investigations/assessment after diagnosis
Last edited 02/2018 and last reviewed 11/2020
The investigations for suspected gastric carcinoma are:
- endoscopy and biopsy: investigation of choice
- chest x-ray, liver enzymes, and liver ultrasound for evidence of metastases
- anaemia in as much as 50% of all cases
- faecal occult blood test positive in the vast majority of subjects
These must be placed against the background of the history which may show dyspepsia for the first time in later life.
Assessment after Diagnosis (1):
Determining suitability for radical treatment of histologically-confirmed oesophageal or gastro-oesophageal junctional cancer after endoscopy and wholebody CT scan diagnosis
- F-18 FDG PET-CT should be offered to people with oesophageal and gastro-oesophageal junctional tumours that are suitable for radical treatment (except for T1a tumours)
- do not offer endoscopic ultrasound only to distinguish between T2-T3 tumours in people with oesophageal and gastro-oesophageal junctional tumours
- endoscopic ultrasound should only be offered to people with oesophageal and gastrooesophageal junctional cancer when it will help guide ongoing management
- staging laparoscopy should only considered for people with oesophageal or gastrooesophageal junctional cancer when it will help guide ongoing management.
HER2 testing in metastatic oesophago-gastric adenocarcinoma
- HER2 testing should be offered to people with metastatic oesophago-gastric adenocarcinoma
Determining suitability for radical treatment of histologically-confifirmed gastric cancer after endoscopy and whole-body CT scan diagnosis
- offer staging laparoscopy to all people with potentially curable gastric cancer.
- endoscopic ultrasound should only be considered for people with gastric cancer if it will help guide ongoing management.
- F-18 FDG PET-CT should only be considered in people with gastric cancer if metastatic disease is suspected and it will help guide ongoing management.
- barium meal (rarely used in UK as superceded by other investigation modalities);
- space occupying mass
- rigidity of adjacent gastric wall
- greater curve ulcer
- an ulcer with irregular borders and disruption of normal mucosal folds
- contracted, non-distensible stomach - linitis plastica
- fundic tumours are difficult to evaluate because of poor filling