Ctrl

K

Table of contents

Expand All Topics

Gastric cancer

What's new

The American College of Gastroenterology (ACG) has published a new guideline on gastric premalignant conditions. The guideline advises against using aspirin, NSAIDs, COX-2 inhibitors, or antioxidants for gastric cancer chemoprevention in gastric premalignant conditions. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of gastric cancer are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG 2025,2023,2017,2015), the American Gastroenterological Association (AGA 2025,2020), the American Academy of Family Physicians (AAFP 2023), the American Society of Clinical Oncology (ASCO 2023), the Society for Immunotherapy of Cancer (SITC 2023), the ...
Show more

Screening and diagnosis

Indications for screening, asymptomatic individuals
As per ACG 2025 guidelines:
Avoid obtaining routine screening with upper endoscopy for gastric cancer and gastric premalignant conditions in the general population in the US.
D
Insufficient evidence to recommend opportunistic screening for gastric cancer and gastric premalignant conditions with upper endoscopy in patients deemed high-risk for gastric cancer based on immigration status, race, ethnicity, and certain environmental factors.
I
Create free account

More topics in this section

  • Indications for screening (familial cancer syndromes)

  • Indications for screening (choice of screening tool)

  • Indications for testing

Classification and risk stratification

Staging: as per ESMO 2022 guidelines, perform a physical examination, obtain CBC with differential, liver and renal function tests, contrast-enhanced CT of the chest, abdomen ± pelvis, and perform upper gastrointestinal endoscopy for initial staging and risk assessment.
B
Show 2 more
Create free account

Diagnostic investigations

Testing for H. pylori infection: as per AGA 2025 guidelines, consider obtaining opportunistic screening for H. pylori infection in patients at increased risk for gastric cancer. Consider offering screening for H. pylori infection in adult household members of patients testing positive for H. pylori (familial-based testing).
E
Create free account

Diagnostic procedures

Biopsy: as per ESGE 2021 guidelines, take at least 6 biopsies in patients with suspected advanced gastric cancer.
B
Show 3 more
Create free account

More topics in this section

  • Histopathology

  • Ancillary testing

  • Diagnostic laparoscopy and peritoneal lavage

Medical management

General principles
As per ESMO 2022 guidelines:
Ensure multidisciplinary treatment planning before any treatment decision.
B
Offer early palliative care referral and nutritional support to patients with gastric cancer.
A
Create free account

More topics in this section

  • Management of locoregional disease (perioperative chemotherapy)

  • Management of locoregional disease (adjuvant chemoradiotherapy)

  • Management of locoregional disease (surgical resection)

  • Management of advanced/metastatic disease (first-line chemotherapy)

  • Management of advanced/metastatic disease (targeted therapy and immunotherapy)

  • Management of advanced/metastatic disease (management of gastric outlet obstruction)

  • Management of advanced/metastatic disease (management of metastases)

Nonpharmacologic interventions

Nutritional support: as per ESMO 2022 guidelines, offer dietary support with attention to vitamin and mineral deficiencies in patients with gastric cancer.
B
Create free account

Perioperative care

Patients with hereditary diffuse gastric cancer: as per ACG 2015 guidelines, include the following in the management of patients with hereditary diffuse gastric cancer:
prophylactic gastrectomy after age 20 years (> 80% risk by age 80)
breast cancer surveillance in females beginning at age 35 years with annual mammography and breast MRI and clinical breast examination every 6 months
colonoscopy beginning at age 40 years in families including colon cancer.
B
Create free account

Specific circumstances

Patients with precancerous gastric lesions, etiology
As per EHMSG/ESGE/ESP/SPED 2019 guidelines:
Recognize that:
patients with chronic atrophic gastritis or intestinal metaplasia are at risk for gastric adenocarcinoma
A
patients with advanced stages of gastritis, that is, atrophy and/or intestinal metaplasia affecting both antral and corpus mucosa, are at higher risk for gastric adenocarcinoma
B
histologically confirmed intestinal metaplasia is the most reliable marker of atrophy in gastric mucosa
A
Recognize that the management of patients with chronic atrophic gastritis or intestinal metaplasia intends to prevent high-grade dysplasia and invasive carcinoma.
B
Create free account

More topics in this section

  • Patients with precancerous gastric lesions (upper gastrointestinal endoscopy)

  • Patients with precancerous gastric lesions (EUS)

  • Patients with precancerous gastric lesions (biopsy)

  • Patients with precancerous gastric lesions (serum pepsinogen levels)

  • Patients with precancerous gastric lesions (H. pylori eradication)

  • Patients with precancerous gastric lesions (NSAIDs)

  • Patients with precancerous gastric lesions (antioxidants)

  • Patients with precancerous gastric lesions (endoscopic resection)

  • Patients with precancerous gastric lesions (surgical resection)

  • Patients with precancerous gastric lesions (endoscopic surveillance)

  • Patients with gastrointestinal stromal tumor (diagnosis)

  • Patients with gastrointestinal stromal tumor (EUS)

  • Patients with gastrointestinal stromal tumor (biopsy)

  • Patients with gastrointestinal stromal tumor (mutational analysis)

  • Patients with gastrointestinal stromal tumor (chemotherapy, local/locoregional disease)

  • Patients with gastrointestinal stromal tumor (chemotherapy, advanced/metastatic disease)

  • Patients with gastrointestinal stromal tumor (radiotherapy)

  • Patients with gastrointestinal stromal tumor (surgical excision, local/locoregional disease)

  • Patients with gastrointestinal stromal tumor (surgical excision, advanced/metastatic disease)

  • Patients with gastrointestinal stromal tumor (surveillance imaging)

Preventative measures

H. pylori eradication: as per AGA 2025 guidelines, offer H. pylori eradication as an adjunct to endoscopic screening and surveillance for primary and secondary prevention of gastric cancer.
E
Create free account

More topics in this section

  • Chemoprevention

Follow-up and surveillance

Follow-up: as per AGA 2025 guidelines, obtain ongoing endoscopic surveillance in patients with a history of successfully resected gastric dysplasia or cancer.
E
Create free account