Diagnosis and staging

The development of cross-sectional radiology, ultrasound, CT, and MRI—together with the radiologist's ability to perform core biopsies or fine-needle aspiration cytology combined with use of endoscopy and biopsies or cytological brushing, allows pre-operative diagnosis to be made in most cases.

A significant advance in reducing unnecessary suffering for patients has been the use of these procedures to stage accurately cancers prior to surgery. This has been most important where surgical treatment carries significant morbidity and mortality, such as in major resection of the stomach or oesophagus.

The approach should be to establish a histological diagnosis by endoscopic biopsy with radiological staging, using a combination of endoscopic ultrasound, CT, or MRI. A useful adjunct to this is laparoscopy that will detect small peritoneal or liver metastases and is helpful in determining fixation. Using these methods, the numbers of 'open and close' laparotomies for unresectable cancer can be reduced to <5%, avoiding unnecessary surgery for patients at a disease's terminal stage.

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