Final answer:
The management of early gastric cancer includes surgical resection, such as EMR/ESD for superficial cancers or a partial/total gastrectomy for more advanced stages. Adjuvant therapies like chemotherapy or chemoradiation may also be considered, and a multidisciplinary approach is essential in treatment planning.
Step-by-step explanation:
The management of early gastric cancer in a 45-year-old man, particularly when episodes of epigastric pain have not resolved with medical therapy, involves a combination of therapeutic strategies. After confirming the diagnosis with a biopsy during an esophagogastroduodenoscopy (EGD), the management typically includes surgical resection as the mainstay treatment. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) may be options for very early-stage cancers that are confined to the mucosa. For cancers that invade deeper layers or with higher risk features, more extensive surgery may be necessary, such as a partial or total gastrectomy, often combined with lymph node dissection.
Additionally, depending on the staging and the patient's overall health, adjuvant therapies such as chemotherapy or chemoradiation may be considered to reduce the risk of recurrence. The multidisciplinary team approach, involving surgeons, oncologists, gastroenterologists, and other healthcare professionals, is crucial in tailoring the treatment plan to the patient's specific situation. It's also important to regularly monitor the patient for any signs of recurrence and manage possible postoperative complications and nutritional deficiencies resulting from gastric surgery.