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Oncology
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Staging of Gastric Adenocarcinoma
Flowchart
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CT first, then EUS + PET + laparoscopy for full staging.
Decision
Outcome
Decision
Biopsy-positive gastric adenocarcinoma. First staging study?
✓
CT abdomen and pelvis
✗
Bone scan
Decision
After CT — next steps?
✓
PET/CT, endoscopic ultrasound, CT chest, laparoscopy (± peritoneal lavage)
✗
Start chemo without staging
Decision
Stage assessment?
✓
Limited (resectable) → surgical resection ± perioperative chemo
✓
Advanced → systemic chemotherapy ± palliative measures
Outcome
Surgical resection (subtotal/total gastrectomy + D2 lymphadenectomy); perioperative chemo (FLOT)
Outcome
Systemic chemo ± immunotherapy (HER2, PD-L1 targeted) + palliative surgery for obstruction/bleeding