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The overall prognosis for patients with gastric cancer remains poor as tumors are often diagnosed at an advanced stage, despite new developments and technical advances in endoscopic diagnosis and therapy. This publication brings together leading experts in the fields of basic research and clinical management of gastric cancer, to share their expertise with the clinical community. State-of-the-art reviews discuss the pathogenesis of and the most important risk factors for the development of gastric cancer, potential benefits of chemoprevention and Helicobacter pylori eradication. Moreover, new diagnostic modalities and surgical therapy, including the potential benefits of neoadjuvant and adjuvant therapies, are presented. As most patients require palliative therapy because of locally advanced or metastasized cancers, several reviews are dedicated to advances in the chemotherapy of advanced gastric cancers and peritoneal metastasis. Finally, future approaches towards a molecular diagnosis and therapy are described. Those involved in the management of gastric cancer patients will find the information presented in this publication of utmost help and will benefit greatly for their daily routine.
Gastric cancer has been one of the great malignant scourges affecting man kind for as long as medical records have been kept. Until operative resection pioneered by Bilroth and others became available, no effective treatment was feasible and death from cancer was virtually inevitable. Even with resection by total gastrectomy, the chances of tumor eradication remained small. Over recent years, however, the situation has been changing. Some changes have resulted from better understanding of the disease, early detec tion, and better management techniques with applied clinical research, but the reasons for other changes are poorly understood. For example, the incidence of gastric cancer is decreasing, especially in westernized societies, where it has fallen from one of the most common cancers to no longer being in the top five causes of cancer death. Still it remains the number one killer of adult males in Japan and Korea. Whether the reduced incidence in western societies is a result of dietary changes or methods of food preservation, or some other reason, is as yet uncertain. Improvements in outcome have been reported from mass screening and early detection; more refined techniques of establishing early diagnosis, tumor type, and tumor extent; more radical surgical resection; and resection at earlier stages of disease.
Included here is a discussion of the pathophysiological aspects and risks of laparoscopic staging (such as trocar metastases) on the basis of international experience.
As aging trends in the United States and Europe in particular are strongly suggestive of increasingly older society, it would be prudent for health care providers to better prepare for such changes. By including physiology, disease, nutrition, pharmacology, pathology, radiology and other relevant associated topics, Geriatric Gastroenterology fills the void in the literature for a volume devoted specifically to gastrointestinal illness in the elderly. This unique volume includes provision of training for current and future generations of physicians to deal with the health problems of older adults. It will also serve as a comprehensive guide to practicing physicians for ease of reference. Relevant to the geriatric age group, the volume covers epidemiology, physiology of aging, gastrointestinal physiology, pharmacology, radiology, pathology, motility disorders, luminal disorders, hepato-biliary disease, systemic manifestations, neoplastic disorders, gastrointestinal bleeding, cancer and medication related interactions and adverse events, all extremely common in older adults; these are often hard to evaluate and judge, especially considering the complex aging physiology. All have become important components of modern medicine. Special emphasis is be given to nutrition and related disorders. Capsule endoscopy and its utility in the geriatric population is also covered. Presented in simple, easy to read style, the volume includes numerous tables, figures and key points enabling ease of understanding. Chapters on imaging and pathology are profusely illustrated. All chapters are written by specialists and include up to date scientific information. Geriatric Gastroenterology is of great utility to residents in internal medicine, fellows in gastroenterology and geriatric medicine as well as gastroenterologists, geriatricians and practicing physicians including primary care physicians caring for older adults.
Despite recent advances in adjuvant therapies of cancer, the regi mens of postoperative adjuvant chemotherapy treatment which are presently available fail to cure the majority of cancer patients. Pre operative (neoadjuvant) chemotherapy represents a new approach in drug scheduling, based on sound theoretical, pharmacokinetic, and experimental principles. The preoperative timing of chemotherapy before definitive sur gery is not a minor change in the therapy of cancer. To be successful, large numbers of practitioners and their patients must participate. Substantial alterations of many aspects of the present management of cancer will have to follow. Therefore, before such therapy can be fully and routinely implemented, results of the novel treatment and its rationale have to be carefully evaluated. In preoperative treatment, other features will likely gain impor tance. For the first time, clinicians have a chance to follow the in vivo response of the tumor exposed to preoperative chemotherapy. The subsequent histological assessment of the tumor sample may likely become an important prognostic guide, permitting more re fined individual approaches to the planning of postoperative adju vant treatment. The value of such a treatment strategy can already be appreciated in the clinical setting, as seen from the therapy of osteosarcoma. Furthermore, preoperative chemotherapy might render previously inoperable tumors operable and hence resectable with a curative intention. The preoperative reduction of tumor bulk may also effectively decrease the need for more radical operations, permitting a more uniform adoption of conservative surgery.
One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g .• breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example.
This book is a practical guide on how best to incorporate advanced radiation therapy techniques into the multimodality treatment of a wide range of gastrointestinal tumors, including esophageal cancer, gastric cancer, hepatobiliary malignancies (primary and metastatic liver tumors, intrahepatic, perihilar, and extrahepatic cholangiocarcinomas, and gallbladder cancer), pancreatic cancer, colorectal cancer, and carcinoma of the anal canal. Practical considerations when treating patients with external beam radiation therapy, intensity-modulated radiation therapy, particle therapy, and stereotactic body radiation therapy are clearly explained. Detailed attention is devoted to the safety and efficacy of radiotherapy in combination with current and emerging systemic therapies (chemotherapy, immunotherapy, and biologic agents), surgery, and ablative therapy, and the advantages and disadvantages of alternative treatment approaches for different tumor types are carefully evaluated. The book will benefit radiation oncologists, medical and surgical oncologists, medical physicists, medical dosimetrists, and other oncology professionals.
Gastric cancer is the second most common cause of cancer-related death in the world. There are no screening tests available for its diagnosis, therefore patients usually presents in late stages, associated with poor prognosis. Currently, many efforts are made toward new advances in the treatment strategies. The book makes an insight into the assessment of premalignant lesions, current management of early gastric cancer, risk and protective factors in gastric carcinogenesis. "Gastric cancer" provides a detailed description of the morphologic classification, molecular changes and epigenetic alterations of this tumor. The book describes the role of different diagnostic tools in the preoperative assessment of patients and the most important factors contributing to the prognosis. Moreover, it describes the current surgical and chemotherapeutic options for gastric neoplasm. This publication may open new and interesting gates for further research concerning carcinogenesis, genetic and epigenetic alterations, signaling pathways, H. pylori infection, the discovery of protective factors against gastric cancer and of revolutionary therapies of this tumor.
Highly illustrated clinical review of diagnosis, staging and treatment of gastric cancer by expert multidisciplinary author team for wide readership.
This book is a comprehensive understanding of the evolution of pre-malignant disease, emphasizing common themes in the field, including stem cell biology and histologic modes of cancer progression between the distal esophagus and stomach. Its sixteen chapters discuss metaplastic tissue change in the upper GI, clonalexpansion of early neoplasia, stem cell dynamics in experimental models, pathology of early esophageal squamous cell carcinoma, therapeutic modalities for esophageal squamous cell carcinoma, pathology of Barrett’s esophagus, screening, early detection and novel diagnostic tools for Barrett's esophagus, clonal evolution of Barrett’s esophagus, endoscopic therapeutic modalities of early esophageal cancer, pathology of early gastric cancer, and experimental models for gastric cancer. Stem Cells, Pre-neoplasia and Early Cancer of the Upper Gastrointestinal Tract is an integrative text on both the current state of translational research on every cancer development of the upper gastrointestinal tract as well as on novel clinical diagnostic and therapeutic modalities. It highlights a rapidly growing field within cancer research and is essential reading for oncologists, biochemists and advanced graduate students alike. Springer’s Advances in Experimental Medicine and Biology series presents multidisciplinary and dynamic findings in the broad fields of experimental medicine and biology. The wide variety in topics it presents offers readers multiple perspectives on a variety of disciplines including neuroscience, microbiology, immunology, biochemistry, biomedical engineering and cancer research.