High-yield map
Key points before the detail
- 01
Early gastric cancer can present subtly with dyspepsia or iron-deficiency anaemia.
- 02
Diagnosis requires OGD with multiple targeted biopsies.
- 03
Potentially curable gastric cancer should undergo staging laparoscopy.
- 04
Distal tumours may permit subtotal gastrectomy; proximal/diffuse disease often requires total gastrectomy.
- 05
Post-gastrectomy nutritional care is lifelong.
1. Pathology and risk
More than 90% of gastric cancers are adenocarcinomas. Intestinal-type disease often follows H. pylori-associated atrophy, metaplasia and dysplasia; diffuse-type disease can infiltrate the wall with less obvious mucosal change.
- H. pylori, atrophy/intestinal metaplasia and pernicious anaemia.
- Smoking, age and family history.
- Previous gastric surgery after a long interval.
- Hereditary diffuse gastric cancer and selected inherited syndromes.
2. Presentation
- Dyspepsia, epigastric discomfort, early satiety or iron-deficiency anaemia.
- Weight loss, anorexia, persistent vomiting or gastric outlet obstruction.
- Haematemesis/melaena, Virchow node, Sister Mary Joseph nodule, ascites or hepatomegaly in advanced disease.
- Linitis plastica can produce a rigid nondistensible stomach with subtle mucosal findings.
3. Diagnosis and staging sequence
- 1. High-quality OGD with multiple targeted biopsies.
- 2. Whole-body contrast CT after histological diagnosis.
- 3. Staging laparoscopy for potentially curable disease, with washings/biopsy as indicated.
- 4. EUS only when it will guide selected early-disease decisions.
- 5. PET-CT selectively when suspected metastases would change management.
- 6. Specialist oesophago-gastric MDT review.
4. Radical treatment
- A D2 lymph-node dissection is considered in specialist curative surgery.
- Do not perform splenectomy or pancreatectomy solely to increase nodal yield.
| Pattern | Treatment principle |
|---|---|
| Selected superficial early cancer | Expert endoscopic resection when invasion and nodal risk criteria are met. |
| Resectable distal tumour | Subtotal/distal gastrectomy plus lymphadenectomy. |
| Proximal, diffuse or extensive tumour | Total gastrectomy with Roux-en-Y oesophagojejunostomy plus lymphadenectomy. |
| Locally advanced resectable adenocarcinoma | Perioperative chemotherapy integrated with surgery according to MDT plan. |
5. Life after gastrectomy
| After operation | Key consequences |
|---|---|
| Total gastrectomy | No gastric reservoir or intrinsic-factor source: small frequent meals, lifelong B12 replacement and micronutrient monitoring. |
| Distal gastrectomy | Reduced reservoir, bile reflux and dumping can occur. |
| Any gastrectomy | Leak, bleeding, pancreatic injury, delayed emptying, infection and VTE. |
| Long term | Dumping, hypoglycaemia, diarrhoea, sarcopenia and osteoporosis require specialist follow-up. |
6. Advanced disease
- Use current biomarker testing such as HER2, PD-L1 and MSI/MMR to guide oncology options.
- Palliate obstruction with stent or bypass according to anatomy, prognosis and fitness.
- Bleeding may be managed endoscopically, radiologically, with radiotherapy or surgery depending on severity and goals.
- Integrate dietetics and palliative care early.
Active recall
Close the notes and answer these
Try each question from memory before revealing the answer. These public prompts are a small preview of the integrated retrieval system inside SurgAtlas.
01What is the first diagnostic investigation for suspected gastric cancer?
High-quality upper-GI endoscopy with multiple targeted biopsies.
02Why is staging laparoscopy important?
CT can miss small-volume peritoneal metastases, and laparoscopy can prevent non-therapeutic major surgery.
03Which operation is typical for a resectable distal gastric tumour?
Subtotal/distal gastrectomy with appropriate lymphadenectomy.
04Which operation is typical for proximal, diffuse or extensive gastric cancer?
Total gastrectomy with Roux-en-Y oesophagojejunostomy and lymphadenectomy.
05What lifelong replacement is required after total gastrectomy?
Vitamin B12 replacement, with ongoing nutritional and micronutrient monitoring.
Sources & editorial basis
References & editorial basis
- SurgAtlas production source. General Surgery — Gastric Cancer. Public lesson curated from the corresponding production chapter.
- NICE NG83. Oesophago-gastric cancer: assessment and management in adults.
This lesson is derived from the corresponding SurgAtlas production teaching material. Where the source makes current management or guideline claims, the public lesson uses the cited contemporary guidance. It is written for education and examination preparation, not as patient-specific clinical advice.
Editorial details
Medical Doctor (MD) · MRCS Part A · Physician · Surgical Educator
SurgAtlas is an educational resource. For patient care, verify current national guidance, local antimicrobial and transfusion policies, specialty pathways and individual patient factors.
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