Gastric Cancer Follow Up

A regular follow-up may allow investigation and treatment of symptoms, psychological support and early detection of recurrence, though there is no evidence that it improves survival outcomes. The response to systemic treatments should normally be assessed with CT imaging of chest, abdomen and pelvis every 6 to 12 weeks. In the advanced disease setting, identification of patients for second-line chemotherapy and clinical trials requires regular follow-up to detect symptoms of disease progression before significant clinical deterioration. The type of pathological response and histologic tumor regression after neoadjuvant therapy has been shown to be a predictor of survival. Follow-up should include a complete history and physical examination every 3-6 months for 1-2 years, every 6-12 months for 3-5 years and annually thereafter. Patients who have undergone surgical resection should be monitored and treated as indicated for vitamin B12 and iron deficiency. 

Endoscopic surveillance requires multiple (4-6) biopsies of any visualized abnormalities after definitive treatment of gastric cancer. Strictures found on endoscopy should be biopsied. Endoscopic ultrasound-guided fine needle aspiration is recommended if areas of wall thickening or suspicious lymph nodes are noted. Patients with Tis successfully treated with endoscopic resection should undergo EGD every 6 months for 1 year then annually for 3 years. Patients with pathologic stage I who underwent surgical resection for T1a, T1b, N0-1 or endoscopic resection for T1a should undergo EGD every 6 months for 1 year then annually for 5 years with subsequent follow-ups based on symptoms or radiologic findings. Patients with pathologic stage II/III or postneoadjuvant stage I-III who underwent neoadjuvant therapy with or without adjuvant therapy should have CT scans of the chest, abdomen and pelvis every 6-12 months for the first 2 years, then annually up to 5 years with subsequent follow-ups based on risk factors and comorbidities.