Gastric cancer

1. Big picture

Gastric cancer is a malignant tumor of the stomach, most commonly adenocarcinoma, and is a major surgical oncology topic because curative treatment depends on complete tumor removal with lymphadenectomy. The practical exam logic is:

Alarm symptoms → upper GI endoscopy + biopsy → staging CT ± laparoscopy
→ MDT decision → perioperative chemotherapy + radical gastrectomy if resectable
→ palliation if metastatic, unresectable, or unfit

For the oral exam, the most important surgical sentence is:

“Gastric cancer is diagnosed by endoscopy and biopsy, staged by CT and staging laparoscopy if potentially curable, and treated curatively by gastrectomy with adequate lymph node dissection, usually combined with perioperative chemotherapy.”

NICE recommends staging laparoscopy for all people with potentially curable gastric cancer and chemotherapy before and after radical surgery; D2 lymph node dissection should be considered during curative gastrectomy. ([NICE][1])

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