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DOI: 10.1055/a-0956-0933
Diagnostik und Therapie des Magenkarzinoms
Welche Therapie für welches klinische Stadium?Publication History
Publication Date:
17 July 2019 (online)
ZUSAMMENFASSUNG
Mögliche Indizien für ein Magenkarzinom sind Dysphagie und rezidivierend auftretendes Erbrechen. Zur genauen Abklärung sollte eine Ösophago-Gastro-Duodenoskopie empfohlen werden. Zur histologischen Sicherung eines verdächtigen Befundes muss eine Gewebeprobe entnommen werden. Nach Bestätigung eines malignen Tumors wird mittels einer Endosonografie die Eindringtiefe des Tumors in die einzelnen Schichten des Magens untersucht. Die einzige Option zur Kuration des Magenkarzinoms ist die chirurgische Therapie. Ziel der Behandlung ist eine komplette Tumorentfernung einschließlich der abführenden Lymphdrainagesysteme. Nach der Erfassung des klinischen Stadiums – Magenfrühkarzinome (Stadium 0/IA), lokal fortgeschrittene Magenkarzinome (Stadium IB–IIIC), fernmetastasierte Tumoren (Stadium IV) – ergeben sich abhängig von der Tumorsituation, unterschiedliche chirurgische Konsequenzen. Bei Beschränkung auf die Mukosa (T1m) kann eine lokale Exzision ausreichend sein, da die Wahrscheinlichkeit der Lymphknotenmetastasierung in diesem Stadium bei nahezu 0 % liegt. Im lokal fortgeschrittenen Stadium erfolgt prinzipiell präoperativ zunächst eine neoadjuvante (Radio-)Chemotherapie. Beim metastasierten Magenkarzinom kann eine Kuration durch eine chirurgische Resektion nicht mehr erreicht werden. Das Ziel chirurgisch palliativer Maßnahmen ist die Therapie lokaler Komplikationen wie Tumorblutung, Stenose oder Tumorperforation. Mittlerweile werden fast alle Patienten mit einem lokal fortgeschrittenen Tumorstadium (uT3, N0/ +) einem multimodalen Therapiekonzept zugeführt. Eine neoadjuvante oder perioperative Therapie kann bei gutem Ansprechen nicht nur die lokale Resektabilität, sondern auch das Gesamtüberleben verbessern.
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