Staging of gastric cancer. A 73 year old man underwent EGD for gastroesophageal reflux disease. It revealed a 3 cm antral mass; biopsies were positive for cancer. He was referred to our center for tumor staging. It consisted of a CT scan to rule out metastasis and an EUS for locoregional staging. Let us look at the CT scan first. As you can see here, there is an antral nodular mass on CT scan. On endoscopy, a nodular ulceratd mass was noted with folds converging to the mass. Biopsies were taken and subsequently an EUS was performed with a radial echoendoscope under water immersion. Gently scan the lesion and try to get perpendicular images. Let us look at the EUS in detail. As you scan, initially, we saw, a tumor stage of T1b. This is confined to the mucosa and submucosa. As we gently scan further making smaller movements, here is a tumor stage T2, with tumor invading the muscularis propria. On further scanning, we got the accurate staging of this tumor. This is tumor stage T3 with tumor penetrating the serosa. You can appreciate the pseudopodia. In summary, we have shown an EUS staging of gastric cancer T3.
Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Muslim Atiq, MD, MD Anderson Cancer Center
Jeffrey H. Lee, MD, MD Anderson Cancer Center