Endoscopic ultrasound allows for a more precise preoperative assessment of the tumor stage. Endoscopic sonography is becoming increasingly useful as a staging tool when the CT fails to find evidence of T3, T4, or metastatic disease. Institutions that favor neoadjuvant chemoradiotherapy for patients with locally advanced disease rely on endoscopic ultrasound data to improve patient stratification.
MRI (or CT) of the chest, abdomen, and pelvis assesses the local disease process as well as evaluates potential areas of spread (ie, enlarged lymph nodes or possible liver metastases).
Double-contrast upper GI series and barium swallows may be helpful in delineating the extent of disease when obstructive symptoms are present or when bulky proximal tumors prevent passage of the endoscope to examine the stomach distal to an obstruction (more common with gastroesophageal junction tumors). These studies are only 75% accurate and should for the most part be used only when upper GI endoscopy is not feasible.
Chest radiograph is done to evaluate for metastatic lesions.
Learn more about the workup for gastric cancer.
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Cite this: Elwyn C. Cabebe. Fast Five Quiz: Advanced and Metastatic Gastric Cancer - Medscape - Apr 06, 2022.