Risk of peritoneal dissemination in stomach cancer

With regard to gastric cancer, an important disease and a public health problem, it is expected that understanding the molecular make up of carcinomas will provide us with more precise targets for therapy. Indeed advanced molecular technology has made it possible to classify according to genotype instead of phenotype. For advanced stomach cancer, however, surgery is still the only option for cure. Yet, also after surgery, more than 50% of the patients will die of peritoneal dissemination of their disease. This review looks at the molecular mechanism of peritoneal spread of stomach cancer in order to arrive at a risk profile that enables medical personnel to raise the index of suspicion for peritoneal carcinomatosis. The peritoneal cancer index (PCI) provides a scoring system to measure the extent of peritoneal spread during laparoscopic staging. A recently developed device called the ‘MacSpec pen’ maybe of use to confirm the presence of tumor when there is doubt about the diagnosis. Treatment of peritoneal dissemination consists of cytoreduction, combined with hyperthermic peritoneal chemotherapy (HIPEC).