Investigations

1st investigations to order

upper gastrointestinal endoscopy with biopsy

Test
Result
Test

Upper gastrointestinal endoscopy with biopsy is the initial diagnostic test. It allows precise localisation of the primary tumour and acquisition of tissue for diagnosis, histological classification, and molecular biomarkers.[25][26]

Result

ulcer or mass or mucosal changes

FBC

Test
Result
Test

Initial tests should include FBC to assess for iron deficiency anaemia.[25][26]

Result

normal or microcytic anaemia

comprehensive metabolic panel

Test
Result
Test

Initial tests should include a renal function test and a liver function test to help determine suitable therapeutic options.[25][26]

Result

variable

Investigations to consider

CT of chest/abdomen/pelvis

Test
Result
Test

Chest, abdomen, and pelvis CT scans with oral and intravenous contrast are recommended for all patients to detect local or distant lymphadenopathy and metastatic disease or ascites.[25][26]

Result

metastatic lesions

endoscopic ultrasound

Test
Result
Test

Used to assess the proximal and distal extent of the tumour and provide accurate tumour and nodal assessment if no metastatic disease is detected by CT scan.[25][26]

Result

determines clinical tumour (T) and node (N) stage

laparoscopy

Test
Result
Test

Staging laparoscopy should be considered, as peritoneal and metastatic disease <5 mm in size may be missed, even with high-quality CT scans.

The European Society for Medical Oncology recommends laparoscopy with or without peritoneal washing for malignant cells for all patients with stage 1B to 3 potentially resectable gastric cancers, to exclude radiologically occult metastatic disease.[26]

The US National Comprehensive Cancer Network recommends laparoscopy with cytology for clinical stage T1b or higher to evaluate for peritoneal spread when considering chemoradiation or surgery, unless a palliative resection is planned.[25]

Result

metastatic lesions

PET/CT

Test
Result
Test

PET/CT imaging may improve staging by detecting involved lymph nodes or metastatic disease, which would make the patient ineligible for curative therapy.[25][26] However, accuracy of fluorodeoxyglucose (FDG)-PET may be low in some gastric cancer types (e.g., diffuse and mucinous) because of low FDG uptake.[27][28]

Result

metastatic disease

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