Suggested approach to staging evaluation in patients with gastric cancer

CT: computed tomography; FNA: fine-needle aspiration; PET: positron emission tomography.
* The goal of the initial staging evaluation is to initially stratify patients into two clinical groups in order to guide initial management: those with locoregional, potentially resectable (stage I to III) disease and those with either locally advanced, unresectable or metastatic (stage IV) disease.
¶ Suspicious visceral or omental lesions or retroperitoneal nodes require biopsy confirmation. Paracentesis should be performed when ascites is detected, and the fluid should be sent for cytology and standard chemical analysis.
Δ Either the cross-sectional imaging studies are not definitive or the patient has clinical symptoms that raise suspicion for metastatic disease but there is no radiographic correlation on cross-sectional imaging.
◊ Assessment is typically based on general fitness and comorbidity. Nonsurgical candidates might be treated with palliative systemic chemotherapy, with or without local radiation therapy for symptom control. Refer to UpToDate topic on diagnosis and staging of gastric cancer in adults for additional details.