Diagnostik und Therapie des Magenkarzinoms

 

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Zusammenfassung

Magenkarzinome und Karzinome des ösophago-gastralen Übergangs sind die vierthäufigste Tumorerkankung weltweit und stehen an zweiter Stelle der tumorbedingten Todesursachen. Fehlende Früherkennungsprogramme in der westlichen Welt führen dazu, dass viele Patienten in fortgeschrittenen Erkrankungsstadien diagnostiziert werden. Zum sorgfältigen Staging sollte dann ein hochauflösendes Computertomogramm von Thorax, Abdomens und Beckens sowie eine videodokumentierte Endoskopie und Endosonographie zählen. Beim Mukosakarzinom kann bei Vorliegen spezifischer Kriterien eine endoskopische Mukosaresektion die chirurgische Resektion ersetzen. In den lokal fortgeschrittenen Tumorstadien II und III ist eine perioperative Chemotherapie jetzt als Standard etabliert und sollte durchgeführt werden. In der metastasierten Situation sind die Behandlungsziele palliativ. Eine Chemotherapie kann zur Verlängerung des Überlebens, zur besseren Symptomkontrolle und zu einer verbesserten Lebensqualität beitragen. Kombinationen auf der Basis eines Platinsalzes und Fluorpyrimidins sind etabliert. Etwa jedes 5. Magenkarzinom weist eine Überexpressions des Wachstumsfaktorrezeptor-Proteins Her2 auf. Der gegen Her2 gerichtete monoklonale Antikörper Trastuzumab führt bei Her2-überexprimierender Erkrankung in Kombination mit Cisplatin und 5-Fluorouracil oder Cisplatin zu einer Verlängerung des Gesamtüberlebens.

Abstract

From a global perspective, gastric cancer including cancer of the esophago-gastric junction is the fourth most common malignant tumor and the second-most common cause of cancer-related death. Due to the lack of screening programs in Western countries, most gastric cancers are diagnosed in advanced stages. A sophisticated staging should include high-resolution computed tomography of the thorax, abdomen and pelvis and video-documented endoscopy and endoscopic ultrasound. In mucosal gastric cancer, endoscopic resection can replace surgical resection if specific criteria are present. In the stages II and III perioperative chemotherapy has been established as a standard of care and should be applied. In the metastatic setting, treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can help to maintain a better quality of life. Combination chemotherapy including a platinum compound and a fluoropyrimidine regarded as standard. About 20 % of gastric cancers exhibit overexpression of the growth factor receptor family member Her2. Trastuzumab is a monoclonal antibody directed against Her2 and has shown to prolong survival when combined with cisplatin and 5-fluorouracil or capecitabine.

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Priv.-Doz. Dr. med. Florian Lordick

Chefarzt Medizinische Klinik III (Hämatologie und Onkologie)

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38114 Braunschweig

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