How is stomach cancer diagnosed?
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> Diagnosing stomach cancer
> Tests and investigations
> Waiting to have tests carried out
> Receiving a stomach cancer diagnosis
Diagnosing stomach cancer
A diagnosis of stomach cancer is usually based on the results of a clinical examination, blood tests, an endoscopy (oesophagoscopy, upper gastrointestinal endoscopy or gastroscopy) procedure, imaging scans using magnetic resonance imaging (MRI) or computed tomography (CT), a biopsy and sometimes a barium swallow.
Stomach cancer tests and investigations
The following tests and scans are used to confirm a stomach cancer diagnosis. Your doctors will use the test results to work out the best treatment for you. You may not need all the tests listed below. Your specialist will give you more detailed information about what tests are most appropriate for your condition.
If you have symptoms of stomach cancer, your doctor may carry out a general clinical examination to feel your abdomen to check for lumps or swelling. The doctor will ask about your medical history to learn about your symptoms and possible risk factors.
Your doctor may recommend that you have blood tests. These are to check your liver function (LFTs) and your overall health (FBE). An FBE test measures the different types of cells in your blood. It can show if you have anaemia (too few red blood cells). Some people with stomach cancer have low red blood cell counts because the tumour has caused bleeding. A blood test alone cannot provide a diagnosis. A Faecal Occult Blood test (FOBT) may be done to look for blood in stool (faeces) that can’t be seen by the naked eye (which could be caused by the cancer bleeding into the stomach).
This procedure allows the diagnosis to be made with greater accuracy and allows biopsies (samples of tissue) to be taken. An endoscope is a flexible, narrow tube with a tiny video camera and light on the end that is used to look inside the body. Endoscopes can help diagnose stomach cancer or determine the extent of its spread. Upper endoscopy or gastroscopy During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes an endoscope down your throat and into the oesophagus and stomach. The endoscope’s camera is connected to a monitor, which lets the doctor see any abnormal areas in the wall of the stomach clearly. The doctor can take tissue samples from any abnormal areas. These samples are sent to the lab to check if they contain cancer. Upper endoscopy can give the doctor important information about the size and spread of the tumour, which can be used to help determine if the tumour can be removed with surgery. Endoscopic ultrasound An endoscopic ultrasound, a probe that gives off sound waves is at the end of an endoscope. This allows the probe to get very close to tumours in the stomach. This test is very useful in determining the size of a stomach cancer and how far it has grown into nearby areas.
In some circumstances a biopsy is performed as part of the investigations to be certain about your diagnosis. Tissue samples for examination under a microscope can be taken during an EUS, ERCP or laparoscopy, or through your skin with local anaesthetic and guided by CT. A biopsy may not be performed in certain cases when surgical removal is planned upfront. In cases when surgery is not planned at the beginning, you will need to have a biopsy before starting chemotherapy or taking part in a clinical trial, to obtain a definite cancer diagnosis.
A CT scan uses X-rays to build up a three-dimensional picture of the stomach and the other organs around it. It is common practice to scan your chest and pelvic area to check for any signs of cancer outside the stomach. A CT scan can also be used to guide the needle during a biopsy that is performed in some cases. The biopsy procedure involves a tissue sample being taken for examination under a microscope.
A PET scan is a test where a small amount of radioactive substance is injected into a vein. On the scans, the injected substance shows areas where the cells are more active in the body. The scan works by highlighting where growing cells, such as cancer cells, use glucose for energy and growth faster than other non-cancerous cells. A PET scan may indicate whether a mass is cancerous and has spread. It can also help your healthcare team develop the right treatment plan, including whether surgery is possible.
MRI uses magnetic fields and radio waves to produce detailed images of the inside of the body. Like a CT scan, an MRI photographs the organs several times, while a patient lies on a table. A computer creates a 3D image that doctors can use to help diagnose and monitor stomach cancer.
In this test, you will be asked to swallow a thick, chalky liquid called barium. The barium coats the lining of the oesophagus, stomach, and small intestine. Several X-ray pictures are then taken. Because X-rays cannot pass through the coating of barium, this will outline any abnormalities of the lining of these organs.
If a laparoscopy procedure is done, it is usually only after stomach cancer has already been found. Although CT or MRI scans can make detailed pictures of the inside of the body, they can miss some small tumours. Doctors might do a laparoscopy before any other surgery to help confirm the cancer is still only in the stomach and can be removed completely with surgery. It may also be done before chemotherapy and/or radiation if these are planned before surgery. This procedure is done in an operating room with the patient under general anaesthesia (in a deep sleep). A laparoscope (a thin, flexible tube) is inserted through a small surgical opening in the patient’s side. The laparoscope has a small video camera on its end, which sends pictures of the inside of the abdomen to a TV screen. Doctors can look closely at the surfaces of the organs and nearby lymph nodes, or even take small samples of tissue. If it does not look like the cancer has spread, sometimes the doctor will “wash” the abdomen with saline (salt water) this is called peritoneal washing. The fluid is then removed and checked to see if it contains cancer cells. If it does, the cancer has spread, even if the spread could not be seen.
Another type of ultrasound – called an endoscopic ultrasound (EUS) – is a procedure that uses sound waves to take pictures of the pancreas, bile duct and digestive tract from within the body. This type of ultrasound is usually performed by a specialist gastroenterologist and involves an endoscope, which is a thin tube, entering a patient’s mouth and being guided down through the stomach and into the first part of the small intestine (duodenum). An EUS can help a doctor see a pancreatic tumour’s location and size, check whether the cancer has spread to other nearby areas of the body, or take a biopsy/tumour sample for examination. The images provided by this internal ultrasound have been shown to be helpful in diagnosing and staging pancreatic cancer.
Waiting to have tests carried out
Even if you have been given an urgent referral for a particular scan or investigation you may have to wait several days or possibly weeks for your appointment. This can be frustrating and worrying, especially if you are already feeling unwell.
If your symptoms get worse or you start to feel more unwell while you are waiting, it’s a good idea to get in touch with your GP or specialist if you already have one. If you cannot get in contact with them you may need to present to the closest emergency department of your symptoms cannot be controlled at home.
How long will I have to wait for my test results?
Depending on which tests you have had it may take from a few days to a few weeks for the results to come through. Waiting for test results can be an anxious time.
It is a good idea to ask how long you may have to wait when you go for tests. If you think you have been waiting too long, then contact your GP or a specialist to follow up on the progress of your results. Usually the doctor who does the test will write a report and send it to your specialist. If your GP sent you for the test the results will be sent to the GP clinic.
You will need an appointment with your specialist or GP to discuss the test results and how they might affect your treatment. Usually your specialist will discuss your results and plan your subsequent care.
Your test results will enable your doctors to make a detailed diagnosis and indicate to them at what stage your cancer is.
Staging is how doctors refer to the size of a cancer and whether it has spread around the tumour site or to other areas of the body. It is an important part of their assessment and contributes to treatment planning.
One system uses numbers to describe the stage of the cancer, the other uses the tumour-nodes-metasteses staging system. Your cancer staging may be explained to you by one or both ways.
|Stage 1||The earliest stage when cancer is found only in the stomach lining.|
|Stage 2||The cancer has spread deeper into the layers of the stomach.|
|Stage 3||The cancer has spread to nearby lymph nodes, known as locally advanced disease.|
|Stage 4||The cancer has spread to other parts of the body (metastatic cancer) such as the liver, lungs, distant lymph nodes or to the tissue lining the abdominal cavity (peritoneum).|
TNM (Tumour-Nodes-Metastases) staging
The TNM gives a number according to tumour size (T), how many lymph nodes are affected (N), and how far the cancer has spread, or metastasised, to distant parts of the body (M). This information is used to help decide the best treatment.
|Tis||Cancer only found in cells on the surface of the lining of the stomach, has not spread to other layers of the stomach.|
|T1||Tumour has grown in to inner layers of the wall of the stomach (the lamina propria, muscularis mucosae, or the submucosa).|
|Tumour has grown into the muscle layer of the stomach (the muscularis propria).|
Tumour has grown through all of the layers of the muscle into the connective tissue outside the stomach. It has not grown into the lining of the abdomen, called the peritoneal lining, or into the serosa, which is the outer layer of the stomach.
Tumour has grown through all of the layers of the muscle into the connective tissue outside the stomach. It has also grown into the peritoneal lining or serosa or the organs surrounding the stomach.
1-2 lymph nodes involved
3-6 lymph nodes involved
7 or more lymph nodes involved
Receiving a stomach cancer diagnosis
Receiving the diagnosis of stomach cancer can be unnerving, confusing, and disorienting. You have mixed emotions of surprise, disbelief, and anger; and you may feel sad and disappointed, with fear and uncertainty for the future. But you are not alone.
The PanSupport Team is here for you – to connect you with a community of people who have a shared experience and to support you through all stages of your experience.
A Common Path: Oesophagogastric cancer
The ‘A Common Path’ suite of cancer support and advice videos have been developed by the North Eastern Melbourne Integrated Cancer Service, with support from Pancare, for people who have been newly diagnosed with cancer. They provide people with an opportunity to learn from others who have already experienced a cancer diagnosis and treatment, highlighting how they made decisions, the things they learned along the way, the things that helped, and the things they wish they had known or done better.
> Stomach cancer treatment options