Gastric cancer & GIST
Surgery for tumours of the stomach — from gastric cancer to gastrointestinal stromal tumours (GIST) — through a minimally invasive approach, with lymphadenectomy to international standards and integration into a treatment plan coordinated with oncology.
Two different diseases of the stomach
Two types of tumour develop in the stomach and are treated differently. Gastric cancer (most commonly adenocarcinoma) arises from the lining of the stomach and usually requires an extensive operation, removing the surrounding lymph nodes.
Gastrointestinal stromal tumours (GIST) are a distinct type, arising from the muscular wall of the digestive tract. They behave and are treated differently: often it is enough to remove the tumour with a safe margin, without extensive lymphadenectomy, and targeted drug therapy plays an important role.
The distinction is made by biopsy and analysis under the microscope. That is why the first step — endoscopy with tissue sampling — is essential: it establishes exactly what we are dealing with and the strategy to follow.
When to see a doctor
Stomach tumours can be silent for a long time. When they do appear, symptoms are often non-specific — all the more reason not to ignore them if they persist.
Upper abdominal pain
Persistent discomfort or pain in the upper abdomen.
Early satiety
Feeling full after small amounts of food, loss of appetite.
Nausea & vomiting
Persistent nausea, sometimes vomiting, especially after meals.
Difficulty swallowing
A sense that food gets stuck, in tumours of the upper stomach.
Anaemia & fatigue
Unexplained anaemia or black stools (a sign of digestive bleeding).
Weight loss
Losing weight with no obvious cause, over a short period.
Worth remembering: many of these symptoms resemble a simple “upset stomach” and often go unnoticed. If they persist for a few weeks — especially after age 45–50, or with anaemia or weight loss — an upper GI endoscopy provides a quick, reliable answer.
From suspicion to a clear plan
As with any digestive cancer, the strategy is set by a multidisciplinary team, after full assessment of the tumour type and the extent of disease.
Upper GI endoscopy
Directly visualises the inside of the stomach and allows biopsy — the step that confirms the diagnosis and distinguishes adenocarcinoma from GIST.
CT & endoscopic ultrasound
CT assesses spread and possible metastases; endoscopic ultrasound (EUS) gauges how deeply the stomach wall is involved — key for planning.
Molecular testing
Testing for HER2, MSI/dMMR status and, for GIST, KIT / PDGFRA mutations guides targeted drug therapy.
Multidisciplinary team
Surgeon, oncologist, gastroenterologist and radiologist together define the stage and sequence of steps, per international guidelines (ESMO, JGCA).
Surgery, tailored to the tumour
The extent of the operation depends on the location, size and nature of the tumour. The principle stays the same: complete removal, with safe margins, through the least invasive approach possible.
Subtotal or total gastrectomy
Removal of part or all of the stomach, depending on tumour location, with restoration of the digestive tract.
D2 lymphadenectomy
Systematic removal of the surrounding lymph nodes — the international standard that ensures the oncological quality of the operation.
Function-preserving resection
Removal of the tumour with a safe margin, avoiding rupture, often without the need for total gastrectomy — preserving as much stomach as possible.
Laparoscopic & robotic
Whenever oncologically appropriate, the operation is performed through small incisions, with less pain and faster recovery. About robotic surgery →
In locally advanced gastric cancer, surgery is usually part of a multimodal plan: chemotherapy before and after the operation (perioperative), to improve the chance of cure. For high-risk or advanced GIST, targeted drug therapy (tyrosine-kinase inhibitors) complements surgery. The sequence of steps is set individually by the multidisciplinary team.
Enhanced recovery (ERAS)
- Early mobilisation and gradual return to eating, with modern protocols.
- Controlled pain, with reduced need for opioids.
- Shorter hospital stay than open surgery.
- Nutritional counselling after gastrectomy, to adapt to the new anatomy.
- Scheduled follow-up, with a dedicated point of contact.
Risk factors to know
- Helicobacter pylori infection — a treatable risk factor for gastric cancer.
- Chronic atrophic gastritis and certain pre-cancerous changes of the lining.
- Smoking and a diet high in salt and smoked foods, low in fresh vegetables.
- Family history of gastric cancer or hereditary syndromes.
A persistent symptom deserves an endoscopy
Unlike colorectal cancer, gastric cancer has no population screening programme. That makes attention to symptoms doubly important.
If you have persistent digestive discomfort, early satiety, anaemia or a family history, an upper GI endoscopy — and, if needed, treatment of Helicobacter pylori — can make the difference between early and late detection.
Speak with a specialistHigh-volume digestive oncology surgery
Outcomes in gastric surgery depend directly on the team's experience and rigorous adherence to international oncological standards.
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The first step is a conversation.
International patients welcome. Begin with a remote second opinion — share your records and receive an honest assessment of your options.
Request a second opinion international@drvalentincalu.ro International office · Bucharest