Gastric cancer

Last updated: September 23, 2022

Summarytoggle arrow icon

Gastric cancer is the fifth most common cancer worldwide. Although the incidence is declining in the United States, it remains high in some Asian countries, most notably Japan, South Korea, and Mongolia. The main risk factor for developing gastric cancer is infection with Heliobacter pylori. Other risk factors include GERD, a diet high in salts and nitrates, and tobacco use. Adenocarcinoma accounts for 95% of gastric cancer and is further classified as intestinal or diffuse type. Less frequent gastric cancers include gastric lymphomas, gastrointestinal stromal tumors, and neuroendocrine tumors. Early on, patients are commonly asymptomatic or have nonspecific symptoms (e.g., dyspepsia, epigastric pain). Later on patients may develop signs of metastatic disease or complications (e.g., gastric outlet obstruction, GI bleeding, ascites). Diagnosis is confirmed with upper endoscopy and biopsy. Staging via imaging or diagnostic laparoscopy helps inform the treatment. Early nonmetastatic disease is typically treated with surgery and perioperative chemotherapy. Unresectable or metastatic disease is treated with systemic chemotherapy or chemoradiation. Targeted therapy can be added based on tumor molecular characteristics. Palliative care is the mainstay of therapy for patients with frailty and an advanced cancer stage. The prognosis varies according to tumor stage, but the overall 5-year survival rate is low as the diagnosis is often made late once symptoms progress.

  • Incidence
    • An estimated 27,600 new cases were diagnosed in the US in 2020. [1][2]
    • Highest incidence in South Korea, Mongolia, and Japan [3]
  • Sex: > [2]

Epidemiological data refers to the US, unless otherwise specified.

Exogenous risk factors [2]

Endogenous risk factors [2]

Early stages of gastric cancer

  • Often asymptomatic
  • Loss of appetite, nausea

Late stages of gastric cancer

Gastric cancer is frequently diagnosed during the endoscopic evaluation of nonspecific symptoms or findings (e.g., heartburn, dyspepsia, anemia, weight loss). Patients typically need repeat endoscopic tissue sampling for histopathologic studies and imaging studies for cancer staging.

Diagnostic approach [10][11][12]

Over half of patients with gastric cancer in the US present with advanced disease (stage III or higher) at the time of diagnosis. [14]

EGD with biopsy [15][16]

  • Indications include:
    • Clinical features suspicious for gastric cancer
    • Incidental finding of gastric cancer on previous EGD
  • Procedure
    • Visual identification and biopsy of suspicious lesions
    • Frequently combined with EUS
  • Findings

Staging investigations [10][11][13]

Imaging

Diagnostic laparoscopy [10][13][20]

The peritoneum is the most common site of metastasis in gastric cancer. Curative gastrectomy is typically not attempted if diagnostic laparoscopy or peritoneal cytology indicate peritoneal metastasis. [13][21]

Additional diagnostics [10][12][13]

pTNM classification of gastric cancer [33]
Intent AJCC/UICC TNM Tissue invasion Lymph node metastases Distant metastasis
Curative
  • Stage 0
  • None
  • None
  • Stage IA
  • T1, N0, M0
  • Stage IB
  • T1, N1, M0
  • T2, N0, M0
  • Muscularis propria
  • None
  • Stage IIA
  • T1, N2, M0
  • T2, N1, M0
  • Muscularis propria
  • T3, N0, M0
  • Subserosal tissue
  • None
  • Stage IIB
  • T1, N3a, M0
  • T2, N2, M0
  • Muscularis propria
  • T3, N1, M0
  • Subserosal tissue
  • T4a, N0, M0
  • None
Intermediate
  • Stage IIIA
  • T2, N3a, M0
  • Muscularis propria
  • T3, N2, M0
  • Subserosal tissue
  • T4a, N1, M0
  • T4a, N2, M0
  • T4b, N0, M0
  • Adjacent organs/structures
  • None
  • Stage IIIB
  • T1, N3b, M0
  • T2, N3b, M0
  • Muscularis propria
  • T3, N3a, M0
  • Subserosal tissue
  • T4a, N3a, M0
  • T4b, N1, M0
  • Adjacent organs/structures
  • T4b, N2, M0
  • Stage IIIC
  • T3, N3b, M0
  • Subserosal tissue
  • T4a, N3b, M0
  • T4b, N3a, M0
  • Adjacent organs/structures
  • T4b, N3b, M0
Palliative
  • Stage IV
  • Any T, any N, M1
  • Any structure
  • Any number
  • Yes

Gastric adenocarcinoma

General features

  • Accounts for ∼ 95% of cases [34]
  • Most commonly located on the lesser curvature
  • Arises from glandular cells in the stomach

Lauren classification of gastric adenocarcinoma

  • Intestinal type gastric carcinoma
    • Typically localized
    • Polypoid, glandular formation
    • Similar to an ulcerative lesion with clear raised margins
    • Commonly located on the lesser curvature
  • Diffuse type gastric carcinoma
    • No clear border
    • Spreads earlier in the course of disease
    • Infiltrative growth
    • Diffuse spread in the gastric wall
    • Linitis plastica: gastric wall thickening and leather bottle appearance
    • Composed of signet ring cells: round cells filled with mucin, with a flat nucleus in the cell periphery
    • Associated with E-cadherin mutation [35]
  • Intermediate type (the least common type): should be treated as the diffuse type, as the extent of tumor infiltration is difficult to assess

See also “Approach to dyspepsia” and “Acute abdominal pain.”

Gastric conditions

Other types of cancer

Gastrointestinal stromal tumor (GIST) [36]

The differential diagnoses listed here are not exhaustive.

Approach [10][13]

Provide multidisciplinary care where available (e.g., tumor board) and base treatment plan on patient fitness, disease characteristics, and goals of care (see “Principles of cancer care” for more information).

  • Localized, resectable disease
    • Stages 0 and IA (≤ T1 and ≤ N0): surgical or endoscopic resection
    • Stage IB or higher (≥ T2 and/or N > 0): surgical resection plus perioperative chemotherapy or adjuvant chemoradiotherapy
  • Specific molecular markers present: Consider adding targeted therapy and/or immunotherapy.
  • Metastatic or unresectable cancer: Provide palliative care.

The mainstay of treatment for nonmetastatic gastric cancer is surgical resection with perioperative chemotherapy.

Resection [13][14]

Margin-free resection (R0 resection) is the only potentially curative therapy. However, it is only possible in 30% of patients and is associated with a high recurrence rate. [32][38]

Surgical

The following procedures are typically combined with radical lymphadenectomy and reconstructive procedures (e.g., Roux-en-Y anastomosis). [10]

Endoscopic

Reconstructive procedures [40][41][42]

Chemotherapy and radiotherapy [10][13]

A combination of preoperative and postoperative chemotherapy significantly improves survival in resectable disease. [45]

Personalized treatment [10][12][13]

Gastric cancers are genetically diverse and have multiple possible genetic mutations amenable to therapeutic manipulation. Systemic therapy may be modified based on the presence of specific molecular markers.

For the forms of cancer associated with HER2 gene overexpression and the medication used for treatment, think TRUST HER, GaBriel! (TRUSTuzumab; HER2; Gastric cancer; Breast cancer)

Supportive and palliative care [46]

Metastatic disease

The Skeleton (bones), Liver, Lung, and Brain are the structures most commonly affected by hematogenous spread of gastric cancer: Zombie SKELETONs don't LIVE LONG (lung) without eating BRAINs.

Paraneoplastic syndromes

Paraneoplastic syndromes may be signs of visceral malignancies, especially GI carcinomas. These syndromes include:

Always rule out malignancy in patients with acanthosis nigricans.

Gastric outlet obstruction (GOO) [46][51]

Postgastrectomy complications

Malabsorption

Small intestinal bacterial overgrowth (SIBO)

Efferent loop syndrome

  • Definition: kinking or anastomotic narrowing of the efferent loop that causes emesis and/or a feeling of fullness
  • Management

Afferent loop syndrome

  • Definition
    • Biliary and pancreatic obstruction due to stenosis, kinking, or incorrect anastomosis of the afferent loop
    • Chyme enters the afferent loop instead of the efferent loop and causes loss of appetite, a feeling of fullness, and bilious vomiting with subsequent relief of nausea.
  • Management: surgical treatment

Dumping syndrome

  • Definition: rapid gastric emptying as a result of defective gastric reservoir function, impaired pyloric emptying mechanisms, or anomalous postsurgery gastric motor function

Early dumping

Late dumping

Suspect late dumping syndrome in a patient with previous gastric surgery and hypoglycemia.

Remnant gastric cancer [57][58][59]

We list the most important complications. The selection is not exhaustive.

  • Because there are no early signs, gastric cancer is often diagnosed very late. Around 50% of cancers have already reached an advanced stage that does not allow for curative treatment due to tissue invasion and metastases. [33]
  • If diagnosed at a very early stage, the 5-year survival rate is 95%. [60]
  • Late-stage disease with distant metastases and/or peritoneal carcinomatosis has a poor prognosis (5-year survival rate of ∼ 5%). [61]
  1. Key Statistics About Stomach Cancer. https://www.cancer.org/cancer/stomach-cancer/about/key-statistics.html. Updated: January 1, 2019. Accessed: December 24, 2019.
  2. Stomach Cancer Risk Factors. https://www.cancer.org/cancer/stomach-cancer/causes-risks-prevention/risk-factors.html. Updated: December 14, 2017. Accessed: December 30, 2019.
  3. Estimated age-standardized cancer incidence rates. http://gco.iarc.fr/today/online-analysis-map. Updated: January 1, 2018. Accessed: January 20, 2020.
  4. Tsugane S. Salt, salted food intake, and risk of gastric cancer: Epidemiologic evidence. Cancer Sci. 2005; 96 (1): p.1-6. doi: 10.1111/j.1349-7006.2005.00006.x . | Open in Read by QxMD
  5. Moss SF. The Clinical Evidence Linking Helicobacter pylori to Gastric Cancer. Cell Mol Gastroenterol Hepatol. 2017; 3 (2): p.183-191. doi: 10.1016/j.jcmgh.2016.12.001 . | Open in Read by QxMD
  6. Nagel G, Linseisen J, Boshuizen HC, et al. Socioeconomic position and the risk of gastric and oesophageal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST). Int J Epidemiol. 2007; 36 (1): p.66-76. doi: 10.1093/ije/dyl275 . | Open in Read by QxMD
  7. Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M. Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study. BMC Endocr Disord. 2020; 20 (1). doi: 10.1186/s12902-019-0472-2 . | Open in Read by QxMD
  8. Vannella L. Risk for gastric neoplasias in patients with chronic atrophic gastritis: A critical reappraisal. World Journal of Gastroenterology. 2012; 18 (12): p.1279. doi: 10.3748/wjg.v18.i12.1279 . | Open in Read by QxMD
  9. Søgaard KK, Farkas DK, Pedersen L, Lund JL, Thomsen RW, Sørensen HT. Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers. Cancer Medicine. 2016; 5 (6): p.1341-1351. doi: 10.1002/cam4.680 . | Open in Read by QxMD
  10. Ajani JA, D’Amico TA, Almhanna K, et al. NCCN clinical practice guidelines in oncology: Gastric cancer. JNCCN. 2016; 14 (10): p.1286-1312. doi: 10.6004/jnccn.2016.0137 . | Open in Read by QxMD
  11. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016; 27 (5): p.v38-v49. doi: 10.1093/annonc/mdw350 . | Open in Read by QxMD
  12. Hallinan JT, Venkatesh SK. Gastric carcinoma: imaging diagnosis, staging and assessment of treatment response.. Cancer Imaging. 2013; 13 : p.212-27. doi: 10.1102/1470-7330.2013.0023 . | Open in Read by QxMD
  13. Sexton RE, Al Hallak MN, Diab M, Azmi AS. Gastric cancer: a comprehensive review of current and future treatment strategies. Cancer and Metastasis Reviews. 2020; 39 (4): p.1179-1203. doi: 10.1007/s10555-020-09925-3 . | Open in Read by QxMD
  14. Joshi SS, Badgwell BD. Current treatment and recent progress in gastric cancer. CA Cancer J Clin. 2021; 71 (3): p.264-279. doi: 10.3322/caac.21657 . | Open in Read by QxMD
  15. Dikken JL, van de Velde CJ, Coit DG, Shah MA, Verheij M, Cats A. Treatment of resectable gastric cancer.. Therap Adv Gastroenterol. 2012; 5 (1): p.49-69. doi: 10.1177/1756283X11410771 . | Open in Read by QxMD
  16. Evans JA, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc. 2015; 82 (1): p.1-8. doi: 10.1016/j.gie.2015.03.1967 . | Open in Read by QxMD
  17. Kwack WG, Ho WJ, Kim JH, et al. Understanding the diagnostic yield of current endoscopic biopsy for gastric neoplasm. Medicine. 2016; 95 (30): p.e4196. doi: 10.1097/md.0000000000004196 . | Open in Read by QxMD
  18. Hosoda K, Watanabe M, Yamashita K. Re‐emerging role of macroscopic appearance in treatment strategy for gastric cancer. Ann Gastroenterol Surg. 2018; 3 (2): p.122-129. doi: 10.1002/ags3.12218 . | Open in Read by QxMD
  19. Shah SC, Canakis A, Peek RM, Saumoy M. Endoscopy for Gastric Cancer Screening Is Cost Effective for Asian Americans in the United States. Clin Gastroenterol Hepatol. 2020; 18 (13): p.3026-3039. doi: 10.1016/j.cgh.2020.07.031 . | Open in Read by QxMD
  20. Kim GH, Liang PS, Bang SJ, Hwang JH. Screening and surveillance for gastric cancer in the United States: Is it needed?. Gastrointest Endosc. 2016; 84 (1): p.18-28. doi: 10.1016/j.gie.2016.02.028 . | Open in Read by QxMD
  21. Bejgum P, Cheela S, Gil C. Linitis Plastica, an often missed diagnosis. AJG. 2009; 104 (Supplment 3): p.S216.
  22. Martinez-Ares D, Alonso Aguirre PA, Yáñez López J, et al. Sensitivity of Ultrasonography for Gastric Cancer Diagnosis in Symptomatic Patients. Dig Dis Sci. 2008; 54 (6): p.1257-1264. doi: 10.1007/s10620-008-0474-9 . | Open in Read by QxMD
  23. Machairas N, Charalampoudis P, Molmenti EP, et al. The value of staging laparoscopy in gastric cancer.. Ann Gastroenterol. 2017; 30 (3): p.287-294. doi: 10.20524/aog.2017.0133 . | Open in Read by QxMD
  24. De Andrade JP, Mezhir JJ. The critical role of peritoneal cytology in the staging of gastric cancer: An evidence-based review. J Surg Oncol. 2014; 110 (3): p.291-297. doi: 10.1002/jso.23632 . | Open in Read by QxMD
  25. Huang X zhang, Yang Y chong, Chen Y, et al. Preoperative Anemia or Low Hemoglobin Predicts Poor Prognosis in Gastric Cancer Patients: A Meta-Analysis. Dis Markers. 2019; 2019 : p.1-9. doi: 10.1155/2019/7606128 . | Open in Read by QxMD
  26. Kenar G, Köksoy EB, Ürün Y, Utkan G. Prevalence, etiology and risk factors of anemia in patients with newly diagnosed cancer. Support Care Cancer. 2020; 28 (11): p.5235-5242. doi: 10.1007/s00520-020-05336-w . | Open in Read by QxMD
  27. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017; 112 : p.212-238. doi: 10.1038/ajg.2016.563 . | Open in Read by QxMD
  28. Liou JM, Malfertheiner P, Lee YC, et al. Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus. Gut. 2020; 69 (12): p.2093-2112. doi: 10.1136/gutjnl-2020-322368 . | Open in Read by QxMD
  29. Ye D, Xu G, Ma W, et al. Significant function and research progress of biomarkers in gastric cancer (Review). Oncol Lett. 2019 . doi: 10.3892/ol.2019.11078 . | Open in Read by QxMD
  30. Oshima H, Ishikawa T, Yoshida GJ, et al. TNF-α/TNFR1 signaling promotes gastric tumorigenesis through induction of Noxo1 and Gna14 in tumor cells. Oncogene. 2013; 33 (29): p.3820-3829. doi: 10.1038/onc.2013.356 . | Open in Read by QxMD
  31. Tsujimoto H, Ono S, Ichikura T, Matsumoto Y, Yamamoto J, Hase K. Roles of inflammatory cytokines in the progression of gastric cancer: friends or foes?. Gastric Cancer. 2010; 13 (4): p.212-221. doi: 10.1007/s10120-010-0568-x . | Open in Read by QxMD
  32. Bartley AN, Washington MK, Colasacco C, et al. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society of Clinical Oncology.. J Clin Oncol. 2017; 35 (4): p.446-464. doi: 10.1200/JCO.2016.69.4836 . | Open in Read by QxMD
  33. Puliga E, Corso S, Pietrantonio F, Giordano S. Microsatellite instability in Gastric Cancer: Between lights and shadows. Cancer Treat Rev. 2021; 95 : p.102175. doi: 10.1016/j.ctrv.2021.102175 . | Open in Read by QxMD
  34. Nakamura Y, Kawazoe A, Lordick F, Janjigian YY, Shitara K. Biomarker-targeted therapies for advanced-stage gastric and gastro-oesophageal junction cancers: an emerging paradigm. Nat Rev Clin Oncol. 2021; 18 (8): p.473-487. doi: 10.1038/s41571-021-00492-2 . | Open in Read by QxMD
  35. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical ; 2018
  36. Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric Adenocarcinoma. Ann Surg. 2005; 241 (1): p.27-39. doi: 10.1097/01.sla.0000149300.28588.23 . | Open in Read by QxMD
  37. Torabizadeh Z, Nosrati A, Sajadi Saravi SN, Yazdani Charati J, Janbabai G. Evaluation of E-cadherin Expression in Gastric Cancer and Its Correlation with Clinicopathologic Parameters.. International journal of hematology-oncology and stem cell research. 2017; 11 (2): p.158-164.
  38. Juárez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment.. Cancer Control. undefined; 25 (1): p.1073274818778256. doi: 10.1177/1073274818778256 . | Open in Read by QxMD
  39. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis.. Arch Pathol Lab Med. 2006; 130 (10): p.1466-78. doi: 10.1043/1543-2165(2006)130[1466:GSTROM]2.0.CO;2 . | Open in Read by QxMD
  40. Parab TM, DeRogatis MJ, Boaz AM, et al. Gastrointestinal stromal tumors: a comprehensive review. Journal of Gastrointestinal Oncology. 2018; 10 (1): p.144-154. doi: 10.21037/jgo.2018.08.20 . | Open in Read by QxMD
  41. Cardoso R, Coburn NG, Seevaratnam R, et al. A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review. Gastric Cancer. 2012; 15 (S1): p.164-167. doi: 10.1007/s10120-012-0142-9 . | Open in Read by QxMD
  42. Nobel T, Molena D. Surgical principles for optimal treatment of esophagogastric junction adenocarcinoma. Ann Gastroenterol Surg. 2019; 3 (4): p.390-395. doi: 10.1002/ags3.12268 . | Open in Read by QxMD
  43. Cai Z, Zhou Y, Wang C, et al. Optimal reconstruction methods after distal gastrectomy for gastric cancer. Medicine. 2018; 97 (20): p.e10823. doi: 10.1097/md.0000000000010823 . | Open in Read by QxMD
  44. Parray A, Gupta V, Chaudhari VA, Shrikhande SV, Bhandare MS. Role of intraperitoneal chemotherapy in gastric cancer. Surgery in Practice and Science. 2021; 4 : p.100025. doi: 10.1016/j.sipas.2020.100025 . | Open in Read by QxMD
  45. Gurusamy K, Vale CL, Pizzo E, et al. Cytoreductive surgery (CRS) with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) versus standard of care (SoC) in people with peritoneal metastases from colorectal, ovarian or gastric origin: protocol for a systematic review and individual participant data (IPD) meta-analyses of effectiveness and cost-effectiveness. BMJ Open. 2020; 10 (5): p.e039314. doi: 10.1136/bmjopen-2020-039314 . | Open in Read by QxMD
  46. Shinde A, Novak J, Amini A, Chen YJ. The evolving role of radiation therapy for resectable and unresectable gastric cancer. Transl Gastroenterol Hepatol. 2019; 4 : p.64-64. doi: 10.21037/tgh.2019.08.06 . | Open in Read by QxMD
  47. Ye S, Wang L, Zuo Z, Bei Y, Liu K. The role of surgery and radiation in advanced gastric cancer: A population-based study of Surveillance, Epidemiology, and End Results database. PLoS ONE. 2019; 14 (3): p.e0213596. doi: 10.1371/journal.pone.0213596 . | Open in Read by QxMD
  48. Cunningham D, Allum WH, Stenning SP, et al. Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer. N Engl J Med. 2006; 355 (1): p.11-20. doi: 10.1056/nejmoa055531 . | Open in Read by QxMD
  49. Harada K, Zhao M, Shanbhag N, Baba H, Ajani JA. Palliative care for advanced gastric cancer.. Expert Rev Anticancer Ther. 2020; 20 (7): p.575-580. doi: 10.1080/14737140.2020.1781620 . | Open in Read by QxMD
  50. Mulazzani GEG, Corti F, Della Valle S, Di Bartolomeo M. Nutritional Support Indications in Gastroesophageal Cancer Patients: From Perioperative to Palliative Systemic Therapy. A Comprehensive Review of the Last Decade.. Nutrients. 2021; 13 (8). doi: 10.3390/nu13082766 . | Open in Read by QxMD
  51. Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in Patients with Gastric Cancer: An Update.. Gastrointest Tumors. 2016; 2 (4): p.178-87. doi: 10.1159/000445188 . | Open in Read by QxMD
  52. Cho SB, Hur S, Kim HC, et al. Transcatheter arterial embolization for advanced gastric cancer bleeding. Medicine. 2020; 99 (15): p.e19630. doi: 10.1097/md.0000000000019630 . | Open in Read by QxMD
  53. Saif MW, Siddiqui IA, Sohail MA. Management of ascites due to gastrointestinal malignancy.. Ann Saudi Med. undefined; 29 (5): p.369-77. doi: 10.4103/0256-4947.55167 . | Open in Read by QxMD
  54. Pan SW, Wang PL, Huang HW, et al. A Proposal of a Personalized Surveillance Strategy for Gastric Cancer: A Retrospective Analysis of 9191 Patients.. Gastroenterol Res Pract. 2019; 2019 : p.3248727. doi: 10.1155/2019/3248727 . | Open in Read by QxMD
  55. Koop AH, Palmer WC, Stancampiano FF. Gastric outlet obstruction: A red flag, potentially manageable. Cleve Clin J Med. 2019; 86 (5): p.345-353. doi: 10.3949/ccjm.86a.18035 . | Open in Read by QxMD
  56. JAFFIN BW, KAYE MD. The Prognosis Of Gastric Outlet Obstruction. Ann Surg. 1985; 201 (2): p.170-179. doi: 10.1097/00000658-198502000-00007 . | Open in Read by QxMD
  57. Jue TL, Storm AC, Naveed M, et al. ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction. Gastrointest Endosc. 2021; 93 (2): p.309-322.e4. doi: 10.1016/j.gie.2020.07.063 . | Open in Read by QxMD
  58. Kim GH, Shin JH, Zeng CH, Park JH. Recent Updates in Gastrointestinal Stent Placement from the Esophagus to the Colon: A Radiological Perspective. Cardiovasc Intervent Radiol. 2022 . doi: 10.1007/s00270-022-03067-5 . | Open in Read by QxMD
  59. Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review.. Gastroenterology & hepatology. 2007; 3 (2): p.112-22.
  60. Mattsson J, Minaya MT, Monegro M, et al. Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth.. Gastroenterology and hepatology from bed to bench. 2017; 10 (3): p.168-172.
  61. Ohira M, Toyokawa T, Sakurai K, et al. Current status in remnant gastric cancer after distal gastrectomy. World journal of gastroenterology. 2016; 22 (8): p.2424-33. doi: 10.3748/wjg.v22.i8.2424 . | Open in Read by QxMD
  62. Park Y, Kim S. Clinicopathologic features of remnant gastric cancer after curative distal gastrectomy according to previous reconstruction method: a retrospective cohort study. World J Surg Oncol. 2019; 17 (1). doi: 10.1186/s12957-019-1740-3 . | Open in Read by QxMD
  63. Ma FH, Liu H, Ma S, Li Y, Tian YT. Current controversies in treating remnant gastric cancer: Are minimally invasive approaches feasible?. World journal of clinical cases. 2019; 7 (21): p.3384-3393. doi: 10.12998/wjcc.v7.i21.3384 . | Open in Read by QxMD
  64. Green PHR, O’Toole KM, Slonim D, Wang T, Weg A. Increasing incidence and excellent survival of patients with early gastric cancer: Experience in a United States medical center. Am J Med. 1988; 85 (5): p.658-661. doi: 10.1016/s0002-9343(88)80238-9 . | Open in Read by QxMD
  65. Stomach Cancer Survival Rates. https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-staging/survival-rates.html. Updated: December 18, 2017. Accessed: January 20, 2020.
  66. What are the risk factors for stomach cancer?. http://www.cancer.org/cancer/stomachcancer/detailedguide/stomach-cancer-risk-factors. Updated: May 20, 2014. Accessed: January 3, 2017.
  67. Washington K. 7th edition of the AJCC cancer staging manual: Stomach. Ann Surg Oncol. 2010; 17 (12): p.3077-3079. doi: 10.1245/s10434-010-1362-z . | Open in Read by QxMD
  68. Aziz M, Kasi A. Cancer, Krukenberg Tumor. StatPearls. 2019 .

3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer