Gastric cancer screening
- Annie On On Chan, MD
Annie On On Chan, MD
- Department of Medicine
- University of Hong Kong
- Benjamin Wong, DSc, MD, PhD
Benjamin Wong, DSc, MD, PhD
- Honorary Clinical Professor
- Department of Medicine
- University of Hong Kong
- Section Editors
- Mark Feldman, MD, MACP, AGAF, FACG
Mark Feldman, MD, MACP, AGAF, FACG
- Section Editor — Acid Peptic Disease
- Texas Health Presbyterian Hospital Dallas
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical School at Dallas
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, David Geffen School of Medicine at UCLA
- Deputy Editors
- Shilpa Grover, MD, MPH, AGAF
Shilpa Grover, MD, MPH, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Diane MF Savarese, MD
Diane MF Savarese, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology and Palliative Care
- Clinical Instructor of Medicine
- Harvard Medical School
Gastric cancer is one of the most common cancers worldwide . 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 . 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 . In early gastric cancer, the sensitivity of a barium study may be as low as 14 percent . 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- SCREENING MODALITIES
- Upper endoscopy
- Contrast radiography
- Other tests
- - Serum pepsinogen
- - Serum trefoil factor 3
- - MicroRNAs
- COMPARISON OF SCREENING METHODS
- Test performance
- SCREENING STRATEGIES
- Universal screening
- Selective screening of high-risk subgroups
- Helicobacter pylori eradication
- SUMMARY AND RECOMMENDATIONS