Želučani karcinom spada među najčešće maligne
bolesti u svijetu i drugi je na svjetskoj ljestvici uzroka smrti od
malignih bolesti, premda mu incidencija u razvijenim zemljama
s vremenom pada. U patogenezi želučanog raka važnu ulogu
imaju i genetski čimbenici i čimbenici iz okoliša. Kronična infekcija
Helicobacterom pylori glavni je pokretač pretkarcinoznog
procesa. U karcinogenezi također važnu ulogu imaju i dijeta
bogata nitratima, a siromašna antioksidansima. Još nije točno
poznato kojim mehanizmom(-ima) infekcija potiče nastajanje
želučanog karcinoma. Radi se o dugome latentnom vremenu,
što je dobro potkrijepljeno dokazima. U tom periodu prepoznat
je niz preteča, predmalignih, lezija želučane sluznice (kronični
atrofi čni gastritis, intestinalna metaplazija, želučana displazija)
koje stvaraju pretkarcinomsku kaskadu. Postoji više klasifi kacijskih
sustava za rak želuca, a najčešća je TNM-klasifi kacija
o kojoj ovisi izbor terapije te prognoza bolesti. U operabilnih,
uznapredovalih karcinoma prva metoda izbora je kirurški zahvat.
Temeljem rezultata kliničke studije III. faze Intergroup Study
0116 (INT-0116) koji se odnose na produljenje preživljenja i
perioda bez bolesti, adjuvantna konkomitantna radiokemoterapija
postala je standardni oblik liječenja u Americi i znatnom
broju europskih zemalja, među kojima je i Hrvatska. Liječenje
metastatske bolesti kemoterapijom daje dulje preživljenje u
usporedbi sa simptomatskom terapijom.Gastric cancer is one of the most common
malignant diseases worldwide, and the second leading cause
of cancer-related death in the world, although its incidence has
fallen over time in developed nations. Both genetic and environmental
factors play important roles in the pathogenesis of gastric
cancer. Chronic infection with Helicobacter pylori is a major
force driving the precancerous process. Dietary factors including
high nitrate intake and lack of the antioxidants also play an
important role in carcinogenesis. The precise mechanism(s) by
which the infection induces gastric cancer are still unknown.
A very long latency period has been well documented. In this
period, a number of sequential precursor (premalignant) lesions
in the gastric mucosa (chronic atrophic gastritis, intestinal
metaplasia, gastric dysplasia), i.e. the precancerous cascade,
has been identifi ed. Several classifi cation systems for gastric
cancer are available. TNM staging is most frequently used, and
it determines the choice of the therapy and the prognosis of the
disease. In operable advanced carcinomas, surgery is the method
of fi rst choice. Based on the results of Phase III Intergroup
Study 0116 (INT-0116), which demonstrated signifi cant benefi t
in overall and disease-free survival, the adjuvant concomitant
radiotherapy has ever since become the standard of health care
in the United States and many European countries, including
Croatia. The survival rate is higher in patients with metastatic
disease treated with chemotherapy than in those receiving the
best supportive care
