Recent advances in the detection and management of early gastric cancer and its precursors.

Autor:	Waddingham W; Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.; Research Department of Pathology, UCL Cancer Institute, London, UK., Nieuwenburg SAV; Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Carlson S; Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK., Rodriguez-Justo M; Pathology, University College London Hospitals NHS Foundation Trust, London, UK., Spaander M; Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Kuipers EJ; Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Jansen M; Research Department of Pathology, UCL Cancer Institute, London, UK.; Pathology, University College London Hospitals NHS Foundation Trust, London, UK., Graham DG; Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK., Banks M; Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
Jazyk:	angličtina
Zdroj:	Frontline gastroenterology [Frontline Gastroenterol] 2020 Jul 30; Vol. 12 (4), pp. 322-331. Date of Electronic Publication: 2020 Jul 30 (Print Publication: 2021).
DOI:	10.1136/flgastro-2018-101089
Abstrakt:	Despite declines in incidence, gastric cancer remains a disease with a poor prognosis and limited treatment options due to its often late stage of diagnosis. In contrast, early gastric cancer has a good to excellent prognosis, with 5-year survival rates as high as 92.6% after endoscopic resection. There remains an East-West divide for this disease, with high incidence countries such as Japan seeing earlier diagnoses and reduced mortality, in part thanks to the success of a national screening programme. With missed cancers still prevalent at upper endoscopy in the West, and variable approaches to assessment of the high-risk stomach, the quality of endoscopy we provide must be a focus for improvement, with particular attention paid to the minority of patients at increased cancer risk. High-definition endoscopy with virtual chromoendoscopy is superior to white light endoscopy alone. These enhanced imaging modalities allow the experienced endoscopist to accurately and robustly detect high-risk lesions in the stomach. An endoscopy-led staging strategy would mean biopsies could be targeted to histologically confirm the endoscopic impression of premalignant lesions including atrophic gastritis, gastric intestinal metaplasia, dysplasia and early cancer. This approach to quality improvement will reduce missed diagnoses and, combined with the latest endoscopic resection techniques performed at expert centres, will improve early detection and ultimately patient outcomes. In this review, we outline the latest evidence relating to diagnosis, staging and treatment of early gastric cancer and its precursor lesions. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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