Palliative Therapy for Gastric Cancer

Abstract

The past decades have witnessed the constant decrease in the morbidity and mortality of gastric cancer; however, as the fifth most common malignant tumor, gastric cancer is still the third most common cause of cancer death [1]. There were about one million new cases and 723,000 deaths from gastric cancer in 2012, among which Chinese patients accounted for about 50% [1]. Due to its insidious onset and the lack of specificity of signs and symptoms, over 80% of gastric cancer cases are in an advanced stage for being diagnosed. The 5-year survival rate is low. Even in patients who have received radical resection, the risk of distal metastasis or local recurrence can still be high [1]. The vast majority of patients with gastric cancer still need palliative care after the disease progresses to a certain stage. For patients with unresectable or advanced gastric cancer, palliative care should be provided as early as possible. The principles of palliative treatment for advanced gastric cancer are to relieve pain, improve their quality of life, and prolong survival by alleviating symptoms. The palliative care for advanced gastric carcinoma can be either local therapy or systemic therapy. Cytotoxic chemotherapy has been applied as the preferred systemic treatment in patients with metastatic gastric cancer; however, it often cannot alleviate the local symptoms (e.g., nausea, pain, gastrointestinal obstruction, and bleeding) in patients with locally advanced tumors or with distant metastasis. For these patients, multidisciplinary management using local treatments including endoscopy, surgery, and radiotherapy should be used. In this chapter, we will describe the palliative care in patients with locally advanced unresectable gastric cancer or those with metastatic gastric cancer.