Management of Gastric Adenocarcinoma
Introduction to Gastric Adenocarcinoma Management
- For patients with gastric adenocarcinoma pT1apN0 who undergo upfront surgery after staging, observation without additional adjuvant treatment is the recommended oncological approach, as stated by the European Society for Medical Oncology (ESMO) 1, 2
- The ESMO guidelines specify that no additional treatment is necessary for patients with Tis and T1, N0 tumors when there is no residual disease in the surgical margins (R0 resection) 3
- Complete resection with negative margins (R0) is a factor of good prognosis, according to the European Society for Medical Oncology (ESMO) 1
Factors Influencing Decision-Making
- Poorly differentiated or high-grade histological tumors may alter the management approach, as suggested by the National Comprehensive Cancer Network (NCCN) 4
- Age under 50 years may also be a factor that alters the management approach, according to the National Comprehensive Cancer Network (NCCN) 4
- Neural invasion is another factor that may alter the management approach, as stated by the National Comprehensive Cancer Network (NCCN) 4
Alternative Treatment Options
- For selected cases of T1a tumors, endoscopic resection may be an alternative to surgery, especially for well-differentiated tumors ≤2 cm, confined to the mucosa, and non-ulcerated, as recommended by the European Society for Medical Oncology (ESMO) 1, 2
- The risk of lymph node metastasis for this group is virtually zero when adequately selected, according to the European Society for Medical Oncology (ESMO) 1
Special Situations
- If the tumor presents high-risk characteristics (such as lymphovascular invasion or poorly differentiated tumors), even being pT1apN0, a multidisciplinary discussion may be considered to evaluate the benefit of adjuvant treatment, although it is not the standard recommended approach, as suggested by the National Comprehensive Cancer Network (NCCN) 4
- For patients with compromised margins (R1) or macroscopic residual disease (R2), adjuvant chemoradiation based on fluoropyrimidine would be indicated, but this is not the case in the presented scenario, according to the National Comprehensive Cancer Network (NCCN) 3