From the Guidelines
Bulky gastric cancer is considered when the tumor has invaded the muscularis propria or deeper layer of the gastric wall, corresponding to advanced T-stage (T3 or T4) in the TNM staging system, and is typically characterized by significant size and volume, often greater than 8-10 cm in diameter or occupying a large portion of the stomach, as defined by the Borrmann classification 7. When considering the definition of bulky gastric cancer, it is essential to take into account the tumor's size, volume, and extent of invasion into surrounding tissues and organs.
- The Borrmann classification, which includes four subtypes, can be used to describe the tumor's morphology and extent of invasion 7.
- Advanced gastric cancer, which includes bulky tumors, is defined as a tumor that has invaded the muscularis propria or deeper layer of the gastric wall 7.
- The 8th edition of the AJCC/UICC staging system requires the recording of the tumor's size and extent of invasion, which is crucial for determining the tumor's stage and guiding treatment decisions 1. Some key points to consider when evaluating bulky gastric cancer include:
- The tumor's size and volume, which can impact treatment options and outcomes
- The extent of invasion into surrounding tissues and organs, which can affect the tumor's stage and prognosis
- The presence of lymph node metastasis, which can impact treatment decisions and outcomes
- The tumor's morphology and subtype, which can influence treatment options and prognosis According to the Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of gastric cancer, bulky gastric cancer often requires more aggressive treatment approaches, potentially including neoadjuvant chemotherapy, more extensive surgical resection, and multimodal therapy 1.
- The guidelines recommend that surgeons and pathologists collect and group the perigastric lymph nodes according to their respective stations, which should be mentioned in the postoperative pathological report 1.
- The guidelines also emphasize the importance of accurate staging and evaluation of the tumor's extent of invasion, which is crucial for determining the tumor's stage and guiding treatment decisions 1.
From the Research
Definition of Bulky Gastric Cancer
- Bulky gastric cancer is not explicitly defined in the provided studies, but it can be inferred that it refers to advanced gastric cancer with significant tumor burden, such as bulky lymph node metastases 2.
- The study by 2 describes a case of unresectable gastric cancer with bulky lymph node metastases, which suggests that bulky gastric cancer may be characterized by large tumor size and extensive lymph node involvement.
Characteristics of Bulky Gastric Cancer
- Bulky gastric cancer may be associated with advanced disease, such as stage III or IV cancer 2, 3.
- Patients with bulky gastric cancer may have a poorer prognosis and require more aggressive treatment, such as combination chemotherapy and targeted therapy 2, 3.
- The presence of bulky lymph node metastases may make surgery more challenging and require neoadjuvant chemotherapy to shrink the tumor and facilitate resection 2.
Treatment of Bulky Gastric Cancer
- Treatment options for bulky gastric cancer may include combination chemotherapy, such as SOX regimen (S-1 and oxaliplatin) plus apatinib, followed by surgery 2.
- Targeted therapies, such as trastuzumab, may be used in combination with chemotherapy to treat HER2-positive gastric cancer 4, 3.
- Chemoradiotherapy may also be used as an adjuvant treatment for bulky gastric cancer 4.