title: Indian Council of Medical Research consensus document for the management of gastric cancer.
abstract: The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India.Evaluation of a patient with newly diagnosed gastric cancer should include essential tests: A standard white light endoscopy with multiple biopsies from the tumor for confirmation of the diagnosis, a computed tomography (CT) scan (multi-detector or helical) of the abdomen and pelvis for staging with a CT chest or chest X-ray, and complete blood counts, renal and liver function tests. Endoscopic ultrasonography/ magnetic resonance imaging/positron emission tomography-CT is not recommended for all patients.For early stage disease (IA/B, N0), surgery alone is recommended. The need for adjuvant treatment would be guided by the histopathological analysis of the resected specimen.For locally advanced stage (IB, N(+) to IIIC), neoadjuvant chemotherapy may be considered to downstage the disease followed by surgery. This may be followed by adjuvant chemotherapy (as part of the peri-operative chemotherapy regimen)Patients with stage IV/metastatic disease must be assessed for chemotherapy versus best supportive care on an individual basis.Clinical examination including history and physical examination are recommended at each follow-up visit, with a yearly CT scan of the chest, abdomen, and pelvis.HER2 testing should be considered in patients with metastatic disease.5-FU may be replaced with capecitabine if patients do not have gastric outlet obstruction. Cisplatin may be replaced with oxaliplatin in the regimens.
authors.affiliation: Department of Surgical Oncology, Kiran Mazumdar Shaw Cancer Centre, Narayana Health, Bangalore, India.
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.affiliation: Department of Medical Oncology, Kiran Mazumdar Shaw Cancer Centre, Narayana Health, Bangalore, India.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Sirohi
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Savio G
authors.initials: SG
authors.lastname: Barreto
authors.affiliation: Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Raju T
authors.initials: RT
authors.lastname: Chacko
authors.affiliation: Department of Surgical Oncology, Kiran Mazumdar Shaw Cancer Centre, Narayana Health, Bangalore, India.
authors.forename: Purvish M
authors.initials: PM
authors.lastname: Parikh
authors.affiliation: Department of Medical Oncology, Mizoram Sate Cancer Institute, Aizwal, Mizoram, India.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Pautu
authors.affiliation: Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: Supreeta
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of DDCN, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: Prachi
authors.initials: P
authors.lastname: Patil
authors.affiliation: Department of Radiotherapy, Yashoda Hospital, Hyderabad, Andhra Pradesh, India.
authors.forename: Srinivas C
authors.initials: SC
authors.lastname: Chilukuri
authors.affiliation: Department of Epidemiology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: B
authors.initials: B
authors.lastname: Ganesh
authors.affiliation: Indian Council of Medical Research, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Tanvir
authors.initials: T
authors.lastname: Kaur
authors.affiliation: Indian Council of Medical Research, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Shukla
authors.affiliation: Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Goura Shankar
authors.initials: GS
authors.lastname: Rath
keywords: Diagnosis; Indian Council of Medical Research; gastric cancer; guidelines; treatment