Stomach cancer, also called gastric cancer, accounts for roughly 60,000 new diagnoses and 53,000 deaths in India every year according to GLOBOCAN 2022, and the ICMR National Centre for Disease Informatics and Research now records a steady rise in cases among men over fifty in the Delhi NCR registries. The single variable that decides whether a patient ends up under an endoscopist for a curative submucosal dissection, under a surgical oncologist for a perioperative FLOT and D2 gastrectomy, or under a medical oncologist for first-line nivolumab plus chemotherapy is the stage at diagnosis. This page explains how stomach cancer is staged at leading cancer centres in the region Saket, a leading cancer centre and a leading cancer centre using the AJCC TNM 8th edition, what each subtype means biologically, what every stage looks like clinically, and what NCR families can expect at each step. (See the GLOBOCAN India fact sheet and NCI PDQ on gastric cancer treatment.)
What Stomach Cancer Staging Actually Means
Staging in stomach cancer is the formal exercise of measuring how deep the gastric tumour has grown into the wall of the stomach, how many regional lymph nodes around the lesser and greater curvature it has reached, and whether it has seeded the peritoneum, the liver, the ovaries, the supraclavicular nodes or any other distant site. The stage is built from three pieces of information: the depth of mural invasion (T), the number of involved regional nodes (N) and the presence or absence of distant metastases (M). Unlike pancreatic or oesophageal cancer, gastric cancer at a tertiary cancer centre, a tertiary cancer centre and every NCCN-aligned NCR hospital uses one shared anatomic system, the AJCC/UICC TNM 8th edition, so a stage IIIB gastric cancer reported at a leading cancer centre means the same thing as a stage IIIB reported at a leading cancer centre. (See the UICC TNM resources.)
Why Gastric Cancer Uses TNM 8 With Clinical, Pathological and ypTNM Groups
The 8th edition of TNM, in use across Indian gastric cancer practice since 2017, is the first to formally separate clinical (cTNM), pathological (pTNM) and post-neoadjuvant (ypTNM) stage groupings for stomach cancer. This separation matters because perioperative FLOT chemotherapy is now the default for any T2 or higher resectable gastric tumour, which means the pathological stage on the resected specimen has already been altered by chemotherapy and is no longer comparable to the pre-treatment clinical stage. a tertiary cancer centre, a tertiary cancer centre and the NCR tumour boards record cTNM at the multidisciplinary meeting after staging laparoscopy, then ypTNM after the gastrectomy specimen is reported, and use the two together to decide on adjuvant FLOT completion. (See the NCI PDQ Gastric Cancer Treatment and ESMO gastric cancer guidelines.)
Adenocarcinoma Dominates: WHO 5th Edition Stomach Cancer Histologic Subtypes
More than 90 to 95 percent of stomach cancers are adenocarcinomas arising from the gland-forming cells of the gastric mucosa. The 2019 WHO Classification of Tumours of the Digestive System, 5th edition, divides gastric adenocarcinoma into tubular, papillary, mucinous, poorly cohesive (including the signet-ring cell variant), mixed, and rare patterns such as hepatoid, micropapillary and gastric carcinoma with lymphoid stroma, the last of which is usually Epstein-Barr virus associated. a tertiary cancer centre pathology, leading cancer centres Lab and a leading cancer centre histopathology all report under this WHO 5 framework, with the histological subtype written into every gastric biopsy and gastrectomy report because tubular and papillary patterns behave differently from poorly cohesive signet-ring tumours that often present as linitis plastica. (See the IARC WHO Classification of Digestive System Tumours.)
Lauren Classification: Intestinal Versus Diffuse Gastric Cancer
Indian gastric pathologists at a tertiary cancer centre and a tertiary cancer centre still record the Lauren classification on every adenocarcinoma report alongside the WHO subtype, because intestinal and diffuse gastric cancer behave like two distinct diseases. Intestinal-type gastric cancer is better differentiated, more often distal in the antrum, linked to Helicobacter pylori chronic gastritis with intestinal metaplasia, and more common in older men. Diffuse-type gastric cancer is poorly cohesive, commonly signet-ring, more often proximal or presenting as linitis plastica, more common in younger women, and is the histology associated with the hereditary CDH1 germline syndrome. The Lauren split drives surgical planning at a tertiary cancer centre and the NCR cancer boards because diffuse tumours need wider proximal margins and a lower threshold for total gastrectomy. (See the a tertiary cancer centre Evidence Based Management of Cancers in India, gastric chapter.)
TCGA Molecular Subtypes: EBV, MSI-H, Genomically Stable and CIN Stomach Cancer
Beyond histology, The Cancer Genome Atlas defined four molecular subtypes of gastric adenocarcinoma in its landmark 2014 Nature paper, and these now guide treatment decisions at leading cancer centres in the region and every major NCR cancer hospital. The Epstein-Barr virus positive subtype carries PIK3CA mutations and high PD-L1 expression and responds well to immune checkpoint inhibition. The microsatellite instability high (MSI-H/dMMR) subtype carries a high tumour mutational burden, often in older patients with antral tumours, and responds dramatically to immunotherapy. The genomically stable subtype is enriched for diffuse and signet-ring histology with CDH1 and RHOA mutations. The chromosomal instability subtype is the largest group, often intestinal-type, and contains the HER2-amplified tumours that are eligible for trastuzumab. (See TCGA, Nature 2014.)
Non-Adenocarcinoma Stomach Tumours: GIST, Gastric NET and MALT Lymphoma
Not every malignant lesion in the stomach is an adenocarcinoma and the alternatives travel completely different treatment pathways. Gastrointestinal stromal tumours (GIST) of the stomach arise from interstitial cells of Cajal, are KIT or PDGFRA driven on NGS, and are treated with imatinib and successor TKIs at leading cancer centres in the region and the major NCR centres rather than with FLOT chemotherapy. Gastric neuroendocrine tumours are categorised as Type 1 (chronic atrophic gastritis associated, indolent), Type 2 (Zollinger-Ellison associated), Type 3 (sporadic, more aggressive) and gastric neuroendocrine carcinoma which is treated like small cell lung cancer with platinum-etoposide. Primary gastric MALT lymphoma is almost always H. pylori driven and frequently regresses with eradication therapy alone, while gastric diffuse large B-cell lymphoma goes to R-CHOP. Each is flagged on the histology report and routed away from the gastric adenocarcinoma pathway. (See the ESMO GIST and gastric NET guidelines.)
The T Descriptor in Gastric Cancer: Tis Through T4b
The T category in gastric TNM 8 reflects the depth of invasion through the wall of the stomach. Tis is high-grade dysplasia or carcinoma in situ confined to the epithelium with no breach of the lamina propria. T1a invades the lamina propria or muscularis mucosae and T1b invades the submucosa, and together these two define early gastric cancer. T2 invades the muscularis propria, T3 penetrates the subserosal connective tissue without breaching the visceral peritoneum, T4a perforates the serosa, and T4b directly invades adjacent structures such as the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal, kidney, small bowel or retroperitoneum. NCR surgical oncologists at leading cancer centres in the region report the T category from a combination of high-definition endoscopy, endoscopic ultrasound and contrast CT before any decision on surgical resectability. (See the NCI PDQ T staging tables.)
Early Gastric Cancer: T1a Versus T1b and ESD Eligibility
Early gastric cancer means a T1 tumour confined to the mucosa or submucosa, regardless of nodal status, and is the only group eligible for endoscopic submucosal dissection (ESD) as a curative organ-sparing treatment. The expanded Japanese Gastric Cancer Association criteria, used at a tertiary cancer centre, GB Pant, ILBS, a leading cancer centre and a small number of high-volume NCR private endoscopy units, accept ESD for differentiated mucosal cancers up to 2 cm without ulceration, larger differentiated mucosal cancers without ulceration, smaller ulcerated differentiated mucosal cancers, and selected very superficial submucosal lesions. Poorly differentiated histology, deep submucosal invasion, lymphovascular invasion and ulcerated tumours larger than 3 cm push the patient out of ESD and into a formal D2 gastrectomy pathway. After curative ESD, surveillance endoscopy is performed at three, six and twelve months and then annually, and any residual H. pylori infection is eradicated. (See the Japanese Gastric Cancer Association 2021 guidelines.)
The N Descriptor: Why 16 Lymph Nodes Are Required for pN
Nodal staging in stomach cancer is unusually demanding because the AJCC requires a minimum of 16 examined regional lymph nodes (and ideally more than 30) for an accurate pN assignment, which is the formal rationale for D2 lymphadenectomy at high-volume centres. N0 is no involved nodes, N1 is 1 to 2 positive nodes, N2 is 3 to 6, N3a is 7 to 15 and N3b is 16 or more. A D1 dissection that yields only 8 or 10 nodes systematically understages the patient and was the main statistical reason the older Macdonald INT-0116 trial appeared to favour postoperative chemoradiotherapy on inadequately dissected specimens. leading cancer centres a leading cancer centre and a leading cancer centre all routinely report 25 to 35 nodes per gastrectomy specimen and use this to drive accurate adjuvant chemotherapy decisions. (See the Songun et al. 15-year Dutch D1D2 follow-up, Lancet Oncol 2010.)
The M Descriptor: Peritoneum, Krukenberg, Virchow and Sister Mary Joseph
The M category in gastric cancer is anatomically broader than in many other tumours because the stomach drains into the peritoneal cavity, the portal venous system and a long chain of lymph nodes that runs all the way to the left supraclavicular fossa. M0 is no distant metastases. M1 covers any distant spread, including non-regional lymph nodes, peritoneal carcinomatosis (with positive peritoneal cytology classified as M1 even without macroscopic deposits), liver, lung, bone, and the classical clinical signs of advanced disease: a left supraclavicular Virchow node, a periumbilical Sister Mary Joseph nodule, a Blumer shelf on rectal exam, and a Krukenberg ovarian metastasis from signet-ring spread in women. Diffuse linitis plastica with rapid weight loss and a rigid stomach on imaging often represents occult peritoneal disease and is one of the strongest indications for staging laparoscopy before any attempted resection. (See the a tertiary cancer centre gastric cancer chapter.)
Silent Early Symptoms: Why Stage 0 and Stage I Stomach Cancer Are Missed
Early stomach cancer is famously silent. Stage 0 (carcinoma in situ) and stage IA disease are usually picked up incidentally on an upper GI endoscopy done for dyspepsia, an iron-deficiency anaemia work-up or H. pylori testing in a relative of an index patient. When symptoms do appear in stage I and stage II disease they are routinely mistaken for ordinary acidity: persistent upper abdominal discomfort, early satiety, mild nausea, intermittent vomiting and unexplained iron-deficiency anaemia in a man over fifty. NCR gastroenterologists at a tertiary cancer centre, GB Pant, a leading cancer centre, a leading cancer centre Saket, a leading cancer centre and a leading cancer centre have repeatedly flagged the pattern of patients self-medicating with proton pump inhibitors for six to twelve months before any scope is done, by which point the index lesion is no longer T1. The a tertiary cancer centre and ESMO recommendation is unambiguous: any patient over forty in Delhi, Gurgaon or Noida with new dyspepsia plus one alarm feature should be scoped without a PPI trial. (See the ESMO gastric cancer clinical practice guidelines.)
Stage III Gastric Cancer Red Flags: Weight Loss, Dysphagia and Melaena
Locally advanced stage III stomach cancer tends to produce more obvious red flags that finally bring patients to a tertiary endoscopy unit. Significant unintentional weight loss, defined as more than 5 percent of body weight in three months, is the most common single trigger. Progressive dysphagia, especially with proximal cardia tumours that involve the gastro-oesophageal junction, brings patients to ENT and gastroenterology clinics across NCR. Persistent vomiting, haematemesis or melaena from a bleeding ulcerated gastric tumour usually triggers an emergency upper GI endoscopy at GB Pant, leading cancer centres. A palpable epigastric mass on physical examination is a late finding. Gastric outlet obstruction from antral or pyloric tumours produces post-prandial vomiting of partially digested food and rapid sarcopenia, and is one of the strongest indicators of T3 or T4 disease. (See the a tertiary cancer centre gastric cancer evidence-based management chapter.)
Stage IV Gastric Cancer Presentations: Ascites, Linitis Plastica and Distant Spread
Stage IV (metastatic) stomach cancer presents in patterns that are almost diagnostic at the bedside. Ascites from peritoneal carcinomatosis, often with positive cytology on diagnostic paracentesis, is one of the most common presentations of advanced signet-ring gastric cancer in younger NCR women. A left supraclavicular Virchow node is a classical sign that the cancer has tracked along the thoracic duct. A periumbilical Sister Mary Joseph nodule, jaundice from porta hepatis nodal involvement, bone pain from vertebral metastases, and Krukenberg bilateral ovarian masses in women all point to disseminated disease. Diffuse linitis plastica, the Borrmann type 4 pattern, can present with rapid weight loss and a rigid, non-distensible stomach on CT without a single dominant exophytic mass and is one of the most aggressive subgroups managed at a tertiary cancer centre and a tertiary cancer centre. (See the NCI PDQ on metastatic gastric cancer presentations.)
Helicobacter pylori as the Dominant Risk Factor for Stomach Cancer
Chronic Helicobacter pylori infection is the single largest attributable risk factor for non-cardia gastric adenocarcinoma and is classified as a Group 1 human carcinogen by the IARC Monographs Volume 100B. H. pylori drives a multi-step cascade from chronic active gastritis through atrophic gastritis, intestinal metaplasia, dysplasia and finally invasive intestinal-type adenocarcinoma over decades. Indian seroprevalence remains high across all socioeconomic strata, and a tertiary cancer centre gastroenterology data show that test-and-treat strategies in first-degree relatives of index patients reduce metachronous gastric cancer after endoscopic resection. NCR gastroenterology units at a tertiary cancer centre, GB Pant, ILBS, a leading cancer centre and a leading cancer centre now offer urea breath testing or stool antigen testing as the first-line diagnostic for any patient with persistent dyspepsia and a family history of stomach cancer. (See the IARC Monograph 100B on H. pylori.)
Tobacco, Diet and Reflux: Lifestyle Drivers of Gastric Cancer in NCR
Tobacco in every form, including cigarettes, bidis, hookah and the smokeless gutkha, khaini and zarda preparations widely used across northern India, is an independent IARC Group 1 risk factor for stomach cancer. Dietary factors with consistent epidemiological evidence include high intake of salt-preserved foods, smoked and pickled foods, processed meats, and a low intake of fresh fruits and vegetables, all of which are common in the dietary patterns the a tertiary cancer centre preventive oncology unit records in NCR cancer registries. Obesity and gastro-oesophageal reflux disease are specifically linked to proximal cardia adenocarcinoma rather than to distal antral disease. Pernicious anaemia, prior partial gastrectomy more than 15 to 20 years earlier, Menetrier disease and chronic atrophic gastritis are recognised premalignant conditions that warrant surveillance endoscopy. (See IARC Monograph 100E on tobacco.)
Hereditary Stomach Cancer: CDH1, Lynch and the NCR Cancer Genetics Clinics
Hereditary syndromes account for a small but clinically critical fraction of stomach cancer cases and matter especially for younger NCR patients with diffuse-type or signet-ring tumours. CDH1 germline mutations cause hereditary diffuse gastric cancer and are managed with prophylactic total gastrectomy at expert centres after formal genetic counselling. Lynch syndrome (MLH1, MSH2, MSH6, PMS2 and EPCAM germline mutations), juvenile polyposis (SMAD4, BMPR1A), Peutz-Jeghers syndrome (STK11), Li-Fraumeni syndrome (TP53) and familial adenomatous polyposis all carry an elevated lifetime risk of gastric cancer and are flagged through the leading cancer centres cancer genetics clinics. Any NCR patient under fifty with diffuse or signet-ring gastric cancer, a strong family history of upper GI cancers, or bilobar lobular breast cancer in the family should be referred for germline testing. (See the NCCN gastric cancer genetics guidelines.)
Diagnosing Gastric Cancer: HD Endoscopy and Biopsy Protocol
The diagnostic pathway for suspected stomach cancer in NCR practice begins with upper gastrointestinal endoscopy performed by a trained gastroenterologist using a high-definition white-light scope, ideally with narrow-band imaging or chromoendoscopy to characterise subtle mucosal lesions and to map the extent of intestinal metaplasia. a tertiary cancer centre, GB Pant, ILBS, leading cancer centres Saket all run high-volume endoscopy units that follow the British Society of Gastroenterology and Japanese quality standards on examination time, photo-documentation and biopsy protocol. Any suspicious lesion is biopsied with at least six to eight forceps samples, and gastric ulcers are biopsied from both the edge and the base because early diffuse cancer can hide under apparently healed mucosa. Benign-looking ulcers in older patients are rebiopsied at follow-up endoscopy. (See the BSG quality standards for upper GI endoscopy.)
Reflex Biomarkers: HER2, MMR, PD-L1 CPS, Claudin 18.2 and EBV in Stomach Cancer
Reflex biomarker testing is now standard for every confirmed gastric adenocarcinoma at leading cancer centres in the region Saket and a leading cancer centre. HER2 IHC is performed on every adenocarcinoma with FISH reflex on 2+ cases, following the original ToGA trial protocol. Mismatch-repair protein IHC (MLH1, MSH2, MSH6, PMS2) is performed with reflex MSI PCR on equivocal cases. PD-L1 22C3 combined positive score is now the gating biomarker for first-line nivolumab plus chemotherapy. EBER in situ hybridisation tests for EBV in suspicious lymphoid stroma histology. Claudin 18.2 IHC using the 43-14A clone identifies tumours with greater than or equal to 75 percent of cells staining 2+/3+ that are eligible for zolbetuximab. NTRK IHC with NGS confirmation is added for very rare fusion-positive tumours. (See Bang et al, ToGA, Lancet 2010.)
Staging Workup: CECT, EUS, PET-CT and Staging Laparoscopy
Staging investigations in stomach cancer follow the NCCN, ESMO and a tertiary cancer centre pathway. Contrast-enhanced multiphase CT of the thorax, abdomen and pelvis is the workhorse and is performed at every NCR tertiary centre. Endoscopic ultrasound (EUS) is reserved for accurate cT and cN assessment of locally confined tumours being considered for endoscopic submucosal dissection and is available at a tertiary cancer centre, GB Pant, ILBS, leading cancer centres. FDG PET-CT is selectively used for cardia and proximal tumours, suspected distant metastases and post-chemotherapy response assessment, while accepting that diffuse and signet-ring tumours can be FDG non-avid. Diagnostic staging laparoscopy with peritoneal washings for cytology is recommended for every cT3-T4 or node-positive tumour considered for curative resection because radiologically occult peritoneal disease is found in 20 to 30 percent of these patients and changes the entire treatment plan. (See the NCCN Gastric Cancer Guidelines version 2.2024.)
Stage 0 and Stage IA Gastric Cancer: ESD as Curative Treatment
For Tis and T1a stomach tumours that are well or moderately differentiated, less than 2 cm, non-ulcerated and free of lymphovascular invasion, endoscopic submucosal dissection following the expanded Japanese Gastric Cancer Association criteria is curative and avoids gastrectomy entirely. ESD is offered at a tertiary cancer centre, GB Pant, ILBS, a leading cancer centre and a small number of high-volume NCR private endoscopy units that have built up adequate experience. Piecemeal endoscopic mucosal resection is reserved for very small lesions where en bloc ESD is not technically feasible. After curative ESD, surveillance upper GI endoscopy is performed at three, six and twelve months and then annually for at least five years, and any residual H. pylori infection is eradicated. Five-year survival after curative ESD for true early gastric cancer in expert hands at a tertiary cancer centre and GB Pant is in the 95 to 98 percent range, comparable to formal gastrectomy without any of its long-term nutritional cost. (See the Japanese Gastric Cancer Association 2021 treatment guidelines.)
Stage IB to IIIC Resectable Stomach Cancer: Perioperative FLOT and D2 Gastrectomy
For T1b and any T2 to T4a, N0 to N+, M0 stomach cancer, the standard of care across leading cancer centres leading cancer centres Saket, a leading cancer centre and a leading cancer centre is perioperative chemotherapy followed by radical gastrectomy with formal D2 lymphadenectomy, followed by completion of postoperative chemotherapy. The FLOT4 trial published by Al-Batran and colleagues in The Lancet in 2019 established perioperative FLOT (fluorouracil, leucovorin, oxaliplatin and docetaxel, four cycles before and four cycles after surgery) as superior to the older ECF/ECX regimen of the MAGIC trial for fit patients with adequate performance status and no significant cardiac or neuropathy contraindication. CAPOX or FOLFOX perioperative chemotherapy is used for patients who are not FLOT-eligible. Restaging CT and clinic review are done after the fourth pre-operative cycle. (See Al-Batran et al, FLOT4, Lancet 2019.)
Why D2 Lymphadenectomy at High-Volume NCR Centres Matters
Surgery for resectable stomach cancer is a total or subtotal (distal) gastrectomy depending on tumour location and the proximal margin requirement, with formal D2 lymphadenectomy as defined by the JCOG 9501 protocol and the Dutch D1D2 long-term follow-up trial. Hospital and surgeon volume are independent predictors of perioperative mortality and long-term survival, which is why leading cancer centres leading cancer centres run dedicated upper GI surgical oncology units that perform 50 or more gastrectomies per year. Open, laparoscopic and robotic D2 gastrectomies are all offered across NCR. The KLASS-02 and JLSSG0901 trials support laparoscopic D2 gastrectomy for locally advanced disease in expert hands, and leading cancer centres leading cancer centres all run robotic GI surgery programmes. (See Hyung et al, KLASS-02, JCO 2020.)
Locally Advanced and Borderline Resectable Stomach Cancer
For locally advanced borderline resectable disease, including bulky nodal disease and T4b tumours invading adjacent structures such as the pancreas, transverse colon or spleen, induction FLOT chemotherapy is used to attempt downstaging, with restaging CT and a second-look laparoscopy before any surgical attempt. The TOPGEAR trial reported that adding chemoradiotherapy to perioperative chemotherapy did not improve overall survival in resectable disease, so radiotherapy is not routinely added in 2026 NCR practice and is reserved for selected gastro-oesophageal junction tumours and palliative indications. For dMMR/MSI-high locally advanced gastric cancer, perioperative chemotherapy alone is associated with reduced benefit and the GERCOR NEONIPIGA trial showed high pathological complete response rates with neoadjuvant nivolumab plus ipilimumab, an approach now being adopted at a tertiary cancer centre and selected NCR units within trial frameworks. (See Andre et al, NEONIPIGA, JCO 2023.)
Metastatic Stomach Cancer First-Line: CheckMate 649 Nivolumab Plus FOLFOX
For metastatic and unresectable stomach cancer, treatment is biomarker-driven and follows a clear sequence at the major NCR units. First-line therapy for HER2-negative, PD-L1 CPS-positive disease is a fluoropyrimidine plus oxaliplatin (FOLFOX or CAPOX) combined with nivolumab, based on the CheckMate 649 trial published by Janjigian and colleagues in The Lancet, which showed an overall survival benefit for nivolumab plus chemotherapy in PD-L1 CPS greater than or equal to 5. Pembrolizumab plus fluoropyrimidine plus platinum is an alternative regulatory option following the KEYNOTE-859 trial. For dMMR/MSI-H or EBV-positive metastatic gastric cancer, single-agent or combination immune checkpoint inhibition is preferred based on KEYNOTE-158 and CheckMate 649 subgroup data. (See Janjigian et al, CheckMate 649, Lancet 2021.)
HER2-Positive Metastatic Gastric Cancer: ToGA, KEYNOTE-811 and Trastuzumab Deruxtecan
For HER2-positive (IHC 3+ or IHC 2+ with FISH amplification) metastatic gastric cancer, first-line therapy is trastuzumab plus a fluoropyrimidine plus platinum, the ToGA regimen that became standard of care after the original Bang et al Lancet 2010 trial. The KEYNOTE-811 trial published in Nature in 2021 supports adding pembrolizumab to trastuzumab and chemotherapy for HER2-positive PD-L1 CPS-positive disease. For HER2-positive gastric cancer that has progressed on trastuzumab, trastuzumab deruxtecan (T-DXd) is a category 1 option following the DESTINY-Gastric01 and DESTINY-Gastric02 trials and is available at leading cancer centres in the region leading cancer centres Saket, a leading cancer centre and a leading cancer centre through Daiichi-Sankyo and AstraZeneca named-patient pathways. (See Shitara et al, DESTINY-Gastric01, NEJM 2020.)
Claudin 18.2 and Zolbetuximab: SPOTLIGHT and GLOW in Gastric Cancer
For Claudin 18.2-positive (greater than or equal to 75 percent of tumour cells staining 2+ or 3+ on the 43-14A IHC clone), HER2-negative metastatic gastric cancer, the SPOTLIGHT and GLOW phase 3 trials demonstrated an overall survival benefit when zolbetuximab was added to mFOLFOX6 or CAPOX respectively. Zolbetuximab is being introduced at a tertiary cancer centre, a tertiary cancer centre and selected NCR private cancer hospitals through expanded access programmes in 2026. Claudin 18.2 is now part of the reflex biomarker panel on every new metastatic gastric adenocarcinoma at a tertiary cancer centre and a tertiary cancer centre. Second-line systemic therapy after a fluoropyrimidine and platinum is paclitaxel plus ramucirumab based on the RAINBOW trial, with weekly paclitaxel, docetaxel or irinotecan used when ramucirumab access is limited. Third-line options include trifluridine-tipiracil, regorafenib and clinical trial enrolment. (See Shitara et al, SPOTLIGHT, Lancet 2023.)
Cost of Stomach Cancer Care Across Delhi, Gurgaon and Noida
The cost of treating stomach cancer in Delhi NCR varies by hospital tier and by treatment intensity. Diagnostic upper GI endoscopy with biopsy ranges from roughly INR 3,000 at a tertiary cancer centre and government units to INR 12,000 to 20,000 at the major private hospitals. A complete staging workup including contrast CT, EUS, PET-CT and staging laparoscopy ranges from INR 60,000 to 1,80,000 depending on the hospital. A radical D2 gastrectomy package at private NCR centres including a leading cancer centre, a leading cancer centre leading cancer centres Saket, a leading cancer centre and a leading cancer centre ranges from approximately INR 3,50,000 to 7,50,000 inclusive of surgery, ICU stay and ward care; the same procedure at a tertiary cancer centre or a tertiary cancer centre under government tariffs is a fraction of that figure. Perioperative FLOT chemotherapy for eight cycles costs roughly INR 1,20,000 to 3,00,000 depending on supportive care and hospital tier. Ayushman Bharat PMJAY covers gastrectomy and chemotherapy packages for eligible patients at empanelled NCR hospitals. (See the PMJAY hospital empanelment portal.)
Stomach Cancer FAQs for NCR Patients and Families
Is every stomach ulcer a cancer? No. Most gastric ulcers in NCR are H. pylori or NSAID related and benign, but every gastric ulcer in a patient over forty must be biopsied from both the edge and the base, and rebiopsied at follow-up endoscopy until complete healing is documented. Can stomach cancer be cured? Yes, when it is found early. Stage 0 and stage IA gastric cancer treated with ESD or D2 gastrectomy at a tertiary cancer centre, a tertiary cancer centre or a high-volume NCR centre have five-year survival rates above 90 percent. Stage III disease treated with perioperative FLOT and D2 gastrectomy has cure rates in the 35 to 55 percent range. Stage IV is generally not curable but is highly treatable and patients with PD-L1 CPS positive or HER2 positive disease are now living substantially longer on first-line nivolumab plus FOLFOX or trastuzumab plus chemotherapy. Will I need a total gastrectomy? Not always. Distal antral tumours often allow a subtotal gastrectomy that preserves the upper stomach, while diffuse-type or proximal tumours typically need a total gastrectomy with Roux-en-Y reconstruction. What follow-up do I need after a curative gastrectomy? Three-monthly clinical review for two years, then six-monthly to year five, with CT scans, B12 and iron levels, and surveillance endoscopy as advised by your tumour board. (See the NCI PDQ on gastric cancer follow-up.)
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