Revised 28 April 2011

Staging Diagram and Classification Criteria-TNM  

Gastric cancer is usually first identified on upper GI endoscopy or upper GI barium study. Patients with a negative barium study and continued symptoms, or in whom there is a high index of suspicion, should undergo upper endoscopy. The extent of disease is assessed with chest X-ray, abdominal CT scan, and possibly abdominal MRI. An ultrasound may be of value in further assessing liver lesions. Endoscopic ultrasound is under investigation as a staging tool, but is not yet utilised or available in standard practice. A pre-operative diagnostic laparoscopy is often of value in determining operability, as other imaging modalities may miss small peritoneal or liver seeding. PET scanning may be of use in detecting clinically occult metastatic disease, but its use in this setting remains investigational. Other investigations for metastatic disease should be directed according to clinical presentation.