Stomach cancer diagnosis and staging

Diagnosis

To properly diagnose stomach cancer, your provider will first take your medical history and perform a physical exam. This includes an assessment of symptoms, checking your overall health and feeling your abdomen for any abnormal changes. Then, if necessary, your doctor will refer you to a gastroenterologist, who specializes in diseases of the digestive tract.

Further diagnostic testing may include:

  • Upper endoscopy or esophagogastroduodenoscopy (EGD). The main test used to find stomach cancer. Your gastroenterologist uses an endoscope—a flexible, lighted tube with a small video camera on the end—to see the lining of your esophagus, stomach, and first part of the small intestine. The endoscope can also take a biopsy sample.
  • Endoscopic ultrasound (EUS). Uses sound waves to produce images of the stomach.
  • Biopsy. The only way to tell for sure if it is definitively cancer is by doing a biopsy. Biopsies to check for stomach cancer are most often obtained during upper endoscopy, where your doctor takes a sample of the abnormal area and sends it to a lab for examination. The samples are checked to see if they contain cancer, and if they do, what type of stomach cancer.
  • Imaging tests. X-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body.
  • Computed tomography (CT or CAT) scan. Uses X-rays to make detailed, cross-sectional images of your body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body. CT scans can also be used to guide a biopsy needle into a suspected area of cancer spread, called a CT-guided needle biopsy.
  • Magnetic resonance imaging (MRI) scan. Like CT scans, MRI scans show detailed images of soft tissues in the body.
  • Positron emission tomography (PET) scan. A PET scan can look for possible areas of cancer spread in all areas of the body at once.
  • PET/CT scan. We can do both a PET and CT scan at the same time.

Staging

Part of a diagnosis is determining the stage of stomach cancer, which helps direct the proper treatment. The stages of adenocarcinoma of the stomach or esophagus include:

  • Stage I. At this stage, the tumor is limited to the top layer of tissue that lines the inside of the esophagus or stomach. Cancer cells also may have spread to a limited number of nearby lymph nodes.
  • Stage II. The cancer at this stage has spread deeper, growing into a deeper muscle layer of the esophagus or stomach wall. Cancer may also have spread to more of the lymph nodes.
  • Stage III. At this stage, the cancer may have grown through all the layers of the esophagus or stomach and spread to nearby structures. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.
  • Stage IV. This stage indicates that the cancer has spread to distant areas of the body.