Stomach Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is stomach cancer found?

If you have any of the symptoms of stomach cancer, you should see your doctor, who will examine you and may order some tests.

Medical history and physical exam

Your doctor will ask you questions about your health and symptoms and do a complete physical exam. The doctor will feel your belly (abdomen) to see if there are any abnormal changes.

If your doctor thinks you might have stomach cancer or another type of stomach problem, he or she will refer you to a gastroenterologist, a doctor who with special training in diseases of the digestive tract, who will examine you and do further testing.

Tests to look for stomach cancer and its spread

Upper endoscopy

In this test, drugs are used to make you sleepy and then a thin, flexible, lighted tube with a tiny video camera on the end (called an endoscope) is put down your throat and into the stomach. This allows the doctor to see the lining of the esophagus, stomach, and the first part of the small intestine. If anything does not look normal, a tissue sample (biopsy) can be taken out through the tube. These samples are sent to a lab, where they are looked at under a microscope to see if cancer is present and, if so, what type of cancer it is.

Upper GI (gastrointestinal) series

This is a type of x-ray test. You drink a chalky liquid that contains barium. The barium coats the lining of the esophagus, stomach, and first part of the small intestine and x-rays are taken. Because x-rays can’t pass through the coating of barium, anything that isn’t normal in the lining of these organs will be outlined. X-rays are then taken. Sometimes, after the barium is swallowed, a thin tube is passed into the stomach and air is pumped in. This makes the barium coating very thin so that even small areas of change will show up. This test is not used as often as endoscopy to look for stomach cancer.

Endoscopic ultrasound (EUS)

In an ultrasound, sound waves are used to make pictures of organs inside the body. Ultrasound can be done with a probe put down the throat into the stomach during endoscopy. It lets the doctor look at the layers of the stomach wall, as well as the nearby lymph nodes and other structures just outside the stomach.

EUS is most useful in seeing how far a cancer may have spread into the wall of the stomach, to structures just outside the stomach, and to nearby lymph nodes. It can also be used to help guide a biopsy needle to get a tissue sample.

Biopsy

The only way to tell for sure if something is really cancer is by removing a sample of tissue or cells and looking at it under a microscope to see if it contains cancer cells. This is called a biopsy. Biopsies for stomach cancer are most often done during endoscopy, but they can also be done during endoscopic ultrasound.

Biopsies may also be taken from places where the cancer might have spread, such as nearby lymph nodes, the liver, or other parts of the body.

CT scan (computed tomography)

This test uses a special x-ray machine that takes pictures from many angles. A computer then combines these pictures into images of slices of the part of your body being studied. CT scans are not good at finding early stomach cancers, but they can help find areas where it can spread such as the liver and nearby lymph nodes.

A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle “hole.” You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

You may be asked to drink 1 or 2 pints of a contrast solution and/or have an IV (intravenous) line through which you get a contrast dye. This can cause some flushing (redness and warm feeling). Some people are allergic and get hives, or — rarely — reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or ever had a reaction to any dye used for x-rays.

CT scans can also be used to guide a biopsy needle into a place that might have cancer. The patient stays on the CT scanning table while a doctor moves a biopsy needle through the skin toward the tumor. A small piece of the tumor is removed and looked at under a microscope.

MRI scan (magnetic resonance imaging)

Like CT scans, MRIs give doctors cross-section pictures of the body. But MRIs use strong magnets instead of x-rays. Sometimes a contrast dye might be used. This is different than the one used for CT scans, so being allergic to one does not mean you are allergic to the other. Most doctors prefer to use CT scans to look at the stomach, but sometimes an MRI can give more information. MRIs are often used to look at the brain and spinal cord.

MRI scans take longer than CT scans, often up to an hour. You may have to lie inside a narrow tube, which can upset some people. Special, open MRI machines can sometimes help with this, but the images they make may not be as clear. The MRI machine makes loud thumps and buzzes. Some places will give you headphones to block this noise out.

PET scan (positron emission tomography)

For this test, a special kind of radioactive sugar is put into your vein. Over time the sugar collects in places that have cancer. After about an hour, you are moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates pictures of the whole body.

Often a PET scan and CT scan are done at the same time. A combined PET/CT scan can be more helpful than a plain PET scan in looking for spread for stomach cancer.

Laparoscopy

This test may be done after cancer is found to help see if the cancer has spread in the belly. It is done in an operating room while you are in a deep sleep (under general anesthesia). A thin, flexible tube with a camera on the end is placed into your belly through a small cut (incision). It sends a picture of the organs inside of the abdomen to a video screen. The doctor can also take biopsy samples from any areas that don’t look normal. The doctor can use this test before surgery to see whether all of the cancer can be removed.

Lab tests

These may include a blood test called a complete blood count (CBC) to look for anemia (a low red blood cell count that may be caused by bleeding), blood chemistry tests to look for signs of cancer spread to the liver, and a fecal occult blood test, which looks for small amounts of blood in the stool.

If cancer is found, the doctor may want to do other tests, especially if you are going to have surgery. For instance, blood tests can be done to make sure your liver and kidneys are working well and your blood is clotting the way it should.


Last Medical Review: 05/27/2014
Last Revised: 05/27/2014