Multidisciplinary approach for the treatment of gastric cancer.

Gastric cancer is a global phenomenon and is the second leading cause of cancer-related deaths worldwide. The highest rates of gastric cancer are seen in Asia and parts of Eastern Europe. In Western countries, the incidence of gastric cancer has declined over the last several decades. At the same time, the distribution of gastric tumors has shifted towards more proximal location in Western patients compared to their Asian counterparts. The most common risk factors include dietary factors, smoking, acid hyposecretory conditions, and H. pylori infection. Clinical diagnosis is made by obtaining a good history and physical exam, complemented by endoscopy and imaging studies. Patients often have advanced disease at time of diagnosis. In the absence of metastases, and provided that the patient is medically fit, surgery is the mainstay of treatment. The extent of gastric resection, including the extent of lymph node dissection, varies by region, with more extensive operations being done in Asia, particularly Japan. Because of the propensity of gastric cancer to recur both locally and distantly, additional therapies including chemotherapy and radiation therapy are recommended along with surgery. These can be administered pre-, peri-, or postoperatively based on institutional practices. As with surgical technique, how and when these additional treatments are offered depends largely on regional practice. In the setting of unresectable, or metastatic disease, palliative options including endoscopic and surgical interventions, radiotherapy, and chemotherapy are available.

Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy.

BACKGROUND: Hyperparathyroidism is associated with subjective feelings of fatigue and depression as well as limitations in physical activity from musculoskeletal complaints. These quality of life symptoms are not widely accepted as an indication for parathyroidectomy. This study quantifies and compares subjective symptoms of patients with hyperparathyroidism before and after surgery. METHODS: Between February 2001 and June 2002, 61 patients (14 males and 47 females, mean age of 60.8+/-14.4 years) underwent parathyroidectomy. There were 45 patients with single-gland adenomas, 9 patients with double adenomas, 3 patients with primary hyperparathyroidism from 4-gland hyperplasia, 3 patients with secondary hyperparathyroidism, and 1 patient with tertiary hyperparathyroidism. Patients filled out a 53-question survey based on the Health Outcomes Institute Health Status Questionnaire 2.0 before surgery, 1 month postoperatively, and 3-24 months postoperatively. The survey included questions on overall health, daily activities, mood, and medical conditions. Surveys were analyzed for changes in symptoms attributable to parathyroidectomy. Serum calcium and intact parathyroid hormone levels were obtained preoperatively and at 1- and 3-month follow-up visits. RESULTS: At both postoperative evaluations, patients' perception of general health, muscle strength, energy level, and mood significantly improved (P<.05). Moreover, there was a significant correlation between the changes in serum calcium and intact parathyroid hormone levels and improvement in symptoms. CONCLUSIONS: Parathyroidectomy for hyperparathyroidism is associated with significant improvement in patient quality of life. These subjective symptoms represent a valid indication for parathyroidectomy.