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1、檢查和附加評估(GAST-1)（Workup and Additional Evaluation)
病情的檢查
- 病史與體格檢查(history and physical examination,H＆P)
- 上消化道內窺鏡檢查和活檢
- 胸部/腹部/骨盆CT，帶口服和靜脈注射對比劑
- FDG-PET/CT(顱底至中高)，如果沒有M1病的證據b和如果臨床表明
- 化學生物化學和綜合化學概況(化驗）
- 內窺鏡超聲檢查(EUS)是否懷疑早期疾病或是否需要確定早期與局部晚期疾病(首選)
- 內鏡下切除對於早期癌症(T1a或T1b)的準確分期至關重要
- 有臨床指徵的轉移性疾病活檢
- MSI-H/DMMRs檢測是否有轉移疾病記錄/可疑
- HER2和PD-L1檢測是否記錄/懷疑轉移性腺癌
- 評估西沃特類別
- 營養評估和諮詢
- 戒菸建議、諮詢和藥物治療
- 描述家族史
臨床分期及附加評估
• H&P
• Upper GI endoscopy and biopsya
• Chest/abdomen/pelvic CT with oral
and IV contrast
• FDG-PET/CT evaluation (skull base to mid-
thigh) if no evidence of M1 diseaseb and if
clinically indicated
• CBC and comprehensive chemistry profile
• Endoscopic ultrasound (EUS) if early-stage
disease suspected or if early versus locally
advanced disease needs to be determined
(preferred)
• Endoscopic resection (ER) is essential for the
accurate staging of early-stage cancers (T1a
or T1b)c
• Biopsy of metastatic disease as clinically
indicated
• MSI-H/dMMR testing if metastatic disease is
documented/suspectedd
• HER2 and PD-L1 testing if metastatic
adenocarcinoma is documented/
suspectedd,e
• Assess Siewert categoryf
• Nutritional assessment and counseling
• Smoking cessation advice, counseling, and
pharmacotherapy as indicatedg
• Screen for family historyh
b.可能不適合T1
c.EMR也可以治療早期疾病/損傷。
d.參見病理檢查和生物標誌物測試的原則。(GAST-B)
e.腫瘤艾巴氏病毒狀態正在成為胃癌個體化治療策略的潛在生物標誌物，但目前不推薦用於臨床護理。
f.見外科治療原則（GAST-C)。
g.參見《NCCN戒菸指南》
h.見《胃癌遺傳風險評估原則》。另請參見NCCN結直腸癌篩查指南和NCCN遺傳/家族性高風險評估指南:乳房和卵巢
i.腫瘤分類見分期(ST-1)。
j.醫學上能夠承受的大手術。
k.醫學上不能承受大手術或醫學上健康的病人拒絕手術。
l.當考慮化學放射或手術時，進行細胞學腹腔鏡檢查以評估腹膜擴散。如果計劃進行姑息性切除術，則不需要進行細胞學腹腔鏡檢查。細胞學腹腔鏡檢查適用於臨床T1b或更高階段
m.見多學科團隊會診原則（MDT)
原文:
- a.See Principles of Endoscopic Staging and Therapy (GAST-A).
- b.May not be appropriate for T1.
- c.EMR may also be therapeutic for early-stage disease/lesions.
- d.See Principles of Pathologic Review and Biomarker T esting (GAST-B).
- e.Tumor Epstein-Barr virus status is emerging as a potential biomarker for
- p.ersonalized treatment strategies for gastric cancer, but is not currently
- r.ecommended for clinical care.
- f.See Principles of Surgery (GAST-C).
- g.See NCCN Guidelines for Smoking Cessation.
- h.See Principles of Genetic Risk Assessment for Gastric Cancer (GAST-D). Also see
- NCCN Guidelines for Colorectal Cancer Screening and NCCN Guidelines for
- Genetic/Familial High-Risk Assessment: Breast and Ovarian.
- i.See Staging (ST-1) for tumor classification.
- j.Medically able to tolerate major surgery.
- k.Medically unable to tolerate major surgery or medically fit patients who decline
surgery.
- l.Laparoscopy with cytology is performed to evaluate for peritoneal spread when
considering chemoradiation or surgery. Laparoscopy with cytology is not indicated
if a palliative resection is planned. Laparoscopy with cytology is indicated for
clinical stage T1b or higher.
- m.See Principles of Multidisciplinary T eam Approach (GAST-E)
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