Review plan
The review plan is different for patients with different stages of gastric cancer. Patients with stage I-III gastric cancer are usually treated with radical aim such as surgery. The risk of recurrence is highest within 2 to 3 years after the end of treatment, and the risk of second primary tumor is also higher. Therefore, patients with stage I to III gastric cancer should have imaging examinations every 6 months for monitoring follow-up for 2 to 3 years after treatment to detect recurrence in a timely manner. After 2 years of treatment, patients should undergo annual imaging surveillance to detect new primary gastric cancer.
Follow-up schedule for patients with stage I gastric cancer
Follow-up schedule for patients with stage II gastric cancer
Note: Parentheses are optional depending on the patient’s condition, especially for patients with high-risk factors and those with H. pylori infection or precancerous lesions in the stomach, who may be reviewed more frequently, as appropriate, due to an elevated risk of recurrence.
Follow-up schedule for patients with stage III gastric cancer
Stage IV gastric cancer is incurable, and patients usually undergo chemotherapy, immunotherapy, or targeted therapy focused on prolonging survival and relieving symptoms. Because of the high risk of progression of advanced gastric cancer, systemic examinations and imaging assessments should be performed every 3 months after the end of treatment for early detection of tumor progression [1].
Follow-up schedule for patients with stage IV gastric cancer
Cautions
- Reviews should be performed as prescribed by the physician, at the time and in accordance with the items prescribed by the physician.
- At each review, bring the initial imaging and pathology reports, along with imaging films of all initial and most recent lesions (chest and whole abdomen CT films), and medical records such as treatment course notes.
- Describe any recent symptoms, especially new discomfort, such as abdominal pain, early satiety (feeling “full” when eating less than normal), poor eating, dark stools, weakness, pallor, and weight loss.
- Any psychological problems should also be described to your doctor.
- Keep a record, such as noting the time of the next review, precautions to take and symptoms that the doctor cautions need extra attention. If medication is required, record in detail the method of administration, duration of treatment, adverse effects and monitoring indicators.
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Indicators requiring special attention
General
Patients with gastric cancer need to have their weight measured regularly and report to their doctor if they experience significant weight loss or weakness or fever in a short period of time without obvious reasons.
Laboratory tests
Some patients with gastric cancer may suffer from malnutrition and anemia due to the disease and treatment, and chemotherapy can also cause adverse effects such as anemia, leukopenia, and liver and kidney impairment. After treatment, blood tests, liver and kidney function, vitamin B12, folic acid, and iron should also be reviewed periodically to understand treatment complications and recovery of organ function.
- Blood tests to be alert for bone marrow suppression
If the report shows white blood cells <3.0×109/L, hemoglobin <90 g/L, and platelets <75×109/L, there is a possibility of bone marrow suppression or other abnormalities.
Bone marrow suppression is a common adverse effect of chemotherapy in patients with gastric cancer. Patients often experience varying degrees of hemoglobin, white blood cell, or platelet reduction, and bone marrow suppression not only delays chemotherapy, thereby affecting the therapeutic effect, but may also lead to life-threatening complications. Therefore, once the possibility of bone marrow suppression is detected, the doctor needs to be contacted for treatment at the first opportunity.
- Blood tests, beware of anemia and malnutrition following you
Because of poor appetite and malabsorption of vitamins, iron, and other hematopoietic materials after major gastrectomy, many patients with gastric cancer develop anemia and malnutrition, so it is necessary to have regular lab tests for vitamin B12 and iron levels in addition to blood work. If the report shows lower than normal levels of vitamin B12 and iron, the doctor should be informed promptly and should be supplemented promptly through diet and supplements.
- Liver and kidney function tests to prevent liver and kidney function impairment
Abnormal elevations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin, as well as blood creatinine above the upper limit of normal, on liver and kidney function tests should alert you to the presence of treatment-related liver and kidney impairment and require prompt consultation with your doctor for further testing.
- Tumor marker values to watch
Patients with gastric cancer need to be tested for gastric cancer tumor markers, such as carcinoembryonic antigen (CEA), glycoantigen 19-9 (CA19-9), and glycoantigen 72-4 (CA72-4), which correlate with tumor disease and may indicate tumor recurrence when elevated. However, it is worth noting that sometimes infection, inflammation, drugs and other factors can also cause tumor markers to rise. Therefore, once there is a sudden and rapid rise in indicators, you should inform your doctor in time and perform imaging examinations in time to exclude recurrence of metastasis, which is the means to determine whether there is recurrence.
Imaging
Patients with gastric cancer should have regular review of whole abdomen CT and chest CT to detect tumor recurrence and metastasis in a timely manner. If the report suggests abnormal changes in the residual stomach, enlargement of the original lesion or new lesions and other abnormalities, you should promptly ask your doctor to review the films to clarify the nature of the lesions and to determine whether the tumor has recurred and metastasized.
Gastroscopy
The role of gastroscopy in the post-treatment review of patients with gastric cancer is controversial. It is generally accepted that review should be noted at the initial diagnosis or 1 to 1.5 years after surgery for timely detection of tumor recurrence or heterochronic second gastric cancer (second gastric cancer is different from recurrence in that it refers to a second cancer in the stomach, and the stomach is an organ prone to second cancers), especially in patients with residual stomach, H. pylori infection, and precancerous lesions in the stomach, and should be reviewed at the onset of clinical symptoms.
It is important to note that some novel circulating markers, such as circulating tumor cells and free DNA, have not been recommended by guidelines for follow-up surveillance of gastric cancer, so self-examination is not necessary and should follow the guidance of your physician.