8. Diagnosis, Staging, and Workup of Gastric Cancer

Gastric cancer remains a significant health issue and remains the 4th leading cause of cancer worldwide. Unfortunately, most disease is detected at a late stage, where symptoms and physical exam findings usually indicate advanced or metastatic disease. Although symptoms may help identify the presence and location of malignancy, diagnosis is largely based on early endoscopy. Endoscopy allows for characterization of the tumor as well as obtaining a tissue diagnosis. With the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual, better understanding of disease has reorganized the staging groups as well as placed greater emphasis on lymph node involvement. The goals of staging are to predict long term survival as well as guide treatment options. Although the new AJCC staging system has improved compared to earlier versions, new nomograms may be a better predictor of survival and recurrence.

Workup of gastric cancer involves a select variety of diagnostic tests which include endoscopy, CT, endoscopic ultrasound (EUS), diagnostic laparoscopy, and positron emission tomography (PET) scan in order to stage patients. These tests can be used to stratify patients who are candidates for resection versus those who need palliative therapy. As technology, imaging, gene profiling, and tumor marker identification improve, disease may be detected at an earlier stage and improve overall survival for patients with gastric cancer.