Gastric adenocarcinoma--management of the primary disease.

While it will be another decade before the results are apparent, the past decade has sown the seeds of new generation of concepts regarding the initial management of gastric adenocarcinoma. Those seeds will come to flower when we fully utilize the management tools that have been developed. Endoscopy provides the opportunity for earlier diagnosis of gastric cancer. More liberal use of gastroscopy and cytology when x-rays are not completely diagnostic should identify the still surgically curable tumor. An improved understanding of the routes of tumor spread--by invasion and metastases--have identified a number of practical alterations to the surgical procedures for the removal of gastric adenocarcinoma arising from various sites in the stomach. Suggestions for effective adjuvant therapies, based on the realization that most gastric cancer has become a systemic disease by the time of diagnosis, are apparent from the clinical trials to date: Local control of microscopic disease with radiotherapy and treatment of transperitoneal tumor spread by the intraperitoneal route are logical additions to systemic therapy. More careful and thorough pathologic examination of resected tissues, with adjuvant treatment planning based on the results of that examination, should alter what has in the past been the grim prognosis of this disease. Careful follow-up evaluation and attention to nutrition can improve the quality of the patient's life, just as carefully planned antineoplastic therapy can improve its duration.