胃癌课件英文Gastric Cancer
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最新医学英语疾病介绍——gastriccarcinoma胃癌精品课件
• The cancer have not invaded the muscularis propria(肌层) and are therefore limited to the mucosa(黏膜层) and submucosa(黏膜下层).
➢Advance gastric carcinoma:进展期胃癌
医学英语疾病介绍—— gastriccarcinoma胃癌
Introduction
➢Description ➢Classification ➢Causes ➢Symptoms ➢Pathlogical Changes ➢Exams and Tests ➢Treatment ➢Outlook(Prognosis) ➢Prevention
Appetite: [ˈæpitait] n.胃口，食欲 Nausea:[ˈnɔ:zi:ə, -ʒə, -si:ə, -ʃə] n. 作呕； 恶心； 反胃 Vomit:[ˈvɔmit] vt.& vi. 呕吐 Fatigue:[fə'ti:g] n. 疲劳
Pathlogical Changes
➢Early gastric cancer:早期胃癌
(1)息肉型或蕈伞型
(2)溃疡型
polypoid or fungating type Ulcerative type
Polypoid:['pɔlipɔid]息肉样 Fungating:['fʌngeit] [医]真菌样生长 Ulcerative:[ˈʌlsərətiv] adj. 溃疡（性）的 Infiltrating:[ɪnˈfɪlˌtreɪtɪŋ] v. （使）渗透
Pathlogical Changes
➢ Protruded type (Ⅰ型 隆起型) ➢ Superficial type (Ⅱ型 表浅型)
➢Advance gastric carcinoma:进展期胃癌
医学英语疾病介绍—— gastriccarcinoma胃癌
Introduction
➢Description ➢Classification ➢Causes ➢Symptoms ➢Pathlogical Changes ➢Exams and Tests ➢Treatment ➢Outlook(Prognosis) ➢Prevention
Appetite: [ˈæpitait] n.胃口，食欲 Nausea:[ˈnɔ:zi:ə, -ʒə, -si:ə, -ʃə] n. 作呕； 恶心； 反胃 Vomit:[ˈvɔmit] vt.& vi. 呕吐 Fatigue:[fə'ti:g] n. 疲劳
Pathlogical Changes
➢Early gastric cancer:早期胃癌
(1)息肉型或蕈伞型
(2)溃疡型
polypoid or fungating type Ulcerative type
Polypoid:['pɔlipɔid]息肉样 Fungating:['fʌngeit] [医]真菌样生长 Ulcerative:[ˈʌlsərətiv] adj. 溃疡（性）的 Infiltrating:[ɪnˈfɪlˌtreɪtɪŋ] v. （使）渗透
Pathlogical Changes
➢ Protruded type (Ⅰ型 隆起型) ➢ Superficial type (Ⅱ型 表浅型)
(精品) 胃癌 (英文版)课件
Macroscopic type AGC:Borrmann’s classification
Type IV: Diffuse infiltrative
Photomicrographs of Gastric Carcinoma
H&E, ×25
H&E, ×400
Arrows on signet ring cells
✓Surgery
Endoscopic mucosal resection (EMR) Endoscopic submucosal dissection (ESD) Laparoscopic Surgery Open Surgery
✓Chemotherapy ✓Chemoradiotherapy ✓Target therapy
Surgical Treatment for Gastric Cancer
NCCN 2015 V3:
Resectable Tumors
Tis or T1a------EMR/ESD T1b-T3-----Gastrectomy with negative microscopic
margins (typically ≥4 cm from gross tumor) T4-----En bloc resection of involved structures
Gastrectomy plus D1/D2
Surgical Treatment for Gastric Cancer
NCCN 2015 V3:
Unresectable Tumors
Locoregionally advanced
• Disease infiltration of the root of the mesentery or paraaortic lymph node highly suspicious on imaging or confirmed by biopsy
胃癌(gastric carcinoma)--课件
3.疾病因素
慢性萎缩性胃炎、胃黏膜上皮异型增生、胃息肉、残 胃、胃溃疡、幽门螺杆菌（HP）感染等。
病
因
幽门螺杆菌（helicobacter pylori,HP）感染
1.HP是一种微弯曲棒状的革兰氏阴性杆菌，存在于多数慢性胃炎病 人的胃型上皮表面和腺体内的粘液层中。HP通过其产生的粘附素粘附到 胃上皮细胞表面，分泌尿素酶、细胞毒素相关蛋白和细胞空泡毒素及其 他一些物质而致病。 2.HP与胃癌有共同的流行病学特点, 胃癌高发区HP感染率高; 动物实 验示HP可诱发胃癌 3.WHO已将HP列为胃癌的I类致癌原
预
防
A.改变不良饮食习惯：避免暴饮暴食，三餐不定；进食不宜过快、过烫、过硬。
预
防
预防胃癌必吃五种食物： 大蒜
洋葱
菌菇类 椰菜花
西红柿
预
防
B.去除不良嗜好：吸烟，饮酒等不良的嗜好要改变；
C.积极治疗癌前病变，
争取做到“三早” ；
D.保持良好心态。
世界胃癌年龄调整发病率
Parkin, D. M. et al. CA Cancer J Clin 2005;55:74-108.
病
1.环境、饮食因素
A.环境因素：
因
火山岩地带、微量元素比例失调、化学污染、水源 B.饮食因素： 霉粮、霉制食品、腌制鱼肉、咸菜、烟熏食物
病
2.遗传因素
因
胃癌有明显的家族聚集现象，浸润性胃癌有更高的家 族发病倾向.
2.姑息性手术：
姑息性切除术 短路手术
治
疗
化学治疗： A. 手术治疗补充，可以在术前、术中和术后使用； B. 化疗起姑息治疗的作用，可减轻症状和延长寿 命；
治
化学治疗分类：
胃癌ppt课件
幽门螺杆菌感染等。
5
.
解剖学分类
解剖分类很重要，因为胃和胃食管结合癌发生率、地 域分布、病因、临床过程和治疗完全不同。胃食管结 合癌多采用Siewert分类：贲门癌（Siewert II型）中心 位于胃食管结合部下1–2cm；远端食管腺癌（Siewert I型）和贲门下胃癌（Siewert III型）中心位于胃食管 结合部上1cm以上或下2cm以下。II和III型肿瘤生物学 差别不清楚。
WHO分类包括5种组织病理类型：管状、乳头状、粘液性、 粘附性差和少见组织型，某种病理类型中多会伴有其它组 织成分。WHO中管状和乳头状相当于Lauren中的肠型，粘 附性差型（部分或全部为印戒细胞）相当于Lauren中的弥 漫型。
7
.
胃鳞癌是胃癌中很少见的一种，仅占全 部胃癌的0.04%-0.7%，多局限于胃窦部， 一般认为系由胃黏膜上皮在慢性炎症基 础上发生鳞状化生而形成，与食管鳞癌 侵及胃无关。多见于男性。虽然胃鳞癌 发生概率较低，但胃鳞癌的5年生存率低， 亦应重视胃鳞癌的治疗。
胃癌（Gastric Cancer ）
齐齐哈尔建华医院肿瘤一科 张旭阳
1
.
什么是胃癌？
胃癌是第四常见肿瘤，第二致死癌症，亚洲、 拉丁美洲和中欧、东欧胃癌发病率仍很高，但 西方欧洲国家明显下降，可能与低水平幽门螺 杆菌感染有关，不过近年胃食管结合部腺癌发 病率上升。
胃癌目前的临床治疗效果很不理想，我国胃癌 手术治疗后，五年生存率仅有20% -30%。
12
.
图2 HER2检测流程
13
.
早期胃癌
14
什么叫早期？很多患者 搞不懂，简单概括了一 下：就是胃肿瘤局限于 黏膜和黏膜下层，不考 虑癌灶大小和淋巴结转 移。对于早期的胃癌， 一般考虑的就是切除， 通过手术获取其他的方
5
.
解剖学分类
解剖分类很重要，因为胃和胃食管结合癌发生率、地 域分布、病因、临床过程和治疗完全不同。胃食管结 合癌多采用Siewert分类：贲门癌（Siewert II型）中心 位于胃食管结合部下1–2cm；远端食管腺癌（Siewert I型）和贲门下胃癌（Siewert III型）中心位于胃食管 结合部上1cm以上或下2cm以下。II和III型肿瘤生物学 差别不清楚。
WHO分类包括5种组织病理类型：管状、乳头状、粘液性、 粘附性差和少见组织型，某种病理类型中多会伴有其它组 织成分。WHO中管状和乳头状相当于Lauren中的肠型，粘 附性差型（部分或全部为印戒细胞）相当于Lauren中的弥 漫型。
7
.
胃鳞癌是胃癌中很少见的一种，仅占全 部胃癌的0.04%-0.7%，多局限于胃窦部， 一般认为系由胃黏膜上皮在慢性炎症基 础上发生鳞状化生而形成，与食管鳞癌 侵及胃无关。多见于男性。虽然胃鳞癌 发生概率较低，但胃鳞癌的5年生存率低， 亦应重视胃鳞癌的治疗。
胃癌（Gastric Cancer ）
齐齐哈尔建华医院肿瘤一科 张旭阳
1
.
什么是胃癌？
胃癌是第四常见肿瘤，第二致死癌症，亚洲、 拉丁美洲和中欧、东欧胃癌发病率仍很高，但 西方欧洲国家明显下降，可能与低水平幽门螺 杆菌感染有关，不过近年胃食管结合部腺癌发 病率上升。
胃癌目前的临床治疗效果很不理想，我国胃癌 手术治疗后，五年生存率仅有20% -30%。
12
.
图2 HER2检测流程
13
.
早期胃癌
14
什么叫早期？很多患者 搞不懂，简单概括了一 下：就是胃肿瘤局限于 黏膜和黏膜下层，不考 虑癌灶大小和淋巴结转 移。对于早期的胃癌， 一般考虑的就是切除， 通过手术获取其他的方
胃癌英文Gastric Cancerppt课件
In the Western Hemisphere, R0 resection is possible in approximately 50% to 80% of patients.
The median survival of patients who undergo an R0 resection is approximately 25 months, and 5year survival rates range from 30% to 37%.
It is possible that in the coming decades these changing trends will also occur in South America and Asia.
Nearly 70% to 80% of resected gastric carcinoma specimens have metastases in the regional lymph nodes. Thus, it is common to encounter patients with advanced gastric carcinoma at the outset.
Southern Africa
Central America
Male Female
Male Female
11.5 4.3
18.6 13.3
Almost 40% of cases occur in China .
Pazdur R et al. Cancer management: A multidisciplinary approach. 6th edition,2002
Patients with apparent locoregional disease can be further classified: (1) those who are medically fit and whose cancer is resectable, (2) those who are medically fit but whose cancer is unresectable, and (3) those who are inoperable (medically unfit).
The median survival of patients who undergo an R0 resection is approximately 25 months, and 5year survival rates range from 30% to 37%.
It is possible that in the coming decades these changing trends will also occur in South America and Asia.
Nearly 70% to 80% of resected gastric carcinoma specimens have metastases in the regional lymph nodes. Thus, it is common to encounter patients with advanced gastric carcinoma at the outset.
Southern Africa
Central America
Male Female
Male Female
11.5 4.3
18.6 13.3
Almost 40% of cases occur in China .
Pazdur R et al. Cancer management: A multidisciplinary approach. 6th edition,2002
Patients with apparent locoregional disease can be further classified: (1) those who are medically fit and whose cancer is resectable, (2) those who are medically fit but whose cancer is unresectable, and (3) those who are inoperable (medically unfit).
胃癌ppt课件
精选课件PPT
37
护理目标
病人每夜睡眠时间超过6小时 病人呼吸道通畅，感觉舒适 病人口腔黏膜完整，感觉舒适 营养状况改善，能耐受手术 病人情绪稳定，能积极接受治疗与护理
精选课件PPT
38
护理措施
心理护理 改善病人的营养状况
术前营养支持 术后营养支持：肠外营养、肠内营养
用药的护理
急性穿孔病人的护理：严密观察、伴有休克者平 卧，禁食、禁饮、胃肠减压，补液、抗感染、预 防及治疗休克，作好急症手术准备
精选课件PPT
29
护理评估（术前）
健康史：一般资料，家族史，既往史。 身体状况 ：局部症状，全身表现。 心理和社会支持状况
精选课件PPT
30
健康史
一般资料：年龄、性别、性格特征、职业、饮食 习惯。药物，如阿司匹林和激素类。 家族史：家族中有无胃癌或其他肿瘤患者。 既往史：有无长期溃疡病史或萎缩性胃炎、胃息 肉等癌前病变。
亚硝酸盐及3，4-苯并芘对胃有很强的致 癌作用，并有很高的器官亲和性。
精选课件PPT
5
幽门螺杆菌感染
幽门螺杆菌感染也是引发胃癌的主要因素之一。 它能促使硝酸盐转化亚硝胺，还能引起胃粘膜慢性炎症 并通过加速粘膜上皮细胞的增殖，导致畸变致癌； 其毒性产物和癌基因产物也具有很强的致癌和促癌作用。 控制幽门螺杆菌的感染已越来越受到高度重视。
胃癌
精选课件PPT
1
胃癌（gastric carcinoma）是人类发病率 最高的恶性肿瘤。
发病率有地区差。日本、哥斯达黎加、巴西是 世界上胃癌发病率和死亡率最高的国家，我国 属高发区。
男女发病率之比为2：1，好发年龄在50岁以 上。我国的早期胃癌就诊率、检出率很低，明 确诊断时多已为进展期胃癌，治疗效果不理想， 五年及十年生存率较低。
胃癌PPT
谢谢
五、治疗
早期胃癌的内镜下治疗：直 径小于 2cm 的无溃疡表现的分 化型黏膜内癌，可在内镜下行胃 黏膜切除术（EMR）或内镜下黏 膜剥离术（ESD）。
内镜下治疗的示意图
五、治疗
2.手术治疗 外科手术是胃癌的主要治疗手段，分为根治性手术和姑息性手术两类。 （1）根治性手术（radical surgery）：原则为彻底切除胃癌原发灶，按临床分期标准清除胃 周围的淋巴结，重建消化道。目前公认的胃癌根治性手术的标准术式是 D2 淋巴结清扫的胃切 除术。 1）常用的胃切除术和胃切除范围：全胃切除术（total gastrectomy），包括贲门和幽门的 全胃切除；远端胃切除术（distal gastrectomy），包括幽门的胃切除术，保留贲门，标准 手术为切除胃的 2/3 以上；近端胃切除术（proximal gastrectomy），包括贲门的胃切除 术，保留幽门。切除范围：胃切断线要求距肿瘤边缘至少 5cm；远侧部癌应切除十二指肠球 部 3～4cm，近侧部癌应切除食管下端 3～4cm。保证切缘无肿瘤残留。
胃癌的扩散与转移
临床病理分期：国际抗癌联盟和美国癌症联合委员会（UICC/AJCC）胃癌 TNM 分期（第八版） 的病理依据主要是肿瘤浸润深度、淋巴结以及远处转移情况。以 T 代表原发肿瘤浸润胃壁的深 度。
➢ Tx：原发肿瘤无法评估。T0：无原发肿瘤的证据。Tis 代表原位癌：上皮内肿瘤，未侵及黏 膜固有层，高度不典型增生。T1：肿瘤侵及黏膜固有层、黏膜肌层或黏膜下层；T1a：肿瘤 侵犯黏膜固有层或黏膜肌层；T1b：肿瘤侵犯黏膜下层。T2：肿瘤侵犯固有肌层。T3：肿瘤 穿透浆膜下结缔组织，而尚未侵犯脏层腹膜或邻近结构。T4：肿瘤侵犯浆膜（脏层腹膜）或 邻近结构；T4a：肿瘤侵犯浆膜（脏层腹膜）；T4b：肿瘤侵犯邻近结构。
胃癌 (英文版)课件
i) Lacks specific symptoms early: vague epigastric discomfort indigestion.
ii) Epigastric pain, nonradiating, and unrelieved by food ingestion.
iii) Weight loss, anorexia, fatigue, or vomiting. iv) Hematemesis, anemic.
Macroscopic type AGC:Borrmann’s classification
Type IV: Diffuse infiltrative
Photomicrographs of Gastric Carcinoma
H&E, ×25
H on signet ring cells
Type I: Mass
Type II: Ulcerative
Type III: Infiltrative ulcerative
Type IV: Diffuse infiltrative Linitis plastica
Macroscopic type AGC:Borrmann’s classification
• Others
• Male gender • Low social class
Causes
NCCN 2015 ver.3
• Hereditary
• Hereditary Diffuse Gastric Cancer • Lynch Syndrome • Juvenile Polyposis Syndrome • Peutz-Jeghers Syndrome • Familial Adenomatous Polyposis
ii) Epigastric pain, nonradiating, and unrelieved by food ingestion.
iii) Weight loss, anorexia, fatigue, or vomiting. iv) Hematemesis, anemic.
Macroscopic type AGC:Borrmann’s classification
Type IV: Diffuse infiltrative
Photomicrographs of Gastric Carcinoma
H&E, ×25
H on signet ring cells
Type I: Mass
Type II: Ulcerative
Type III: Infiltrative ulcerative
Type IV: Diffuse infiltrative Linitis plastica
Macroscopic type AGC:Borrmann’s classification
• Others
• Male gender • Low social class
Causes
NCCN 2015 ver.3
• Hereditary
• Hereditary Diffuse Gastric Cancer • Lynch Syndrome • Juvenile Polyposis Syndrome • Peutz-Jeghers Syndrome • Familial Adenomatous Polyposis
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Louvet C, De Gramont A, Demuynck B, et al:. Ann Oncol 2: 229-230, 1991
Chemotherapy of Gastric Cancer
5-FU, doxorubicin, and mitomycin (FAM); 5-FU, doxorubicin, and high-dose methotrexate (FAMTX); etoposide, doxorubicin, and cisplatin (EAP); etoposide, leucovorin, and 5-FU (ELF); epirubicin, cisplatin, and 5-FU continuous infusion (ECF); cisplatin, epirubicin, leucovorin, and 5-FU (PELF); cisplatin and 5-FU.
2nd most common cancer in the world, 558400new cases and 405200 deaths. Almost 40% of cases occur in China .
Pazdur R et al. Cancer management: A multidisciplinary approach. 6th edition,2002
Global Consensus
Good local control is essential to cure gastric carcinoma The only potentially curative treatment for localized gastric cancer is surgery.
Nearly 70% to 80% of resected gastric carcinoma specimens have metastases in the regional lymph nodes. Thus, it is common to encounter patients with advanced gastric carcinoma at the outset. In the Western Hemisphere, R0 resection is possible in approximately 50% to 80% of patients. The median survival of patients who undergo an R0 resection is approximately 25 months, and 5year survival rates range from 30% to 37%.
NCNN Guidelines
The workup permits classification of patients into 1 of 2 groups: (1)patients with apparent locoregional carcinoma (stages I to III or M0),and (2) those with obvious metastatic carcinoma (stage IV or M1). Patients with apparent locoregional disease can be further classified: (1) those who are medically fit and whose cancer is resectable, (2) those who are medically fit but whose cancer is unresectable, and (3) those who are inoperable (medically unfit).
5-FU modulation by folinic acid (FA) has generally resulted in enhanced antitumor efficacy (22% to 48% overall response rate) and has led to some complete responses (5% to 9%). All current reference combination regimens in AGC contain 5-FU.
Chemotherapy of Gastric Cancer
Most gastric cancers are diagnosed at an advanced stage. The 5-year survival rate after “curative resection” for gastric cancer is only between 30% and 40%. The efficacy of chemotherapy with palliative intent is now widely accepted.
*Incidence per 100,000 population.
Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64.
Countries in which the incidence of gastric carcinoma isextremely high include Japan, Costa Rica, Peru, Brazil, China,Korea, Chile, Taiwan, and the countries of the former Soviet Union. At diagnosis,approximately 50% of patients have gastric carcinoma that extends beyond the locoregional confines. Approximately 50% of patients with locoregional gastric carcinoma cannot undergo a curativeresection (R0).
Kohne CH, Wils JA, Wilke HJ: Developments in the treatment of gastric cancer in Europe.Oncology (Huntingt) 14: 22-25, 2000
Chemotherapy of Gastric Cancer
FluorourБайду номын сангаасcil (5-FU) is one of the most effective and widely used drugs in the treatment of advanced gastric cancer (AGC), producing a response rate of approximately 20%, with manageable toxicity. Overall survival of between 5 and 7 months has been reported for 5-FU monotherapy in phase III randomized studies.
Australia/ Male New Zealand Female China Northern Africa Southern Africa Central America North America
Male Female Male Female Male Female Male Female Male Female
In countries in the Western Hemisphere, gastriccarcinoma has migrated proximally, occurring most frequently along the proximal lesser curvature, in the cardia, and involving the gastroesophageal junction. It is possible that in the coming decades these changing trends will also occur in South America and Asia.
Chemotherapy of Gastric Cancer
Several randomized studies comparing FAM versus FAMTX (5- FU, adriamycin, and methotrexate [with leucovorin rescue), FAMTX versus ECF (epirubicin, cisplatin, and 5- FU), and FAMTX versus ELF (etoposide, leucovorin, and 5- FU) versus 5- FU plus cisplatin have been reported in the past several years. No one standard therapy has emerged from these trials. Outside of clinical trials, the recommended chemotherapy for advanced gastric carcinoma is either cisplatin- based or 5- FU-- based combination chemotherapy.
Coombes R, Chilvers CE, Amadori D, et al: An International Collaborative Cancer Group (ICCG) study. Ann Oncol 5: 33-36, 1994 6.
Chemotherapy of Gastric Cancer
Chemotherapy of Gastric Cancer
5-FU, doxorubicin, and mitomycin (FAM); 5-FU, doxorubicin, and high-dose methotrexate (FAMTX); etoposide, doxorubicin, and cisplatin (EAP); etoposide, leucovorin, and 5-FU (ELF); epirubicin, cisplatin, and 5-FU continuous infusion (ECF); cisplatin, epirubicin, leucovorin, and 5-FU (PELF); cisplatin and 5-FU.
2nd most common cancer in the world, 558400new cases and 405200 deaths. Almost 40% of cases occur in China .
Pazdur R et al. Cancer management: A multidisciplinary approach. 6th edition,2002
Global Consensus
Good local control is essential to cure gastric carcinoma The only potentially curative treatment for localized gastric cancer is surgery.
Nearly 70% to 80% of resected gastric carcinoma specimens have metastases in the regional lymph nodes. Thus, it is common to encounter patients with advanced gastric carcinoma at the outset. In the Western Hemisphere, R0 resection is possible in approximately 50% to 80% of patients. The median survival of patients who undergo an R0 resection is approximately 25 months, and 5year survival rates range from 30% to 37%.
NCNN Guidelines
The workup permits classification of patients into 1 of 2 groups: (1)patients with apparent locoregional carcinoma (stages I to III or M0),and (2) those with obvious metastatic carcinoma (stage IV or M1). Patients with apparent locoregional disease can be further classified: (1) those who are medically fit and whose cancer is resectable, (2) those who are medically fit but whose cancer is unresectable, and (3) those who are inoperable (medically unfit).
5-FU modulation by folinic acid (FA) has generally resulted in enhanced antitumor efficacy (22% to 48% overall response rate) and has led to some complete responses (5% to 9%). All current reference combination regimens in AGC contain 5-FU.
Chemotherapy of Gastric Cancer
Most gastric cancers are diagnosed at an advanced stage. The 5-year survival rate after “curative resection” for gastric cancer is only between 30% and 40%. The efficacy of chemotherapy with palliative intent is now widely accepted.
*Incidence per 100,000 population.
Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64.
Countries in which the incidence of gastric carcinoma isextremely high include Japan, Costa Rica, Peru, Brazil, China,Korea, Chile, Taiwan, and the countries of the former Soviet Union. At diagnosis,approximately 50% of patients have gastric carcinoma that extends beyond the locoregional confines. Approximately 50% of patients with locoregional gastric carcinoma cannot undergo a curativeresection (R0).
Kohne CH, Wils JA, Wilke HJ: Developments in the treatment of gastric cancer in Europe.Oncology (Huntingt) 14: 22-25, 2000
Chemotherapy of Gastric Cancer
FluorourБайду номын сангаасcil (5-FU) is one of the most effective and widely used drugs in the treatment of advanced gastric cancer (AGC), producing a response rate of approximately 20%, with manageable toxicity. Overall survival of between 5 and 7 months has been reported for 5-FU monotherapy in phase III randomized studies.
Australia/ Male New Zealand Female China Northern Africa Southern Africa Central America North America
Male Female Male Female Male Female Male Female Male Female
In countries in the Western Hemisphere, gastriccarcinoma has migrated proximally, occurring most frequently along the proximal lesser curvature, in the cardia, and involving the gastroesophageal junction. It is possible that in the coming decades these changing trends will also occur in South America and Asia.
Chemotherapy of Gastric Cancer
Several randomized studies comparing FAM versus FAMTX (5- FU, adriamycin, and methotrexate [with leucovorin rescue), FAMTX versus ECF (epirubicin, cisplatin, and 5- FU), and FAMTX versus ELF (etoposide, leucovorin, and 5- FU) versus 5- FU plus cisplatin have been reported in the past several years. No one standard therapy has emerged from these trials. Outside of clinical trials, the recommended chemotherapy for advanced gastric carcinoma is either cisplatin- based or 5- FU-- based combination chemotherapy.
Coombes R, Chilvers CE, Amadori D, et al: An International Collaborative Cancer Group (ICCG) study. Ann Oncol 5: 33-36, 1994 6.
Chemotherapy of Gastric Cancer