What are the NCCN diagnostic guidelines for gastric cancer?

Updated: May 21, 2019
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

NCCN recommendations for diagnosis of gastric cancer are as follows [4] :

  • Endoscopy is the primary procedure for diagnosis, surveillance, and staging of gastric cancer
  • Endoscopic ultrasound (EUS) is preferred if early stage disease suspected or if early versus locally advanced disease needs to be determined
  • Multiple biopsies should be performed, especially with ulcerated lesions
  • Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of small lesions (eg, focal nodules ≤2 cm) can be safely performed to provide a larger specimen that may contribute to accurate staging of early-stage cancers; in addition, such excisional biopsies are potentially therapeutic
  • Chest/abdomen/pelvic CT with oral and IV contrast
  • PET/CT evaluation (skull base to mid-thigh) if no evidence of M1 disease and if clinically indicated 
  • Biopsy of metastatic diseas,e as clinically indicated
  • High microsatellite instability/deficient mismatch repair (MSI-H/dMMR) testing if metastatic disease is documented or suspected
  • HER2 and PD-L1 testing if metastatic adenocarcinoma is documented or suspected

The European Society for Medical Oncology/ European Society of Surgical Oncology/ European Society for Therapeutic Radiology and Oncology (ESMO-ESSO-ESTRO) guidelines provide similar recommendations. [70]


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