Clinical Pathways of Stomach Cancer

Stomach cancer ranks as the fifth most prevalent cancer and the fourth leading cause of cancer-related deaths worldwide, with over ۱ million new cases reported annually.Its asymptomatic nature often results in late-stage diagnoses,complicating treatment and management.Understanding clinical pathways—structured plans detailing essential steps in patient care including diagnostic tests, medications, and management designs—is vital for improving outcomes.This review aims to synthesize recent literature focusing on diagnostic methods,treatment modalities,and management strategies for stomach cancer from ۲۰۱۹ to ۲۰۲۴. Method: A systematic literature search was conducted using databases such as PubMed, Scopus, and Web of Science.The search terms included "stomach cancer," "gastric cancer," "clinical pathways," "diagnosis," and "treatment".Articles published between January ۲۰۱۹ and June ۲۰۲۴ were prioritized. Inclusion criteria focused on studies addressing diagnostic techniques, treatment options, and management strategies.A total of ۴۰ articles were initially identified;۹ relevant studies were selected based on their contributions to understanding clinical pathways in stomach cancer. Results:The diagnostic pathway for gastric cancer typically begins with a comprehensive patient history and physical examination. Endoscopy remains a cornerstone for direct visualization and biopsy collection. Recent advancements in imaging modalities like endoscopic ultrasound (EUS) have improved staging accuracy by providing detailed information about tumor depth and lymph node involvement. Additionally, liquid biopsy techniques are emerging as promising tools for early detection by identifying circulating tumor DNA and other biomarkers associated with gastric cancer. Surgical resection is the primary curative approach for localized stomach cancer. Total or partial gastrectomy is performed based on tumor location and extent. However, many patients present with unresectable disease due to late-stage diagnosis. Neoadjuvant chemotherapy has gained traction as it can downstage tumors before surgical intervention, improving surgical outcomes. Chemotherapy is integral to managing stomach cancer, utilized in both neoadjuvant and adjuvant settings. The FLOT regimen (۵-fluorouracil, leucovorin, oxaliplatin, and docetaxel) has shown better pathological responded compared to FOLFOX regimen. The advent of targeted therapies has transformed the management landscape for stomach cancer.Trastuzumab significantly enhances survival rates for HER۲-positive gastric cancers when combined with chemotherapy. Immune checkpoint inhibitors like pembrolizumab are also being explored for their potential benefits in patients with microsatellite instability-high tumors. Conclusion: The clinical pathways for managing stomach cancer encompass a multifaceted approach that integrates early diagnosis, accurate staging, and a combination of surgical and non-surgical interventions based on the stage, lymph node size and metastase.It typically begin with patient history and physical examination, with endoscopy as the primary diagnostic tool.Advances in imaging, such as endoscopic ultrasound (EUS), and liquid biopsy techniques offer improved staging and early detection.Surgical resection remains the primary curative treatment, though neoadjuvant chemotherapy has emerged to downstage tumors and improve surgical outcomes. The FLOT regimen is more effective than FOLFOX for chemotherapy. Targeted therapies, such as trastuzumab for HER۲-positive cancers, and immune checkpoint inhibitors like pembrolizumab, show promise in advanced cases. For late-stage diagnoses, palliative care is crucial, with a multidisciplinary approach optimizing patient outcomes. Emerging therapies and personalized medicine are critical for improving patient care and survival rates. Future researches should focus on refining clinical pathways for better outcomes.

کلیدواژه ها:

Stomach cancer ، clinical pathways ، diagnosis ، management strategies ، gastric cancer