Gastric Carcinoma Diagnosis and Management

Clinical Presentation

The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) recommend that gastric carcinoma diagnosis requires endoscopic biopsy, and management centers on surgical resection with perioperative chemotherapy for resectable disease 1, 2
Iron-deficiency anemia may be the only presenting sign of gastric cancer and should never be dismissed without investigation, according to the European Society for Medical Oncology (ESMO) 1, 3
The American College of Gastroenterology (ACG) suggests that dyspepsia, particularly when persistent or unexplained, warrants investigation, especially in high-risk patients or those with alarm symptoms 3

The National Comprehensive Cancer Network (NCCN) recommends that endoscopy with biopsy is the gold standard for diagnosis and must obtain tissue for histological classification and molecular biomarkers (particularly HER2 status) 1, 2, 4
The European Society for Medical Oncology (ESMO) suggests that contrast-enhanced CT scan of thorax, abdomen, and pelvis is the primary staging modality to detect lymphadenopathy, metastatic disease, and ascites 1, 2, 4
The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) recommend that TNM staging according to the 8th edition AJCC/UICC should be documented 1, 2, 4

The European Society for Medical Oncology (ESMO) recommends that multidisciplinary treatment planning is mandatory before any treatment decision and should include surgeons, medical and radiation oncologists, gastroenterologists, radiologists, pathologists, dieticians, and nurse specialists 1, 2, 6
The National Comprehensive Cancer Network (NCCN) suggests that perioperative chemotherapy with a triplet regimen including fluoropyrimidine, platinum compound, and docetaxel should be given when possible for localized resectable disease 1, 7, 8
The American Society of Clinical Oncology (ASCO) recommends that adjuvant chemotherapy with a doublet regimen (fluoropyrimidine plus oxaliplatin or docetaxel) for 6 months total duration is recommended for patients who undergo surgery without preoperative chemotherapy 1, 7, 8

The European Society for Medical Oncology (ESMO) recommends that endoscopic resection is recommended for very early gastric cancer (T1a) if ALL of the following criteria are met: confined to mucosa, well-differentiated (G1-2), non-ulcerated, and <2 cm in diameter 1, 2, 7, 8
The National Comprehensive Cancer Network (NCCN) suggests that surgical resection with perioperative chemotherapy is the standard of care for localized resectable disease (Stage IB and above) 1, 2, 6
The American Society of Clinical Oncology (ASCO) recommends that palliative chemotherapy should be considered for metastatic disease (Stage IV) and combination regimens incorporating cisplatin, 5-fluorouracil with or without anthracyclines are among the most active and well-tolerated combinations 9, 5

The European Society for Medical Oncology (ESMO) recommends that symptom-driven visits are recommended rather than intensive routine surveillance, as there is no evidence that regular intensive follow-up improves outcomes 9, 5
The National Comprehensive Cancer Network (NCCN) suggests that history, physical examination, and blood tests should be performed if symptoms of relapse occur, and radiological investigations should be considered for patients who are candidates for palliative chemotherapy 9, 5