Gastric Cancer

Diagnosing gastric cancer typically involves a combination of endoscopic procedures, biopsy, and imaging studies to confirm the presence of cancer and determine its stage.

1. Upper Endoscopy (Esophagogastroduodenoscopy, EGD)

An upper endoscopy is the most important test for diagnosing gastric cancer. A thin, flexible tube with a camera is inserted through the mouth to directly visualize the stomach lining. If any abnormal areas are seen, tissue samples (biopsies) are taken for analysis.

2. Biopsy and Pathological Examination

The diagnosis is confirmed by examining the biopsied tissue under a microscope to determine whether cancer cells are present and to identify the cancer type.

3. Imaging Studies for Staging

Once cancer is confirmed, additional tests are performed to determine how far it has spread (staging):

• CT (Computed Tomography) scan of the chest, abdomen, and pelvis
• PET-CT scan, in selected cases
• Endoscopic ultrasound (EUS) to assess the depth of tumor invasion, in selected cases
• Laparoscopy may be used in some cases to detect hidden metastasis not visible on imaging

These evaluations help the medical team develop an appropriate treatment plan tailored to the individual’s cancer stage and overall health.

Treatment for gastric cancer depends on several factors, including the stage of the cancer, tumor location, overall health of the patient, and molecular characteristics of the tumor. A multidisciplinary team—including gastroenterologists, surgeons, oncologists, and radiologists—works together to create an individualized treatment plan.

1. Endoscopic Resection

For early gastric cancers, endoscopic submucosal dissection (ESD) can be performed. This minimally invasive procedure removes the tumor without the need for open surgery and preserves the stomach.

2. Surgery

Gastrectomy, or surgical removal of part or all of the stomach, is a standard treatment for localized gastric cancer. The extent of surgery depends on the tumor's size and location, and it is usually combined with lymph node dissection to remove potentially affected lymph nodes.

3. Chemotherapy

Chemotherapy may be given before surgery (neoadjuvant) to shrink the tumor or after surgery (adjuvant) to reduce the risk of recurrence. In advanced stages, it can be used to control cancer and relieve symptoms.

4. Radiation Therapy

Radiation therapy is sometimes used along with chemotherapy to target residual cancer cells, especially when complete surgical removal is not possible.

5. Targeted Therapy and Immunotherapy

In advanced or metastatic gastric cancer, targeted therapies (such as HER2-directed agents) and immune checkpoint inhibitors are used based on the tumor’s molecular profile. These treatments are part of precision oncology and offer new hope for patients with specific genetic or protein markers.

The choice and sequence of treatments are tailored to each patient’s condition. Early diagnosis significantly increases the chance of successful treatment. Advances in minimally invasive techniques and personalized medicine continue to improve outcomes.