Biopsy-Proven Gastric Adenocarcinoma
Histologically confirmed
All Pathways
Upper GI SurgeryManagement
Gastric Cancer Staging and Resection (NCCN 2024)
Gastric Cancer Staging and Resection (NCCN 2024): Biopsy-Proven Gastric Adenocarcinoma → Staging Workup → Clinical Stage → Early Stage → Endoscopic Rese...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action Staging Workup
CT, EUS, PET-CT, diagnostic laparoscopy
- CT C/A/P with contrast
- EUS for T/N staging
- Staging laparoscopy for cT1b+
03Decision Clinical Stage
- Early (cT1a-T1b, N0)
- Localized (cT2-T4a, M0)
- Metastatic (M1)
04Action Early Stage
T1a-T1b, N0
05Action Endoscopic Resection
EMR/ESD if meets criteria
- T1a, well-diff, <2cm, no ulcer
- Curative if LVI-, clear margins
06End Adjuvant Therapy & Surveillance
Complete periop chemo, surveillance imaging
07Action Upfront Surgery
T1b or limited T2
08Action Gastrectomy
Subtotal or total with D2 LND
- Distal: antral tumors (5cm margin)
- Total: proximal, diffuse, linitis
- D2 lymphadenectomy standard (≥16 nodes)
- Path rejoins step 06Shared downstream outcome
09Action Localized
T2-T4a, any N, M0
- Path rejoins step 07Shared downstream outcome
10Action Perioperative Chemo
FLOT x 4 pre-op + 4 post-op
- ≥cT2 or N+
- Restaging after neoadjuvant
- Path rejoins step 08Shared downstream outcome
11Action Metastatic
Liver, peritoneum, distant LN
12Action Palliative Treatment
Systemic therapy, stent, BSC
- HER2 testing for targeted therapy
- PD-L1/MSI for immunotherapy
- Path rejoins step 06Shared downstream outcome
Guideline Source
NCCN Guidelines - Gastric Cancer Version 2.2024
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Linitis plastica has poor prognosis even with R0 resection
- Signet ring cell may warrant upfront chemo even if early stage
- HER2, PD-L1, MSI testing important for systemic therapy
Applicable Regions
USAUUKEU
EU: ESMO gastric cancer guidelines
JP: Japanese gastric cancer treatment guidelines (more extensive LND)
US: NCCN guidelines
Version 1Next review: 2028-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Gastric Cancer Staging and Resection (NCCN 2024)?
The Gastric Cancer Staging and Resection (NCCN 2024) is a management clinical algorithm for Upper GI Surgery. It provides a structured decision tree to guide clinical decision-making, based on NCCN Guidelines - Gastric Cancer Version 2.2024.
What guideline is the Gastric Cancer Staging and Resection (NCCN 2024) based on?
This algorithm is based on NCCN Guidelines - Gastric Cancer Version 2.2024 (DOI: 10.6004/jnccn.2024.0015).
What are the limitations of the Gastric Cancer Staging and Resection (NCCN 2024)?
Known limitations include: Linitis plastica has poor prognosis even with R0 resection; Signet ring cell may warrant upfront chemo even if early stage; HER2, PD-L1, MSI testing important for systemic therapy. Individual patient factors may require deviation from these recommendations.
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