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Gastric cancer screening

Annie On On Chan, MD
Benjamin Wong, DSc, MD, PhD
Section Editors
Mark Feldman, MD, MACP, AGAF, FACG
Joann G Elmore, MD, MPH
Deputy Editors
Shilpa Grover, MD, MPH, AGAF
Diane MF Savarese, MD


Gastric cancer is one of the most common cancers worldwide [1]. However, there are significant differences in the incidence of gastric cancer by region. The value of screening asymptomatic individuals for gastric cancer is controversial even in areas with a relatively high incidence of gastric cancer [2]. This topic will review the screening of gastric cancer. The epidemiology, risk factors, pathogenesis, clinical features, diagnosis, and management of gastric cancer are discussed in detail, separately. (See "Epidemiology of gastric cancer" and "Risk factors for gastric cancer" and "Pathology and molecular pathogenesis of gastric cancer" and "Clinical features, diagnosis, and staging of gastric cancer" and "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging" and "Early gastric cancer: Treatment, natural history, and prognosis" and "Surgical management of invasive gastric cancer" and "Adjuvant and neoadjuvant treatment of gastric cancer".)


The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography.

Upper endoscopy — Upper endoscopy allows for direct visualization of the gastric mucosa and for biopsies to be obtained for diagnosing precancerous lesions such as gastric atrophy, intestinal metaplasia, or gastric dysplasia in addition to gastric cancer. Although it is more invasive and has a higher cost, upper endoscopy is also more sensitive for diagnosing a variety of gastric lesions as compared with alternative diagnostic strategies. (See 'Test performance' below.)

Contrast radiography — Double-contrast barium radiographs with photofluorography or digital radiography can identify malignant gastric ulcers, infiltrating lesions, and some early gastric cancers. However, false-negative barium studies can occur in as many as 50 percent of cases [3]. In early gastric cancer, the sensitivity of a barium study may be as low as 14 percent [4]. The one scenario in which a barium study may be superior to upper endoscopy is in patients with linitis plastica. The decreased distensibility of the stiff, "leather-flask" appearing stomach is more obvious on the radiographic study, and the endoscopic appearance may be relatively normal. (See "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging", section on 'Upper endoscopy' and "Clinical features, diagnosis, and staging of gastric cancer", section on 'Endoscopy'.)

Other tests — While other modalities of screening for gastric cancer or its precursors have been proposed, further studies are needed to support their use.

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Literature review current through: Nov 2017. | This topic last updated: Sep 07, 2017.
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