How is stomach cancer diagnosed and assessed?
Initial assessment and gastroscopy (endoscopy)
If a doctor suspects that you may have stomach (gastric) cancer, he or she may examine you. The examination is often normal, especially if the cancer is at an early stage. Therefore, a gastroscopy is usually arranged. A gastroscope (endoscope) is a thin, flexible, telescope. It is passed through the mouth, into the gullet (oesophagus) and down towards the stomach and the first part of the small intestine (the duodenum). The endoscope contains fibre-optic channels which allow light to shine down so the doctor or nurse can see inside your stomach and duodenum.
Biopsy - to confirm the diagnosis
When a small sample of tissue is removed from a part of the body, the procedure is called a biopsy. The sample is then examined under the microscope to look for abnormal cells. When you have a gastroscopy, if anything abnormal is seen, the doctor or nurse can take a biopsy. This is done by passing a thin grabbing instrument down a side channel of the gastroscope. It can take two weeks for the biopsy results.
Assessing the extent and spread
If you are confirmed to have stomach cancer, further tests may be done to assess if it has spread. For example, a barium meal X-ray, a computerised tomography (CT) scan, a magnetic resonance imaging (MRI) scan, an ultrasound scan, laparoscopy or other tests. This assessment is called staging of the cancer.
The aim of staging is to find out:
- How much the tumour in the stomach has grown, and whether it has grown partially or fully through the wall of the stomach.
- Whether the cancer has spread to local lymph nodes.
- Whether the cancer has spread to other areas of the body (metastasised).
By finding out the stage of the cancer it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). (See separate leaflet called Stages of Cancer for more details.)
Removing the tumour may be curative if the cancer is in an early stage. The common operation is to cut out the affected part of the stomach. Sometimes the whole of the stomach is removed. Sometimes this is done laparoscopically (keyhole surgery). Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, a blockage may be eased by removing part of the stomach, or by using laser surgery or by a bypass operation.
Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells or stop them from multiplying. (See separate leaflet called Chemotherapy for more details.) When chemotherapy is used in addition to surgery it is known as adjuvant chemotherapy. For example, following surgery you may be given a course of chemotherapy. This aims to kill any cancer cells which may have spread away from the primary tumour. Sometimes, chemotherapy is given before surgery, to shrink a large tumour so that surgery is easier - this is known as neoadjuvant chemotherapy.