Stomach Cancer Diagnosis

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.