Gastric Cancer

Basic Overview

Etiology: Helicobacter pylori (Hp) infection is the dominant risk factor. Additional risk factors include high-salt diet, pickled/smoked food intake, tobacco smoking, excessive alcohol consumption, family history, precancerous lesions (atrophic gastritis, intestinal metaplasia, dysplasia), and hereditary cancer syndromes (Lynch syndrome, familial adenomatous polyposis [FAP]).
Clinical Manifestations: Early gastric cancer is mostly asymptomatic or presents with non-specific dyspepsia. Advanced disease presents with persistent epigastric pain, anorexia, unintended weight loss, melena, hematemesis, iron-deficiency anemia, and abdominal mass. Terminal disease presents with gastric outlet obstruction, jaundice, ascites, and distant metastases (most commonly to peritoneum, liver, and lymph nodes).
Diagnosis: Gastroscopy with biopsy is the gold standard for definitive diagnosis, with chromoendoscopy, narrow-band imaging (NBI), and magnifying endoscopy widely used for early cancer detection. Hp testing is mandatory for all patients. Contrast-enhanced CT, endoscopic ultrasound (EUS), and PET-CT are used for staging. Mandatory molecular testing includes HER2, MSI/MMR, and PD-L1 expression. Staging follows the AJCC TNM system.

Standard Treatment Modalities

Early Gastric Cancer (Stage I): Endoscopic resection (endoscopic mucosal resection [EMR] or endoscopic submucosal dissection [ESD]) is the curative standard for lesions meeting strict indications, preserving gastric function and quality of life. Radical gastrectomy with D2 lymph node dissection is indicated for lesions not eligible for endoscopic resection, with adjuvant chemotherapy for high-risk patients.
Locally Advanced Gastric Cancer (Stage II-III): Radical D2 gastrectomy is the surgical gold standard. Perioperative chemotherapy (neoadjuvant chemotherapy followed by adjuvant chemotherapy) or postoperative adjuvant chemotherapy is the standard of care to improve R0 resection rate and long-term survival. Neoadjuvant/adjuvant targeted therapy is indicated for HER2-positive disease, and immunotherapy for MSI-H/dMMR disease.
Advanced/Metastatic Gastric Cancer (Stage IV): Systemic therapy is the core of management. For HER2-positive disease, first-line treatment is chemotherapy plus trastuzumab with or without ICIs. For HER2-negative disease, first-line treatment is chemotherapy plus ICIs for PD-L1-positive patients. Palliative surgery, radiotherapy, and stent placement are used for symptom control of obstruction, bleeding, and pain.

Core Advantages of Treatment in China

Global Leadership in Early Gastric Cancer Endoscopic Diagnosis and Resection

: China is one of the global leaders in gastric ESD, with the second highest procedure volume globally (after Japan). Top-tier endoscopy centers achieve a curative resection rate of over 98% for early gastric cancer, with complication rates <1%, on par with Japan and South Korea. AI-assisted gastroscopy systems are widely deployed in over 2,000 hospitals across China, improving the detection rate of early gastric cancer from 10% to over 30% in the past decade.

Standardized D2 Gastrectomy and Minimally Invasive Surgery

: The Chinese D2 gastrectomy standard is recognized as a global benchmark for locally advanced gastric cancer. China performs the highest number of D2 gastrectomies globally, with laparoscopic and robotic-assisted radical gastrectomy widely standardized. Top-tier gastric surgery centers achieve a 5-year OS rate of over 60% for stage II-III disease, superior to Western institutions and equivalent to Japanese and Korean leading centers.