Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- weight loss
- lymphadenopathy
Other diagnostic factors
- age 50-70 years
- male sex (later-onset gastric cancer)
- female sex (early-onset gastric cancer)
- smoking
- family history
- nausea
- dysphagia
Risk factors
- Helicobacter pylori
- pernicious anemia
- immigration from high-incidence regions
- foods containing N-nitroso compounds
- male sex (later-onset gastric cancer)
- female sex (early-onset gastric cancer)
- diet low in fruits and vegetables
- high-salt diet
- smoking
- family history
Diagnostic tests
1st tests to order
- esophagogastroduodenoscopy with biopsy
- CT scan
- Fluorodeoxyglucose (FDG)-PET/CT scan
- CBC
- comprehensive metabolic panel
- Helicobacter pylori carbon-13 urea breath test or stool antigen test
- molecular and pathological tests
Tests to consider
- endoscopic ultrasound
- endoscopic resection
- laparoscopy
- circulating tumor DNA test
Treatment algorithm
localized: suitable for surgery
localized: not suitable for surgery
advanced and metastatic disease: HER2 positive
advanced and metastatic disease: HER2 negative
advanced and metastatic disease: MSI-H/dMMR tumors (independent of PD-L1 status)
Contributors
Authors
Ahmed Abdelhakeem, MD
Fellow Physician
Department of Hematology and Oncology
Mayo Clinic - Mayo Clinic Comprehensive Cancer Center
Jacksonville, FL
Disclosures
AA declares that he has no competing interests.
Osama MoSalem, MD
Medical Oncologist
Department of Oncology - Saint Luke’s Cancer Institute
Assistant Professor of Medicine
University of Missouri Kansas City
Kansas City, MO
Disclosures
OM declares that he has no competing interests.
Acknowledgements
Dr Ahmed Abdelhakeem and Dr Osama MoSalem would like to gratefully acknowledge Dr Mariela Blum Murphy, Dr Valerie Reed, and Dr Prajnan Das, previous contributors to this topic.
Disclosures
MBM, VR, and PD declare that they have no competing interests.
Peer reviewers
Theodore Hong, MD
Director
Gastrointestinal Radiation Oncology
Massachusetts General Hospital Cancer Center
Boston, MA
Disclosures
TH declares that he has no competing interests.
Andreas Leodolter, MD
Head of Department
Department of Gastroenterology
Sana Klinikum
Remscheid
Germany
Disclosures
AL declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: gastric cancer [internet publication].Full text
Lordick F, Carneiro F, Cascinu S, et al. Gastric cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Oct;33(10):1005-20.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Peptic ulcer disease
- Benign esophageal stricture
- Achalasia
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: genetic/familial high-risk assessment: colorectal, endometrial, and gastric
- Immunotherapy and targeted therapy for advanced gastroesophageal cancer: ASCO guideline update
More GuidelinesPatient information
Endoscopy (upper gastrointestinal)
More Patient information
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