Synopsis
Recognise gastric cancer and its emergency complications, use the current suspected-cancer route, obtain adequate histology and staging, and integrate endoscopic, surgical, systemic, palliative and nutritional care through an oesophago-gastric multidisciplinary team.
- Gastric adenocarcinoma often causes non-specific early symptoms, so progressive weight loss, early satiety, anaemia, persistent vomiting and age-based NICE combinations must trigger timely endoscopy.
- NICE includes people aged 55 or over with weight loss plus upper abdominal pain, reflux or dyspepsia in the suspected oesophageal or stomach cancer pathway.
- High-quality gastroscopy should define tumour site, size, morphology and junctional relationship and obtain multiple adequate biopsies while inspecting the whole stomach for synchronous disease.
- Diffuse infiltrative cancer can produce linitis plastica with deceptively subtle mucosa and negative superficial biopsies; CT, EUS and deeper or alternative tissue acquisition may be needed.
- CT establishes gross local and metastatic anatomy, while potentially curative gastric cancer commonly requires staging laparoscopy to find radiologically occult peritoneal disease.
- Very early low-risk mucosal neoplasia may be treated endoscopically, whereas resectable invasive cancer usually requires gastrectomy with lymphadenectomy and peri-operative oncological treatment.
- Advanced disease treatment depends on performance status, histology and current predictive biomarkers; the oncology MDT must use up-to-date national approval and local genomic pathways.
- Nutrition, iron deficiency, sarcopenia, postoperative micronutrient loss and symptom control are treatment components from diagnosis through survivorship or palliative care.
Key red flags
Recurrent non-bilious food vomiting, dehydration and a succussion splash suggest antral or pyloric tumour and require admission when liquids, renal function or electrolytes are compromised.
Haematemesis, melaena, sudden severe pain, free gas or peritonism is an oncological emergency complication managed through acute bleeding or surgery pathways before elective staging.
Investigation priorities
Locate the lesion, establish histology and assess synchronous gastric disease.
Management branches
Weight loss, early satiety, persistent vomiting, iron deficiency or a current NG12 age-and-symptom combination raises gastric cancer concern.
- Check dysphagia, bleeding, vomiting, measured weight, anaemia, abdominal findings and family history, then use the suspected-cancer or direct-access endoscopy route specified by current NICE and local services.
- Send relevant FBC, renal and liver profiles without allowing normal results to delay endoscopy when the symptom combination already qualifies.
- Safety-net inability to tolerate liquids, haematemesis and sudden pain as acute complications rather than asking the patient to wait for the outpatient cancer pathway.
The MDT has established stage, resectability, physiological fitness and preferred treatment goals.
- Refer eligible superficial low-risk disease for expert en-bloc endoscopic resection, using final depth, margins and lymphovascular findings to decide whether additional surgery is needed.
- For resectable invasive adenocarcinoma, coordinate subtotal or total gastrectomy and nodal dissection with peri-operative oncological therapy and prehabilitation according to the current regional protocol.
- For advanced disease, choose biomarker-informed systemic treatment and proportionate relief of bleeding, pain or obstruction, maintaining dietetic, palliative and psychological support throughout.