MRCP2-1831

MRCP2-1831

A 67-year-old woman has been referred by her General Practitioner for routine upper gastrointestinal endoscopy due to persistent epigastric discomfort induced by eating. Helicobacter pylori testing was negative and there was no dysphagia, vomiting or weight loss. The patient takes ibuprofen as required for osteoarthritis and drinks 20-25 units of alcohol per week. Clinical examination was unremarkable. At endoscopy, a generalised mild gastritis was found and biopsies were taken from a 1.5 cm diameter non-ulcerated lesion noted at the fundus. The results of histology and further investigations subsequently requested are listed below.

Histology: sample of gastric mucosa exhibiting moderately differentiated adenocarcinoma without involvement of sub-serosal connective tissue

CT abdomen: no gastric mass or ulceration identified; no evidence of abdominal lymph node enlargement; liver, gallbladder, spleen and kidneys unremarkable.

PET: no evidence of distant metastasis or nodal involvement

Staging laparoscopy: no evidence of peritoneal or metastatic disease

What is the appropriate treatment for this patient’s gastric carcinoma?