced CT scan of chest, abdomen, and pelvis should be considered. Patients should receive multidisciplinary care under the care of a surgical oncologist, medical and radiation oncologist.
Besides, type III Siewert (oesophageal) and gastric cancer - primary surgery remains the standard of care. Early cancers may be offered up-front surgery with adjuvant treatment (observation versus chemotherapy versus chemoradiotherapy) determined by the pathological examination of resected specimen. Neoadjuvant chemotherapy should be considered in locally advanced tumours to downstage the disease followed by surgery in those with stable or partial response. This may be followed by adjuvant chemotherapy (as part of the peri-operative chemotherapy regimen).
The document further says that HER 2 testing should be considered in patients with metastatic disease and patients with metastatic gastric cancer beyond the regional lymph nodes, should be assessed for chemotherapy versus best supportive care on an individual basis.
Gastric cancer is the fourth leading site of cancer in the world and the second most common cause of death due to malignancy accounting for 736,000 deaths. Gastric cancer, today, is more common in Asia than in US or Europe. 42 per cent of cases occur in China alone.
In India, the incidence rates of gastric is very low compared to western countries and the number of new gastric cancers is about 34,000, with a male predominance ratio of 1:2. It is estimated that by the year 2020, there would be approximately 50,000 new gastric cancer annually in India. The recent nationally representative survey of cancer mortality in India indicated that gastric carcinoma was the second most common cause of cancer-related deaths amongst men and women.