Diagnosis

If you have a symptom that suggests stomach cancer, your doctor must find out whether it is really due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems.

The doctor asks about your personal and family health history. You may have blood or other lab tests. You also may have:

• Physical exam: The doctor checks your abdomen for fluid, swelling, or other changes. The doctor also feels for swollen lymph nodes. Your skin and eyes are checked to see if they seem yellow.
• Upper GI series: The doctor orders x-rays of your esophagus and stomach. The x-rays are taken after you drink a barium solution. The solution makes your stomach show up more clearly on the x-rays.
• Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look into your stomach. The doctor first numbs your throat with an anesthetic spray. You also may receive medicine to help you relax. The tube is passed through your mouth and esophagus to the stomach.
• Biopsy: The doctor uses an endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

To plan the best treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Stomach cancer can spread to the lymph nodes, liver, pancreas, and other organs. The doctor may order tests to check these areas:

• Blood tests: The lab does a complete blood count to check for anemia. Blood tests also show how well your liver is working.
• Chest x-ray: An x-ray machine takes pictures of your lungs. The doctor can then study these pictures on film. Tumors in your lungs can show up on the x-ray.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive an injection of dye. The dye makes abnormal areas easier to see. Tumors in your liver, pancreas, or elsewhere in the body can show up on a CT scan.
• Endoscopic ultrasound: The doctor passes a thin, lighted tube (endoscope) down your throat. A probe at the end of the tube sends out sound waves that you cannot hear. The waves bounce off tissues in your stomach and other organs.
• Laparoscopy: A surgeon makes small incisions (cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen. The surgeon may remove lymph nodes or take tissue samples for biopsy.

Sometimes staging is not complete until after surgery to remove the tumor and nearby lymph nodes.

These are the stages of stomach cancer:

• Stage 0: The cancer is found only in the inner layer of the stomach. It is carcinoma in situ.
• Stage I is one of the following:
  • The tumor has invaded only the submucosa. (The picture in section 2 shows the layers of the stomach.) Cancer cells may be found in up to 6 lymph nodes.
  • Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have not spread to lymph nodes or other organs.
• Stage II is one of the following:
  • The tumor has invaded only the submucosa. Cancer cells have spread to 7 to 15 lymph nodes.
  • Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 1 to 6 lymph nodes.
  • Or, the tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other organs.
• Stage III is one of the following:
  • The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7 to 15 lymph nodes.
  • Or, the tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes.
  • Or, the tumor has invaded nearby organs, such as the liver or spleen. Cancer cells have not spread to lymph nodes or to distant organs.
• Stage IV is one of the following:
  • Cancer cells have spread to more than 15 lymph nodes.
  • Or, the tumor has invaded nearby organs and at least 1 lymph node.
  • Or, cancer cells have spread to distant organs.
• Recurrent cancer: The cancer has come back (recurred) after a period of time when it could not be detected. It may recur in the stomach or in another part of the body.