GASTRIC CANCER. CURRENT STATE OF MORBIDITY, DIAGNOSIS AND TREATMENT

Chornobai A., Chornobai M., Myаsoedov S., Sorokin B.

LITERATURE REVIEWS

Scentific article

According to calculations, every year on the globe with more than 1 million people with stomach cancer. In the vast majority of countries, the incidence of gastric cancer in men is 2 times higher than that of women. The level of disease varies widely enough, the maximum level of gastric cancer is noted in men in Japan (114,7 per 100 thousand), and the minimum –in white women in the United States (3,1). Helicobacter pylori is recognized as leading in the etiology of stomach cancer. In infected patients, this pathology arises 3.8 times more compared with uninfected patients. Endoscopic examination is one of the most informative methods for diagnosing gastric cancer. Endoscopic examination determines the boundary, the nature and form of tumor growth, the spread of infiltration to the esophagus, the presence of complications. The most promising, in terms of complex diagnosis of intramural and lymphogenic prevalence of the tumor process is the use of endoscopic ultrasound examination. The overall reliability of a spiral CT due to the implementation of a two-phase study on the background of oral and intravenous contrast 74%. In determining the metastases to the lymph nodes, the sensitivity, specificity and overall precision of SCT were 84%, 41% and 67% respectively. Today laparoscopic examination is a compulsory method in preoperative stomach cancer progression and should be performed routinely by all patients. The treatment of stomach cancer today includes the sequencing of the use of combined and complex methods for this pathology. The main single radical method of treating gastric cancer is surgical. However, the radicals of most operations are conditional, which is reflected in the poor results of treatment. Thus, within 5 years after radical operations, 20-50% of patients with localized (T1-2N0) and 40-90% of locally advanced tumors (T3-4N1-2) die from the progression of the disease. Randomized studies comparing the results of chemotherapy (FAMTX, FEMTX, ELF) and symptomatic therapy convincingly demonstrated that drug therapy increases the longevity of patients with a metastatic process from 3-5 months to 10-12 months.The introduction of new cytostatics: docetaxel, irinotecan, xeloda, oxaliplatin and the creation of new chemo-therapy regimens increased the survival rate of patients with metastable gastric Cancer by 1.7 times. Immune and target therapy gastric cancer as treatment methods are today on advanced positions in the treatment of malignant neoplasms. There is now a further study of the expression of genes and receptors in the gastric Cancer. These data make it possible to apply monoclonal antibodies to Rh monoclonal antibodies: hercyptin, tremelimumba (fully humanized CTLA-4 monoclonal antigen), nivolumab – (an antibody that blocks the interaction between Pd-1 and the corresponding Pd-L1 ligand), pemribrolimusab (monoclonal IgG4 antibody, which blocks the interaction of PD-1 with its PD-L1 and PD-L2 ligands. Recently, studies have been conducted on the safety and activity of pemribrolimusab in patients with gastric cancer. (40%) patients were PD-L1 positive. 41% of patients have a tumor reduction.

gastric cancer, morbidity, endoscopy, ultrasound examination, spiral computed tomography, surgical treatment, radiotherapy, chemotherapy, targeted therapy

1. Bondar GV, Dumansky YuV, Popovich AYu. Stomach cancer: prevention, diagnosis and treatment at the present stage. Oncology. 2006;8(2):171-5.
2. Berekhov EI, Privezentsev SA, Kuleshov IYu. Surgical treatment of locally advanced gastric cancer with postoperative radiation therapy: Russian Cancer Journal. 2003;4:24-6. 
3. Callahan M, Bendell J, Chan E. Phase I/II, open-label study of nivolumab (anti-PD-1; BMS-936558, ONO-4538) as monotherapy or combined with ipilimumab advanced or metastatic solid tumor. J Clin Oncol. 2014;32:5.
4. Carboni F, Lepiane P, Santoro R. Extended multiorgan resection for T4 gastric carcinoma: 25-year experience. J. Surg. Oncol. 2005;90(2):95-100.
5. Cocconi G, Carlini P, Gamboni A. PELF is more active than FAMTX in metastatic gastric carcinoma (MGC). Proc. ASCO. 2001;20:501.
6. Couzin-Frankel J. Breakthrough of the year 2013. Cancer іmmunotherapy: Science.2013;342:1432-33.
7. Curran MA, Montalvo W, Yagita H. PD-1 and CTLA-4 combination blockade expands infiltrating T cells and reduces regulatory T and myeloid cells within B16 melanoma tumors. Prc Natl Acad Sci USA. 2010;107:4275-80.
8. Davydov MI, Abdikhakimov AN, Polotsky B.E. On the role of surgery in the treatment of locally advanced with disseminated stomach cancer. Annals of surgery. 2002.2:33-41.
9. De Manzoni G, Verlato G, di Leo A. Perigastric lymph node metastasis in gastric cancer: comparison of different staging systems. Gastric Cancer. 1999;2:201-5.
10. Dunn GP, Bruce AT, Ikeda H. Cancer immunoediting: from immuno-surveillance to tumor escape. Nat Immunol. 2002;3:991-8.
11. Duraiswamy J, Kluger H, Callahan MK. Dual blockade of PD-1 and CTLA-4 combined with tumor vaccine effectively restores T-cell rejection function in tumors. Cancer Res. 2013;369:122-33.
12. Fukuyama T, Yamazaki T, Fujita T. Helicobacter pylori, a carcinogen, induces the expression of melanoma antigen-encoding gene (Mage)-A3, a cancer/testis antigen. Tumor Biol. 2012;33:1881-7.
13. Hamid O, Robert C, Daud A. Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma. N Engl J Med. 2013;369:134-44.
14. Jiang J, Xu N, Wu C. Treatment of advanced gastric cancer by chemotherapy combined with autologous cytokine-induced killer cells. Anticancer Res. 2006;26:2237-42.
15. Jiang JT, Shen YP, Wu CP. Increasing the frequency of CIK cells adoptive immunotherapy may decrease risk of death in gastric cancer patients. World J Gastroenterol. 2010;16:6155-62.
16. Kono K, Takahashi A, Ichihara F. Prognostic significance of adoptive immunotherapy with tumor-associated lymphocytes in patients with advanced gastric cancer: a randomized trial. Clin Cancer Res. 2002;8:1767-71.
17. Martin RC, Jaques DP, Brennan MF. Achieving R0 resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J. Am. Coll. Surg. 2002;194(5):568-77.
18. Masuzawa T, Fujiwara Y, Okada K. Phase I/II study of S-1 plus cisplatin combined with peptide vaccines for human vascular endothelial growth factor receptor 1 and 2 in patients with advanced gastric cancer. Int J Oncol. 2012;41:1297-04.
19. Monig SP, Collet PH, Baldus SE. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J. Surg. Oncol. 2001;76(2):89-92. 
20. Muro K, Bang Y, Shankaran V. A phase 1b study of pembrolizumab in patients with advanced gastric cancer. Annals Onc. 2014;5:1-41.
21. Okajima K. Changes in surgical treatment for gastric cancer. Nippon Geka Gakkai Zasshi. 1998;99(6):396-8. 
22. Otsuji E, Yamaguchi T, Sawai K. Total gastrectomy with simultaneous pancreaticosplenectomy or splenectomy in patients with advanced gastric carcinoma. B. J. Cancer. 1999;79(11-12):1789-93. 
23. Piso P, Werner U, Lang H. Proximal versus distal gastric carcinoma what are the differences? Ann. Surg. Oncol. 2000;7(7):520-5. 
24. Ryu SY, Joo JK, Park YK. Prognosis of gastric carcinoma invading the mesocolon. Аsian J. Surg. 2008;31(4):179-84.
25. Ralph C, Elkord E, Burt DJ. Modulation of lymphocyte regulation for cancer therapy: a phase II trial of tremelimumab in advanced gastric and esophageal adenocarcinoma. Clin Cancer Res. 2008;16:1662-72.
26. Robert C, Ribas A, Wolchok JD. Anti-programmed-death-receptor-1 treatment with pembrolizumab in ipilimumab-refractory advanced melanoma: a randomised dose-comparison cohort of a phase 1 trial. Lancet. 2014;384:1109.
27. Segal N. Preliminary data from a multi-arm expansion study of MEDI4736, an anti-PD-L1 antibody. J Clin Oncol. 2014;(suppl; abstr 3002).
28. Sheleshko PV. Possibilities for improvement of functional results of surgical treatment of precancer and stomach cancer with the help of new methods of antireflux anastomoses and ejinoplasty [dissertation]. Leningrad: 1991. 29 p.
29. Shibata SI, Pezner R, Chu D. A study of radiotherapy modalities combined with continuous 5-FU infusion for locally advanced gastrointestinal malignancies: Eur. J. Surg. Oncol. 2004;30:650-7.
30. The Cancer Genome Atlas Research Network. Comprehensive molecular characterization of gastric adenocarcinoma. Nature. 2014;513:202-9.
31. Varennikov AI. Multicomponent treatment of patients with advanced forms of stomach cancer [dissertation]. Ufa: 2003. 32р.
32. Yang J, Li ZH, Zhou JJ. Preparation and antitumor effects of nanovaccines with MAGE-3 peptides in transplanted gastric cancer in mice. Chin J Cancer. 2010;29:359-64.

«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 62-67 pages, index UDK 116.33-006.6085.277.3

10.29254/2077-4214-2018-1-1-142-62-67