Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- weight loss
- lymphadenopathy
Other diagnostic factors
- age 50-70 years
- male sex
- smoking
- family history
- nausea
- dysphagia
- lower gastrointestinal bleeding
Risk factors
- pernicious anemia
- Helicobacter pylori
- N-nitroso compounds
- diet low in fruits and vegetables
- high-salt diet
- smoking
- family history
Diagnostic tests
1st tests to order
- upper gastrointestinal endoscopy with biopsy
- CBC
- comprehensive metabolic panel
Tests to consider
- CT of chest/abdomen/pelvis
- endoscopic ultrasound
- laparoscopy
- PET/CT scan
Treatment algorithm
localized: suitable for surgery
localized: not suitable for surgery
advanced and metastatic disease
Contributors
Authors
Ahmed Abdelhakeem, MD
Fellow Physician
Division of Hematology and Oncology
Mayo Clinic - Mayo Clinic Comprehensive Cancer Center
Jacksonville
FL
Disclosures
AA declares that he has no competing interests.
Mariela Blum Murphy, MD
Associate Professor
Department of GI Medical Oncology
University of Texas
MD Anderson Cancer Center
Houston
TX
Disclosures
MBM declares that she has no competing interests.
Acknowledgements
Dr Ahmed Abdelhakeem and Dr Mariela Blum Murphy would like to gratefully acknowledge Dr Valerie Reed and Dr Prajnan Das, previous contributors to this topic.
Disclosures
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.
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
Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010 May;11(5):439-49. Abstract
Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012 Jul 1;30(19):2327-33. Abstract
Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006 Jul 6;355(1):11-20.Full text Abstract
Bang YJ, Van CE, Feyereislova A, et al; ToGA Trial Investigators. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010 Aug 28;376(9742):687-97. 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: gastric cancer
- Japanese gastric cancer treatment guidelines 2021 (version 6)
More GuidelinesPatient information
Endoscopy (upper gastrointestinal)
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