Gastric cancer. Clinical practice guidelines in oncology.

Gastric cancer is rampant in several countries around the world. Its incidence in the West has been on the decline for more than 40 years; however, the location of gastric cancer has shifted proximally in the past 15 years. The reason for this shift is not clear. Diffuse histology is also more common now than intestinal type of histology. Advances have been made in staging procedures such as laparoscopy and endoscopic ultrasonography and in possible functional imaging techniques. The current TNM classification requires an examination of at least 15 lymph nodes; therefore, at least a D1 dissection is recommended. Patients with locoregional gastric carcinoma should also be referred to high-volume treatment centers. Combination chemotherapy and radiotherapy in the adjuvant setting for select group of patients is considered the new standard in the United States. The NCCN Gastric Cancer Guidelines portray uniformity in the systemic approach to cancer in the United States. We look forward to the results of investigations of a number of new chemotherapeutic agents, including antireceptor agents, vaccines, gene therapy, and antiangiogenic agents. The panel anticipates many advances in the treatment of esophageal carcinoma in the future.