How is stomach cancer diagnosed?

If a physician suspects gastric cancer, he or she will generally perform an upper endoscopy using a gastroscope to help detect abnormalities. The gastroscope is a very thin tube containing a tiny light and a camera, which is inserted through the mouth into the stomach after a local anesthetic is given. Our physicians will take a biopsy via the endoscope, which pathologists will examine to determine the diagnosis.

If cancer is confirmed, doctors will then use state-of-the art technology, including endoscopic ultrasound which can precisely determine the stage of cancer by gauging a cancer's depth and whether it has spread. Like gastroscopy, in the endoscopic ultrasound procedure, the physician inserts a small, thin scope into the stomach which bounces sound waves off the stomach walls and neighboring lymph nodes to pinpoint the cancer's stage, similar to sonar. Other tests often given include high resolution computed tomography (CT or CAT) scans and positron emission tomography (PET) scans.

In patients who present with symptoms and/or signs of stomach cancer on physical exam, laboratory evaluation should include a complete blood count and complete metabolic profile, including tests of liver and kidney function, carcinoembryonic antigen (CEA) level, and alkaline phosphatase. The CEA level, which is commonly used as a marker for colorectal cancer, may also be elevated with stomach cancer in 15% to 20% of cases, especially if advanced disease is present.

Once the diagnosis of a stomach ulcer or stomach cancer is suspected, a referral should be made to a gastroenterologist, a medical specialist in the treatment of diseases of the gastrointestinal tract. This doctor may perform an esophagogastroduodenoscopy (EGD), also called an upper endoscopy. The procedure involves placement of a fiberoptic scope through the nose and throat, in order to look directly at the lining of the upper gastrointestinal (GI) tract, mainly the esophagus and stomach. Biopsy of any suspicious areas should be performed. Approximately 90% of stomach cancers are of the common glandular type, called adenocarcinomas. Occasionally patients will develop lymphomas of the stomach. Other subtypes are fairly rare.

Fecal occult blood test: A fecal occult blood test is used to detect microscopic blood in the stool, which may indicate stomach or other gastrointestinal (GI) cancers, such as colorectal cancer.

Complete blood count: A complete blood count (CBC) is a simple blood test used to measure the concentration of white blood cells, red blood cells, and platelets.

Tumor marker test: The presence of tumor markers, also called biomarkers, may indicate cancer. Tumor markers are substances that are either produced by the tumor or the host when cancer is present. There are several different tumor markers for different cancers. The tumor marker carcinoembryonic antigen (CEA) is present in ovarian, lung, breast, pancreatic, and gastrointestinal cancers.

Upper endoscopy: In an upper endoscopy, the doctor inserts a thin tube that contains a light and camera (called a gastroscope) through the mouth and esophagus and into the stomach. The gastroscope allows the doctor to see the inside of the stomach. Small instruments can be passed through the gastroscope and used to remove a sample of tissue for examination (biopsy) in a laboratory. A local anesthetic is used to reduce sensation in the esophagus during this procedure. Upper endoscopy takes about 20-30 minutes, although individuals are not sent home until the medication wears off, which is usually one to two hours later. Complications of the procedure rarely occur and include bleeding and perforation of the stomach lining. The most common complication is a slight sore throat from swallowing the endoscope.

Imaging tests: Imaging tests such as computerized tomography (CT scan), ultrasound, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan may be used to detect metastatic stomach cancer. Once a diagnosis of stomach cancer is made, the disease is staged.

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Early detection is key to the successful treatment of stomach cancer. In this video, gastroenterologist Dr. Robynne Chutkan discusses a simple test that can reveal whether or not you have this serious disease.