Gastric cancer treatment depends on histology, exact tumor location, depth of invasion, lymph-node and distant stage, resectability, molecular findings, nutritional status and previous treatment. German university centers publish pathways ranging from endoscopic removal of carefully selected superficial lesions to perioperative systemic treatment and subtotal or total gastrectomy with lymph-node surgery. Advanced disease can require biomarker-informed systemic oncology. International patients should send the complete gastroscopy, pathology and current staging before requesting one operation or drug regimen.
Confirm gastric adenocarcinoma and the histologic subtype
Heidelberg emphasizes that a gastric malignancy must be distinguished from other stomach tumors such as lymphoma, while Charité describes intestinal, diffuse and mixed gastric-cancer histologies. The full biopsy pathology should therefore be reviewed before a treatment sequence is chosen, especially when signet-ring or diffuse features are reported.
Staging should precede the treatment proposal
Gastroscopy with biopsy establishes the diagnosis, while endoscopic ultrasound and CT are central to defining local depth, nodal involvement and distant disease. Heidelberg also describes additional imaging or staging laparoscopy in selected cases. The German team should first reconstruct the stage before deciding whether an endoscopic, surgical, perioperative or systemic pathway is appropriate.
Selected superficial tumors can be treated endoscopically
Heidelberg and Freiburg document endoscopic removal for carefully selected early gastric cancers limited to superficial layers. This is an organ-preserving specialist pathway with strict pathology criteria and should not be assumed appropriate simply because the tumor is small on imaging.
More advanced resectable tumors often need perioperative treatment
Freiburg documents preoperative chemotherapy for more advanced gastric cancers before surgical removal, while Heidelberg describes multidisciplinary treatment planning across gastroenterology, surgery, oncology and radiation medicine. The systemic-treatment phase and operation should therefore be considered one coordinated pathway rather than independent services.
Subtotal or total gastrectomy depends on location and extent
Heidelberg describes partial or complete removal of the stomach with regional lymph-node surgery according to tumor location and spread. Freiburg likewise documents operative removal after pre-treatment for appropriate advanced tumors and reconstruction of the gastrointestinal passage. The exact operation should be defined from imaging, endoscopy and pathology before travel.
Nutrition is part of the cancer pathway
Freiburg specifically documents specialist nutrition support after gastric surgery because patients can initially tolerate only smaller meals. Weight loss and reduced intake may already be present before treatment, so international planning should include nutritional assessment before chemotherapy or gastrectomy and a realistic post-discharge eating plan.
Advanced disease needs current biomarker-informed oncology review
Modern gastric-cancer systemic treatment can depend on histology, previous therapy and tumor biomarkers. Because approvals and evidence change, patients should send existing molecular or biomarker reports and obtain a current specialist recommendation rather than relying on a fixed online regimen list.
Records to send before travelling
A useful upper-GI oncology review should allow the German team to verify pathology, stage, resectability and nutritional risk before proposing treatment.
- Gastroscopy report with exact tumor location and extent
- Biopsy pathology including histologic subtype
- Pathology slides or blocks if expert review is requested
- Endoscopic ultrasound report when performed
- Current CT chest/abdomen and other staging images in DICOM format
- Staging laparoscopy findings if already performed
- Existing molecular or biomarker testing
- Previous chemotherapy, surgery or radiation details
- Recent weight history, swallowing/eating problems and nutrition support
- Current medication and major medical conditions
- A clear question about endoscopic treatment, gastrectomy, perioperative therapy or second opinion
Plan recovery and long-term follow-up before returning home
After gastrectomy, patients can need gradual dietary adaptation, vitamin or micronutrient monitoring, pathology review and oncologic surveillance. Clarify how long the patient should remain near the center after discharge and which nutrition, laboratory and cancer follow-up can be transferred to the home-country team.
Sources and review
This guide was last source-reviewed on 2026-08-30.
- Gastric carcinoma – diagnosis, staging and treatment — Heidelberg University Hospital ↗
- Malignant gastric tumor – surgery and endoscopic treatment — Heidelberg University Hospital ↗
- Esophagus and stomach surgery – gastric tumors — University Medical Center Freiburg ↗
- Center for Gastrointestinal Tumors — University Medical Center Freiburg ↗
- Gastric cancer – diagnosis and staging — Charité – Universitätsmedizin Berlin ↗