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Gastric cancer ESMO Clinical Practice Guidelines for
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【pdf】Gastric cancer ESMO Clinical Practice Guidelines for
Almost one million (951 600) new cases of gastric cancer were
diagnosed globally in 2012, resulting in∼723 100 deaths [1]. Of
these ∼140 000 cases and∼107 000 deaths occurred in Europe
[2]. Gastric cancer displays significant global variation in incidence; the highest rates are seen in Eastern Asia, Eastern Europe
and South America, with lower rates in North America and
Western Europe. A gradual decline in the incidence of gastric
cancer has been observed in Western Europe and North
America over the past 60 years and more recent declines in
high-prevalence countries have also become apparent. This is
epidemiologically distinct from the relative increase in tumours
of the gastroesophageal junction, which are discussed in a separate guideline document.
Risk factors for gastric cancer include male gender (incidence
is twice as high),Helicobacter pyloriinfection, tobacco use, atrophic gastritis, partial gastrectomy and Ménétrier’s disease [3].
Regional variation in gastric cancer risk factors influences the
most common anatomical subsites of disease. Distal or antral
gastric cancers that are associated with H. pyloriinfection,
alcohol use, high-salt diet, processed meat and low fruit and
vegetable intake are more common in East Asia. Tumours of the
proximal stomach (cardia) are associated with obesity, and
tumours of the gastroesophageal junction are associated with
reflux and Barrett’s oesophagus and are more common in nonAsian countries [4]. Gastric cancer demonstrates familial aggregation in∼10% of cases, and an inherited genetic predisposition
is found in a small proportion of cases (∼1%–3%); relevant syndromes include hereditary non-polyposis colorectal cancer, familial adenomatous polyposis colorectal cancer, hereditary
diffuse gastric cancer (HDGC), gastric adenocarcinoma and
proximal polyposis of the stomach (GAPPS) and Peutz Jegher’s
syndrome [5, 6]. If a familial cancer syndrome such as HDGC is
suspected, referral to a geneticist for assessment is recommended based on international clinical guidelines [V, B] [7].
diagnosis and pathology
Recommendation: Diagnosis should be made from a gastroscopic
or surgical biopsy reviewed by an experienced pathologist, and
histology should be reported according to the World Health
Organisation (WHO) criteria [IV, C].
Patients in Asian countries are frequently diagnosed with
gastric cancer at an earlier stage than in non-Asian countries.
In Japan and Korea, where the incidence of gastric cancer is
much higher than in Western countries, screening for gastric
cancer is routine. In patients who develop symptoms from an
underlying gastric cancer, these commonly include weight loss,
dysphagia, dyspepsia, vomiting, early satiety and/or iron deficiency anaemia.
Ninety per cent of gastric cancers are adenocarcinomas
(ACs), and these are subdivided according to histological
appearances into diffuse (undifferentiated) and intestinal
(well-differentiated) types (Lauren classification). Recent largescale studies in molecular subtyping have defined four subtypes of gastric cancer across genomic, transcriptomic and
proteomic levels; however, these subtypes do not yet have any
impact on treatment [8]. These Clinical Practice Guidelines do
not apply to rarer gastric malignancies such as gastrointestinal
stromal tumours (GISTs), lymphomas and neuroendocrine
tumours.
If a diagnosis of gastric cancer is suspected, diagnosis should
be made from a gastroscopic or surgical biopsy reviewed by an
experienced pathologist, and histology should be reported
according to the WHO criteria [IV, C].
staging and risk assessment
Recommendation: Initial staging and risk assessment should
include physical examination, blood count and differential, liver
and renal function tests, endoscopy and contrast-enhanced computed tomography (CT) scan of the thorax, abdomen ± pelvis
(Table1)[V, A]. Laparoscopy is recommended for patients with

Approved by the ESMO Guidelines Committee: August 2016.
*Correspondence to:ESMO Guidelines Committee, ESMO Head Office, Via L. Taddei 4,
6962 Viganello-Lugano, Switzerland.
E-mail: clinicalguidelines@esmo.org
clinical practice
guidelines
clinical practice guidelines
Annals of Oncology27 (Supplement 5): v38–v49, 2016
doi:10.1093/annonc/mdw350
© The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
All rights reserved. For permissions, please email: journals.permissions@oup.com.
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【pdf】Gastric cancer ESMO Clinical Practice Guidelines for

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