7. Gastic Cancer

đź“„ Definition

Gastric cancer refers to malignancy of the stomach, most commonly adenocarcinoma. It often presents late, with non-specific symptoms, and carries a poor prognosis unless detected early.

🛡️ Risk Factors (Mnemonic: CHINA GHOST)

  • Chronic H. pylori infection (especially untreated)

  • High salt and smoked food diet

  • Iron-deficiency anaemia (marker, not cause)

  • Nitrates/nitrites in preserved foods

  • Age >50

  • Gastric atrophy / intestinal metaplasia

  • History of gastric surgery (esp. >20 years ago)

  • Other family history of gastric cancer

  • Smoking

  • Type A blood group

đź“‹ Clinical Features (Mnemonic: WEAPON)

  • Weight loss (unintentional)

  • Epigastric pain or discomfort

  • Anaemia (iron-deficiency)

  • Persistent vomiting

  • Overall fatigue / early satiety

  • Nausea ± abdominal mass (advanced cases)

Most patients present with non-specific upper GI symptoms. Alarm features should prompt referral.

⚠️ Red Flag Features – 2WW Referral (NICE NG12)

Urgent upper GI endoscopy referral if:

  • Dysphagia

  • Aged ≥55 with weight loss and any of the following:

    • Reflux

    • Dyspepsia

    • Upper abdominal pain

  • Unexplained iron-deficiency anaemia

  • Palpable epigastric mass

  • Persistent vomiting

🔬 Investigations

  • OGD (gastroscopy) + biopsy – diagnostic gold standard

  • CT chest–abdomen–pelvis – staging

  • Endoscopic ultrasound (EUS) – assess local invasion

  • PET-CT – in selected cases with curative intent

  • FBC – check for anaemia

  • LFTs, U&Es, clotting – baseline

  • CEA/CA 19-9 – sometimes used in follow-up

Management

Curative (if diagnosed early)

  • Surgical resection (subtotal or total gastrectomy ± lymphadenectomy)

  • Perioperative chemotherapy – FLOT regimen commonly used

  • Neoadjuvant chemoradiotherapy – in some cases

Palliative (if advanced)

  • Endoscopic stenting – for gastric outlet obstruction

  • Palliative chemotherapy/radiotherapy

  • Nutritional support – dietetics, feeding tubes

  • Pain control and symptom relief

MDT (multidisciplinary team) planning is essential.

âť— Complications (Mnemonic: LAME)

  • Local invasion (pancreas, liver, transverse colon)

  • Anaemia (chronic bleeding)

  • Metastases (liver, peritoneum, lung, Virchow’s node)

  • Early satiety or gastric outlet obstruction

Last updated in line with NICE NG151 (Oesophago-gastric cancer: diagnosis and management)
Published: January 2023 • Last updated: January 2023
Last reviewed: July 2025
PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

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