Background: Cancer of the stomach carries poor prognosis. Prediction of survival depends on the time of presentation. Fluoroscopy, sonography, and computerized tomography are used for staging of advanced gastric cancers, but these are not accurate enough for grading of advanced gastric cancers.Laparoscopic finding in which lesions are directly seen up to 15 times magnified, has been used for gastric cancer staging.Method: To examine the importance of laparoscopy, we carried out this study over 84 confirmed cases of gastric cancer prior to laparotomy. Results of sonography and computerized tomography were compared with the findings of laparoscopies.Results: Beside 54 cases that were reported without metastases by sonography and computerized tomography, there were 34 patients with a variety of different metastases found in laparoscopic examinations. The fmdings were as follow:Multiple small foci in a liver lobe (four cases)Multiple small foci in two lobes (four cases)Characterized metastatic focus in one lobe (10 cases)Multiple foci in two lobes with multiple deposits in peritoneum (16 cases).Out of thirty patients who were suspected to have intra-abdominal metases or were reported to have some malignant lesions by sonography and computerized tomography, 20 patients (66%) had inoperable advanced lesions.Conclusion: Laparoscopic examination is a valuable tool for diagnosing metastases and should be used in management of advanced gastric cancers. This study suggests that in terminally ill patients, and in advanced gastric cancer where surgery may be ineffective, laparoscopic examination may predict and avoid unnecessary surgical interventions.

Ovarian cancer is the most lethal gynecological cancer and about 70% of the patients are advanced stagein the time of diagnosis. Decision about management (surgical debulking versus neoadjuant chemotherapy) in ovarian cancer patients is dependent on initial staging by abdominopelvic MDCT or MRI, so, Radiologist expertise on ovarian cancer staging is very important. Involvement of mesenteric root, peritoneal implante larger than 2 cm, lymphadenopathy superior to renal hilum and implants near hepatic veins are criteria for nonresectability of ovarian cancer and radiologist must be familiar and expert on the imaging protocol and findings on MDCT for ovarian cancer staging.

Hepatocellular carcinoma (HCC) is the fifth most common tumor in the world, and its incidence is increasing. It is second most common cause of cancer related death worldwide and fastest growing cause of cancer death in the United States. Cirrhosis is the most important clinical risk factor for HCC, with approximately 80% of cases of HCC developing in patients with a cirrhotic liver. HCC differs from most malignancies because it is commonly diagnosed on the basis of imaging features alone, without histologic confirmation. The prognosis of HCC depends largely on the stage at which the tumor is detected. The detection of HCC early in its development, therefore, is critical to improve the survival of affected patients. In this talk, we discuss surveillance strategies with ultrasonography (US) as the primary screening imaging test as well as current state of the art for the imaging-based diagnosis and staging of HCC.