Stomach Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is stomach cancer found?

Screening is the search for a disease like cancer in people without symptoms. Because stomach cancer is not that common in the United States, mass screening for the disease has not been found to be useful. But people at high risk should talk to their doctors about the value of screening.

People who have stomach cancer rarely have symptoms in the early stages of the disease. This is one of the reasons why stomach cancer is so hard to find early. The signs and symptoms of this cancer can include:

  • No desire to eat (poor appetite)
  • Weight loss (without trying)
  • Pain in the area of the stomach (abdominal pain)
  • Vague discomfort in the abdomen (belly), often above the navel
  • A sense of fullness just below the chest bone after eating a small meal
  • Heartburn or indigestion
  • Nausea
  • Vomiting, with or without blood
  • Swelling or fluid build-up in the abdomen

Of course, many of these symptoms can be caused by problems other than cancer. But if you have any of these problems and they don’t go away or get worse, you should see a doctor so the cause can be found and treated.

Medical history and physical exam

If there is any reason to suspect stomach cancer, your doctor will ask you questions about your health, risk factors, 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 that may be done to find stomach cancer

Upper endoscopy: In this test, drugs are used to make the patient sleepy and then a thin, flexible, lighted tube with a tiny video camera on the end (called an endoscope) is put down the throat. Through the tube, the doctor can 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.

Biopsy: The only way to tell for sure if something is really cancer is by doing a biopsy. To do this, the doctor removes a sample of the tissue that doesn’t look normal. This sample is sent to a lab to be looked at under a microscope. Biopsies for stomach cancer are most often done during endoscopy.

Some stomach cancers are deep within the stomach wall, which can make them hard to biopsy with standard endoscopy. If the doctor suspects cancer might be deeper in the stomach wall, endoscopic ultrasound (described below) can be used to guide a thin, hollow needle into the wall of the stomach to get a biopsy sample.

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

Upper GI (gastrointestinal) series: This is a type of x-ray test. It is not used as often as endoscopy to look for stomach cancer. People having this test drink a chalky liquid that contains barium. The barium coats the lining of the esophagus, stomach, and first part of the small intestine. 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.

Endoscopic ultrasound (EUS): In an ultrasound, sound waves are used to make pictures of organs inside the body. Most people know about ultrasound because it is used to get a picture of the baby before birth. Ultrasound can also 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.

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. The CT scan can help show where stomach cancer is and can also show the organs near the stomach, such as the liver, as well as lymph nodes and distant organs where cancer might have spread.

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 just as with CT scans. 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. 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 a pictures. PET is sometimes useful if your doctor thinks the cancer might have spread but doesn’t know where. The picture is not as detailed as a CT or MRI scan, but it can show the whole body.

Some machines can do both a PET and CT scan at the same time (PET/CT scan). This can be helpful in some cases. For instance, it may help show if the cancer has spread beyond the stomach to other parts of the body, in which case surgery might not be a good treatment option.

Chest x-ray: This test can be used to tell whether the cancer has spread to the lungs. It may also be useful to find out if you have any lung or heart problems. This test is not needed if a CT scan of the chest has been done.

Laparoscopy: This test may be done after cancer is found to help see how far the cancer has spread. It is done in an operating room with the patient 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. You may also have an electrocardiogram (EKG) or other tests to make sure your heart is working well.

Last Medical Review: 03/18/2013
Last Revised: 02/11/2014