# Stomach Cancer

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Gastric Cancer - StatPearls - NCBI Bookshelf (NBK459142) - https://www.ncbi.nlm.nih.gov/books/NBK459142/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD25 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Stomach Cancer - disease-level clinical article (gastric-cancer-clinical.txt)
- Stomach Cancer - disease-level clinical article (gastric-cancer-full.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
STOMACH CANCER
Sources: Gastric Cancer - StatPearls - NCBI Bookshelf (NBK459142) -
         https://www.ncbi.nlm.nih.gov/books/NBK459142/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class DD25 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Stomach Cancer - disease-level clinical article (gastric-cancer-
               clinical.txt), Stomach Cancer - disease-level clinical article
               (gastric-cancer-full.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (1)
    - Early on, persistent indigestion, stomach discomfort, and fullness or bloating after small
      meals can occur  [abdominal distension · abdominal pain · indigestion]
  SIGNS - what you find (4)
    - A palpable abdominal mass or a distended stomach suggesting outlet obstruction can be found in
      advanced disease  [abdominal mass]
    - Metastatic spread can show as a left supraclavicular Virchow node, a periumbilical Sister Mary
      Joseph nodule, or a left axillary Irish node  [metastasis]
    - Peritoneal spread can present as a Krukenberg ovarian mass, a rectal Blumer shelf, ascites, or
      an enlarged liver  [ascites · hepatomegaly]
    - Rare paraneoplastic clues include acanthosis nigricans, microangiopathic hemolytic anemia,
      Trousseau syndrome, or membranous nephropathy  [anaemia]
  TESTS (6)
    - A suspicious gastric ulcer needs multiple biopsies - sensitivity rises from about 70% with one
      sample to 98% with seven
    - Endoscopic ultrasound separates T1 from T2 tumor depth with about 85% sensitivity and 90%
      specificity
    - Staging CT is limited for T and N staging and small peritoneal deposits, with accuracy ranging
      only 42% to 82%
    - PET-CT can help assess whether the tumor is resectable when initial staging shows no
      metastatic disease
    - Tumor markers such as CEA, CA-125, CA19-9, and CA72-4 add little diagnostically and can rise
      from unrelated conditions
    - Staging laparoscopy with peritoneal washings finds hidden peritoneal disease in up to 40% of
      patients missed by other imaging
  IF NOT THIS - what else fits (8)
    - Acute gastritis
    - Atrophic gastritis
    - Chronic gastritis
    - Esophageal cancer
    - Esophageal stricture
    - Esophagitis
    - Non-Hodgkin lymphoma of the stomach
    - Peptic ulcer disease
  Source  StatPearls "Gastric Cancer" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Stomach cancer needs urgent endoscopy, biopsy, and oncology/surgical referral. GP gives
            symptomatic relief (acid suppression, analgesia) while arranging urgent referral. -
            Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Stomach cancer needs urgent endoscopy, biopsy, and oncology/surgical referral. GP gives
            symptomatic relief (acid suppression, analgesia) while arranging urgent referral.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - The specific alarm symptoms mandating urgent upper endoscopy are
            gastrointestinal bleeding, unexplained weight loss, and dysphagia.
            RED FLAG - The physical examination signs of metastatic or advanced gastric cancer are
            Virchow node, Sister Mary Joseph periumbilical nodule, and Irish node.
            RED FLAG - Persistent vomiting, black stool, a palpable abdominal mass, or new dyspepsia
            in a patient over 55: refer for urgent upper endoscopy.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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