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.
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.
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.
The MDT has established stage, resectability, physiological fitness and preferred treatment goals.