Gastric Cancer, Complete Surgeon's Guide
Diagnosis and Staging Initial Assessment: Full history & physical examination. Labs: blood count and differential, full liver and renal function tests. Endoscopy. Contrast-enhanced computed tomography (CT) scan of the thorax and abdomen ± pelvis. Diagnosis should be made from a gastroscopic or surgical biopsy reviewed by an experienced pathologist, and histology should be reported according to the World Health Organization criteria. Ninety percent of gastric cancers are adenocarcinomas, and these are sub-divided according to histological appearances into diffuse (undifferentiated) and intestinal (well differentiated) types. Work up: Endoscopy + biopsy to obtain tissue for diagnosis, histological classification and molecular biomarkers, e.g. HER-2 status. Contrast enhanced CT thorax + abdomen + pelvis staging of tumour: particularly to detect local/distant lymphadenopathy and metastatic disease sites. Endoscopic ultrasound (EUS): Accurate assessment of T...