Gastric carcinoma is one of the most lethal malignancies in the world, primarily because of a late diagnosis. Male gender, cigarette smoking, a positive family history, and older age are principal risk factors. Only mild symptoms of dyspepsia and abdominal pain are usually seen in the early stages. Imaging studies including computed tomography, but more importantly, endoscopy with biopsy and histopathological examination, are necessary to make the diagnosis.
Gastric carcinoma, although rarely encountered in the western world (a little over 26,000 cases are estimated in the United States in 2016), is one of the most common cancers worldwide, as a very high number of cases is seen in South America, Eastern Europe, and Eastern parts of Asia   . In fact, almost 1,000,000 people are diagnosed each year, with more than 730,000 deaths, making it the second most common cause of death due to a malignant disease   . One of the reasons for such a poor prognosis is the insidious clinical presentation, particularly in the early stages of the disease. Dyspepsia is the principal complaint, which may be accompanied by mild and nonspecific abdominal pain, weight loss, and/or anorexia . In the presence of larger tumors that obstruct normal passage of food or impair normal stomach function, nausea, vomiting, and early satiety might be reported, whereas hematemesis, melena, and possibly severe hemorrhage appear when ulceration of the tumor occurs . Several risk factors have been established, such as male gender (male-to-female ratio ranging from 2-12:1), cigarette smoking, excess alcohol consumption, as well as genetic factors (a positive family history), Helicobacter pylori infection, and previous radiation   . Furthermore, gastric carcinoma of the cardia region is associated with obesity and gastroesophageal reflux disease (GERD) .
The nonspecific presentation and insidious course of gastric carcinoma make early recognition rather difficult. Nevertheless, the role of the physician in making the initial assumption through a detailed patient history and a complete physical examination is essential. In the presence of dyspepsia and associated gastrointestinal complaints in older individuals (particularly over 55 years of age), gastric carcinoma must be excluded . Thus, the employment of imaging studies is the next step in the workup. Many authors have agreed that upper gastrointestinal tract endoscopy is the cornerstone when it comes to gastric carcinoma, and the technique is widely recommended for both screening and diagnostic purposes  . An additional benefit of upper endoscopy is that it provides the ability to obtain a biopsy sample that will, after histopathological examination, confirm gastric carcinoma. As the treatment strategy (but also the prognosis) depends on the tumor stage, the extent of tumor invasion and dissemination must be assessed as well . Various techniques have been described, but the use of computed tomography (particularly multiple detector CT -MDCT) in the evaluation of the pelvis, abdomen, and chest for the nodal or metastatic spread is the gold standard  . Laparoscopy is also described as a tool for investigating the degree of local invasion and determining optimal treatment strategy .