Gastric Cancer: Diagnosis and Treatment

Diagnosis

In Japan, where there is a particularly high incidence of gastric cancer, mass screening programs of asymptomatic individuals using endoscopy or upper GI series identify early cases that may be curable with immediate treatment. As a result, survival rates have improved significantly. However, due to the relatively low incidence of gastric cancer in the United States, mass screening is not currently recommended.

Upper GI endoscopy with biopsy is diagnostic.

Barium swallow with upper GI series may reveal ulceration, mass, or distortion of the stomach wall. However, false negatives occur in up to 50%, especially with early gastric cancer cases. Subsequent biopsy is necessary for diagnosis.

CBC may show iron deficiency anemia.

CT scan and endoscopic ultrasound are used for staging and to evaluate for metastatic disease.

Treatment

Complete surgical resection offers the only hope for cure. Unfortunately, most tumors are already advanced at diagnosis and not amenable to full resection. Total or subtotal gastrectomy is indicated for tumors confined to the stomach. Resection of adjacent organs may be required if the tumor has spread.

Early detection of gastric cancer may improve patient survival. Patients may elect to be treated with endoscopic mucosal resection, a low–cost and relatively safe alternative to surgery.¹

Surgery, chemotherapy, or radiation may be used for palliation.