Introduction

There has been a steady decline in the incidence of gastric cancer in most countries in the world in the last 50 years. However, gastric cancer remains a major health problem: it is the 13th most common malignancy in the UK, the 7th most common cause of cancer-related death in the UK, and ranks second worldwide. The decline in incidence in the UK has not been in all anatomical locations. The previously most common, distal type, has become less common, but there has been an increase in cancers affecting the gastro-oesophageal junction and cardia, particularly among young Caucasians, reflecting changes in aetiological factors.

The only current curative treatment is surgery, but in the UK most patients present late, with locally advanced or metastatic disease. Only 25–40% of cases are amenable to potentially curative surgery and, even in these, local recurrence may occur in up to 50% and the 5-year survival is 30–40%. Because of this and because response rates to combination chemotherapy are 40–50% in patients with advanced disease, adjuvant therapy is increasingly being used. Perioperative chemotherapy is used most commonly in the UK, while postoperative chemoradiotherapy is more commonly used as standard treatment in the USA.

Each year the outcomes for patients with oesophagogastric cancer are audited in the National Oesophagogastric Audit (https://www.rcseng.ac.uk/media/docs/press_releases/national-oesophago-gastric-cancer-audit-2013, accessed August 2014).

Types of tumour

The types of tumour affecting the stomach are shown in Table 13.1. Adenocarcinoma accounts for 95% of all malignant tumours.

Anatomy

The stomach begins at the gastro-oesophageal junction and ends at the pylorus and is anatomically defined in three parts: the proximal fundus (cardia), the body and the distal pylorus (antrum). Anteriorly it is covered by the peritoneum of the greater sac, posteriorly by the peritoneum of the lesser sac. Proximally it abuts the diaphragm on the left and the left lobe of the liver on the right. Other adjacent organs (and therefore potential sites of direct invasion) are the spleen, the left adrenal gland, the superior portion of the left kidney, the pancreas and the transverse colon.