Leading
cause of morbidity and mortality |
|
Asia,
South America |
Women
in the Western World |
|
Overall
5-year survival |
|
22%
(USA), 50% (Japan) |
86%
(USA) |
|
Scientific
efforts and health policy strategies to
fight cancer |
|
Primary
Prevention of familial cancer |
|
CDH1
carriers:
Surgery: total gastrectomy |
BRCA1,
BRCA2 carriers
Surgery (mastectomy or oophorectomy
Surveillance (plus chemoprevention) |
|
Pathway-based
Chemoprevention |
|
Atrophic
gastritis, intestinal metaplasia, (Non-ulcer
dyspepsia?) |
Women
with risk > 1.66 |
|
Helicobacter
pylori eradication |
.
Tamoxifen |
|
Fruits
& vegetables, vit. C Suppl. |
.
Raloxifene |
|
Early
detection |
|
Screening
endoscopy
Japan:
50% early-stage |
Screening
mammography
USA:
70% early-stage |
|
Increasing
minimally invasive approaches |
|
Endocopic
mucosal resection
Limited
surgery (laparoscopic) |
Breast-conserving
surgery
Sentinel
lymph node biopsy |
|
Quality
of Surgery |
|
Principal
goal: complete (R0) resection. Caution:
Essential in limited surgery
Selection
of tumor stage-targeted extent of surgery
|
|
|
Node-negative
D1; -positive: D2 |
< 5cm: Breast-conserving only by R0 |
|
Splenectomy:
only T2,T3 proximal cancer
Pancreatectomy:
few indications |
SLND:
in specialized institutions and in ongoing
trials only |
|
Postoperative
adjuvant treatment |
|
Little
effectiveness |
Established
benefit |
|
Neoadjuvant
treatment in locally advanced cancer |
|
Preoperative,
intraoperative-intra- peritoneal chemotherapy,
radio- therapy: still experimental |
Increases
rate of breast-conserving surgery, effect
on survival unclear. |
|