MANAGEMENTOF GASTRICCANCER EditedbyNabilIsmaili Management of Gastric Cancer Edited by Nabil Ismaili Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Davor Vidic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Sebastian Kaulitzki, 2010. Used under license from Shutterstock.com First published June, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Management of Gastric Cancer, Edited by Nabil Ismaili p. cm. ISBN 978-953-307-344-6 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Gastric Cancer Staging 1 Chapter 1 The Role of Computed Tomography in the Imaging of Gastric Carcinoma 3 Marco Moschetta, Amato Antonio Stabile Ianora, Federico Cazzato, Arnaldo Scardapane and Giuseppe Angelelli Chapter 2 MR Imaging of Gastric Carcinoma 19 Il Young Kim Chapter 3 PET Imaging in Gastric Carcinoma 37 Kiyohisa Kamimura and Masayuki Nakajo Chapter 4 Novel Biomedical Imaging Approach for Detection of Sentinel Nodes in an Orthotopic Xenograft Rat Model of Human Gastric Carcinoma 55 Akihito Tsubota, Tomoki Koyama, Yoshihisa Namiki, Norio Tada and Hiroshi Takahashi Part 2 Surgery 71 Chapter 5 Laparoscopic Surgery for Gastric Cancer 73 Kyo Young Song and Jung Ho Shim Chapter 6 Lymph Node Dissection 87 Bulent Cavit Yuksel, Okan Murat Akturk and Ilyas Hakan Ozel Part 3 Chemotherapy 117 Chapter 7 Prospective Study of Triple Combination Chemotherapy Consisting of Paclitaxel, S-1, and 24-Hour Infusion of Cisplatin (PSC) for Inoperable Highly Advanced Gastric Cancer 119 Kenji Ina, Ryuichi Furuta, Takae Kataoka, Satoshi Kayukawa and Hiroaki Iwase VI Contents Part 4 A Rare Gastric Carcinoma 127 Chapter 8 A Rare Gastric Carcinoma - Neuroendocrine Tumors 129 Petar Svorcan, Jelena Djordjevic and Branko Maksimovic Preface Gastriccanceristhefifthmostcommoncancerandthesecondmostcommoncauseof cancerdeathworldwide.The highest incidencewasseen in Koreaand Japan because ofearlydiagnosisbyscreeningpolicy.EnvironmentalriskfactorsincludeHelicobacter pyloriinfection,highsaltintake,smokingandgeneticfactors. Twomajorclassificationsarecurrentlyus edandtheJapaneseclassificationisthemost commonly used. More than 50% of the patients have advanced disease at diagnosis and in this case the disease has a poor outcome. The diagnosis is confirmed by endoscopyandthehistologicalexaminationofthebiopsyspecimen.Adenocarcinoma is the most common histological type. The staging of gastric cancers is based on endoscopicultrasound,computedtomography,magneticresonanceimaging,positron emissiontomography,inadditiontothelaparoscopicstaging. In localized disease, the surgery remains the mainstay treatment of this malignancy. Many improvements in the surgical techniques have been seen in the las t decade. Laparoscopic surgery is an emerging approach which offers important advantages: less blood loss, reduced postoperative pain, accelerated recovery, early return to normalbowelfunctionandre ducedhospitalstay.However,laparoscopicsurgeryasa treatment approach to gastric cancer requires further investigations as the extent of lymph node dissection remains controversial. D1 l ymphadenectomy, with a goal of examining 15 or greater lymph nodes is a standard. D2 dissection is considered as a standardinseveralinstitutionsespeciallyineasternAsia.Perioperativechemotherapy is considered as a therapeutic standard for stage 2 disease. Concurrent radiochemotherapyis also recognizedas astandardafter surger yfor patientsathigh riskofrelapse. Palliative chemotherapy is the mainstay treatment of advanced stages of the disease (metastatic and non‐operable tumors). Several randomized studies have the aim to improvethe efficacyandthe safetyofchemotherapy treatments.The bestknowledge in molecular biologyhas led tothe develop ment of new targeted therapies that have improvedtheresultsinefficacyandsafety. Despitethesetreatmentadvances,theprognosisofgastriccancerremainspoorwitha 5‐yearsurvivalrangingfrom10to15%inallstagescombined. X Preface This bookprovides a real insight into thestaging and treatment ofpatients with this illness that is very relevant to clinicians worldwide.In addition, a chapter has been reservedtoararetypeofgastriccarcinoma. NabilIsmaili,MD DepartmentofMedicalOncology RegionalCancerCenter Agadir, Morocco