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Title of Journal: Gastric Cancer

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Abbravation: Gastric Cancer

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Springer Japan

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What studies are appropriate and necessary for staging gastric adenocarcinoma? Results of an international RAND/UCLA expert panel

Authors: Matthew Dixon, Roberta Cardoso, Jill Tinmouth, Lucy Helyer, Calvin Law, Carol Swallow, Lawrence Paszat, Robin McLeod, Rajini Seevaratnam, Alyson Mahar, Natalie G. Coburn, The Gastric Cancer Processes of Care Expert Panel,

Publish Date: 2013/04/30
Volume: 17, Issue:2, Pages: 377-382
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Utilizing a RAND/UCLA appropriateness methodology (RAM), a multidisciplinary expert panel of 16 physicians scored 84 GC staging scenarios. Appropriateness was scored from 1 to 9. Median appropriateness scores from 1 to 3 were considered inappropriate, 4–6 uncertain, and 7–9 appropriate. Agreement was reached when 12 or more of 16 panelists scored the scenario similarly. Appropriate scenarios were subsequently scored for necessity.Pretreatment TNM stage determination is necessary. Necessary staging maneuvers include esophagogastroduodenoscopy (EGD); biopsy of the tumor; documentation of tumor size, description, location, distance from gastroesophageal junction (GEJ), and any GEJ, esophageal, or duodenal involvement; if an EGD report is unclear, surgeons should repeat it to confirm tumor location. Pretreatment radiologic assessment should include computed tomography (CT)-abdomen and CT-pelvis, performed with multidetector CT scanners with 5-mm slices. Laparoscopy should be performed before resection of cT3–cT4 lesions or multivisceral resections. Laparoscopy should include inspection of the stomach, diaphragm, liver, and ovaries.Management of gastric adenocarcinoma (GC) is complex and resource intensive [1]. Decisions require planning by a multidisciplinary team. The foundation of treatment planning is accurate staging of tumor depth (T), regional lymph node (LN) involvement (N), and distant metastases (M) [2]. Several techniques are available for evaluation of GC, including esophagogastroduodenoscopy (EGD) and biopsy, computed tomography (CT) scan of the chest, abdomen, and pelvis, positron emission tomography (PET) scan, endoscopic ultrasound (EUS) with fine-needle aspiration (FNA), staging laparoscopy, and peritoneal cytology.



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