Intended for healthcare professionals

Clinical Review

The diagnosis and management of gastric cancer

BMJ 2013; 347 doi: (Published 04 November 2013) Cite this as: BMJ 2013;347:f6367
  1. Sri G Thrumurthy, honorary research fellow1,
  2. M Asif Chaudry, oesophagogastric surgeon2,
  3. Daniel Hochhauser, Kathleen Ferrier professor of medical oncology3,
  4. Muntzer Mughal, honorary clinical professor and head 1
  1. 1Department of Upper Gastrointestinal Surgery, University College London Hospital, London NW1 2BU, UK
  2. 2Department of Upper Gastrointestinal Surgery, St Thomas’ Hospital, London, UK
  3. 3UCL Cancer Institute, University College London, London, UK
  1. Correspondence to: M Mughal muntzer.mughal{at}
  • Accepted 18 October 2013

Summary points

  • The incidence of gastric cancer is highest in eastern Asia, eastern Europe, and South America, and it affects twice as many men as women

  • Risk factors for gastric cancer include Helicobacter pylori infection, cigarette smoking, high alcohol intake, excess dietary salt, lack of refrigeration, inadequate fruit and vegetable consumption, and pernicious anaemia

  • Patients present with weight loss and abdominal pain, although those with proximal or gastro-oesophageal junction tumours may present with dysphagia

  • Upper gastrointestinal endoscopy with biopsy is used to confirm the diagnosis; precise tumour stage is defined by more sophisticated radiological investigations

  • Multidisciplinary approach to treatment: early gastric cancer is treated with surgery alone, whereas advanced disease is usually managed with chemotherapy before and after surgery, or postoperative chemoradiation

  • Metastatic disease is managed with chemotherapy or chemoradiation as well as supportive care measures

Age standardised mortality rates for gastric cancer are 14.3 per 100 000 in men and 6.9 per 100 000 in women worldwide.1 Incidence shows clear regional and sex variations—rates are highest in eastern Asia, eastern Europe, and South America and lowest in northern and southern Africa.1 Early diagnosis is crucial because of the possibility of early metastasis to the liver, pancreas, omentum, oesophagus, bile ducts, and regional and distant lymph nodes.2 Using evidence from large randomised controlled trials, meta-analyses, cohort studies, and case-control studies this review aims to outline preventive strategies, highlight the presenting features of gastric cancer, and guide generalists in early diagnosis, referral, and treatment.

Sources and selection criteria

We searched PubMed to identify peer reviewed original articles, meta-analyses, and reviews. Search terms were gastric cancer, cancer of the stomach, gastric adenocarcinoma, gastro-oesophageal cancer, gastric neoplasm, and neoplasm of the stomach. We considered only those papers that were written in English, published within the past 10 years, and which described studies that had adequate scientific validity.

What is gastric cancer?

Gastric …

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