Stomach Cancer (Gastric Carcinoma): Diagnostic Tests

Mandatory medical device diagnostics.

  • Esophago-gastro-duodenoscopy (EGD; endoscopy of esophagus, stomach, and duodenum) by high-resolution videoendoscopy with multiple biopsies (specimen collections; from all suspicious lesions; in Barrett’s esophagus, an additional 4 quadrant biopsies) [primary diagnosis: initial diagnostic tool and gold standard for early detection, histologic confirmation, and exclusion of gastric cancer]indications [according to S3 guideline]:

    Indications: High-resolution videoendoscopy should be used for the primary diagnosis of adenocarcinoma of the stomach or esophagogastric junction; narrow-band imaging (NBI) and flexible spectral imaging color enhancement (FICE) techniques facilitate visualization and characterization of malignant gastric mucosal lesions.

  • Endosonography* (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the internal surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument)). – To assess the intramural extent (wall infiltration; T-staging) and lymph node involvement or assessment of radiologically suspicious lymph nodes.
  • Abdominal sonography (ultrasound examination of the abdominal organs)/liver sonography (ultrasound examination of the liver) – to exclude metastases (daughter tumors; esp. liver metastases).
  • Sonography of the neck – for carcinomas of the esophagogastric (esophagus-gastric) transition or clinical suspicion of lymph node metastases.
  • Computed tomography (CT) of the thorax (chest) and abdomen (abdominal CT)* (abdominal CT)* incl. pelvis – for detection or exclusion of gastric carcinomas growing beyond the wall, for local infiltration diagnostics as well as for the detection of distant metases (M-staging).

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.

  • Double contrast X-ray examination – in case of refusal of gastroscopy (gastroscopy).
  • X-ray of the thorax (X-ray thorax/chest), in two planes – to exclude lung metastases.
  • Computed tomography of the thorax/chest (thoracic CT) – to exclude pulmonary metastases.
  • Magnetic resonance imaging (MRI) of the abdomen (abdominal MRI)* – for the detection or exclusion of wall-crossing gastric carcinoma, for local infiltration diagnostics, and for the detection of distant metases (M-staging) [reserved for patients in whom CT cannot be performed].
  • Magnetic resonance imaging of the skull* (cranial MRI, cranial MRI or cMRI) – for suspected brain metastases.
  • Skeletal scintigraphy (bone scintigraphy) – in advanced tumors or in case of discomfort/bone pain or elevated alkaline phosphatase (AP).
  • Gastric pulp passage in double contrast technique – in case of unclear endoscopic findings (e.g. in case of submucosally growing carcinoma (linitis plastica)).

* Determination of the exact N stage by EUS, CT or MRI is problematic. For the diagnosis of peritoneal carcinomatosis (extensive infestation of the peritoneum with malignant tumor cells) laparoscopy (laparoscopy) is the method of choice. Hereditary nonpolyposis colorectal carcinoma (HNPCC).

  • In HNPCC patients (hereditary non-polyposis colorectal cancer; hereditary colorectal cancer without polyposis, also known as “Lynch syndrome“) and persons at risk for HNPCC should undergo regular EGD in addition to colonoscopy from the age of 35 [guidelines: S3 guideline].