How is gastrointestinal (GI) or stomach cancer diagnosed?

Dr. Jill K. Onesti, MD
Surgical Oncologist

Gastrointestinal (GI) or stomach cancer is usually diagnosed by EGD). In this procedure, you receive light sedation and a camera is inserted into your mouth. The doctor is able to look for any abnormalities on the inside of your stomach and take a small portion to send for a biopsy. If the biopsy confirms cancer, further workup is then pursued, which can involve a computed axial tomography (CT) scan of your chest, abdomen and pelvis. If there is no evidence of spread outside your stomach, you may undergo further workup including an (EUS), which is similar to an EGD but has an ultrasound to evaluate how deep the cancer is inside your stomach wall. Your doctors may also check a positron emission tomography (PET) scan, which is similar to a CT scan but specifically looks for spread throughout your entire body.

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.

Often stomach cancer is diagnosed by an upper endoscopy of the stomach with biopsies performed at that time. CT scan and endoscopic ultrasound are a key part of staging tumors of the stomach and determining the exact treatment regimen.

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Because stomach cancer is relatively uncommon in the United States, there are no general screening tests recommended for stomach cancer like mammograms for breast cancer or colonoscopies for colon cancer. When doctors suspect stomach cancer, they may order several tests to make a diagnosis and/or stage the disease.

  • Medical history and physical exam. The doctor feels the abdomen for swelling, fluid or other changes. He also checks for swollen lymph nodes.
  • Imaging tests. Pictures of the inside of the body can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread and to help determine if treatment is working.
  • Endoscopy. Endoscopy allows the doctor to see the lining of the upper digestive system with a thin, lighted, flexible tube called an endoscope. A person is sedated as the tube is inserted through the mouth, down the esophagus, and into the stomach and small bowel. If an abnormality is found, a biopsy is performed.
  • Endoscopic ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This procedure is often done at the same time as the upper endoscopy. The endoscopic ultrasound can show enlarged lymph nodes, which may indicate a tumor or advanced disease.
  • Computed tomography (CT). A CT scan creates a three-dimensional X-ray of the inside of the chest, abdomen and pelvis. A computer combines the images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (dye) is used to provide better detail.
  • Laparoscopy. This minimally invasive procedure allows the doctor to view the lymph nodes and other organs to see if cancer has spread. Biopsies may be taken of the organ tissue.
  • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a person's body. The tumor absorbs the radioactive substance, and a scanner detects this substance to produce images.
  • Biopsy. When other tests find a change that is possibly cancer, a sample of the suspicious area is removed and viewed under a microscope. A biopsy or fine-needle aspiration is the only way to tell if cancer is really present.
  • Lab tests. A doctor may order lab tests to check levels of carcinoembryonic antigen (CEA), protein and enzyme levels that may indicate cancer.
Dr. Robynne K. Chutkan, MD

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.

Dr. Ajay K. Sahajpal, MD
Transplant Surgeon

In the absence of being found on incidental screening such as an ulcer that is found after an endoscopy, typically people present anemia (from bleeding slowly), change in appetite, early satiety/fullness, nausea/vomiting.  The diagnosis is usually confirmed with an endoscopy/esophaogogastroscopy and direct visualization and biopsy.

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