Although stomach cancer is usually slow growing, it is also hard to find. That’s because people do not often have symptoms in the early stages of the disease. The first step in diagnosing stomach cancer will be for your doctor to ask you about symptoms. He or she will be especially looking for:
- Poor appetite
- Losing weight without trying to
- Abdominal (belly) pain
- A sense of fullness just below your chest bone after eating a small meal
- Heartburn or indigestion
- Vomiting, with or without blood
- Swelling or fluid build-up in the abdomen
Keep in mind that many of these symptoms can be caused by other problems. The next step in diagnosing stomach cancer is to do a medical examination. Your doctor will want to feel your abdomen for changes or lumps. Then you may need to have some tests done:
Endoscopic ultrasound (EUS): This is the most common test for stomach cancer. This special kind of ultrasound puts the ultrasound transducer inside your body. This allows your doctor to get more detailed pictures. Sound waves form the pictures.
Here’s how it works. The transducer is on the end of a thin, lighted tube. This tube has an attached device called an endoscope or laparoscope. Your doctor will put the tube down your mouth and into your stomach. EUS can tell your doctor how far the cancer has spread within your stomach. It can also see whether the cancer has spread into nearby tissues and lymph nodes. Your doctor might also use EUS to guide a needle to get a tissue sample (biopsy).
Upper endoscopy: In this procedure, a thin, flexible tube called an endoscope is put down your throat. It has a light on the end of it. Through the tube, your doctor can see the lining of your esophagus, your stomach, and the first part of your small intestine. If your doctor sees anything that looks abnormal, he or she can remove a tissue sample through the tube. This is called a biopsy. The sample is then examined under a microscope. This will tell your doctor if there is cancer and, if so, what type of cancer it is.
Biopsy: A biopsy is the only sure way to tell if something is cancer. In a biopsy, your doctor will take a sample of the tissue that looks abnormal. Usually a biopsy for stomach cancer is done during endoscopy.
Upper GI (gastrointestinal) series: For this test, you will drink a thick, chalky liquid that contains barium. The barium coats the lining of your esophagus, stomach, and first part of your small intestine. Anything that isn't normal in the lining of these organs will be outlined. Then X- rays are taken. Sometimes, after you swallow the barium, a thin tube is passed into your stomach and air is pumped in. This thins the barium coating so that even small areas of change will show up.
CT scan (CAT scan or computed tomography): The CT scan is an X-ray test that produces detailed pictures of your body. Instead of taking one picture, like a regular X-ray does, a CT scanner takes many pictures. It does this by rotating around you while you lie on a table. Then a computer combines all these images. That produces a 3-dimensional picture of the part of your stomach.
Before any pictures are taken, you may have to drink 1 to 2 pints of a liquid. It is called oral contrast. This fluid helps outline your intestine. This helps the doctor identify tumors. You may also receive an IV (intravenous line) in your arm or hand. A different type of contrast dye can be injected through the IV. Its purpose is also to outline structures in your body.
The injection may make you feel flushed or warm. It is a little uncomfortable, but not painful. Many patients say that the worst part is having to lie still. CT scans can:
- Identify tumors in the stomach region.
- Show organs near the stomach to check for cancer spread.
- Show lymph nodes that the cancer might have spread to.
- Be used to guide a biopsy needle precisely into a suspected tumor. This procedure is called a CT-guided needle biopsy. In this procedure, the radiologist puts a biopsy needle through your skin and into the mass. Then a tissue sample is removed and examined under a microscope.
MRI scan (magnetic resonance imaging): MRIs are similar to CT scans. An MRI scan provides detailed pictures like CT scans. The difference is that MRI scans use radio waves and strong magnets instead of X-rays. The energy from the radio waves produces patterns. A computer takes these and turns them into detailed images of specific parts of your body.
Most doctors prefer to use CT scans to look at your abdomen, but sometimes an MRI can give more information.
MRI scans are often little more uncomfortable than CT scans. For one thing, an MRI takes up to an hour. You may be placed inside a narrow tube. This can feel confining. There are newer, open MRI machines in many hospitals and clinics around the country.
PET scan (positron emission tomography): For this test, a special kind of radioactive sugar is put into your vein. The sugar then collects in places that have cancer. A scanner can then identify these places. Your doctor may ask for a PET scan if he or she thinks the cancer has spread but doesn’t know where.
Some machines can do both a PET and CT scan at the same time (PET/CT scan). This can be helpful in some cases. A PET/CT scan can show if the cancer has spread beyond your stomach. This tells your doctor whether surgery is an option.
Chest X-rays: Your doctor may want a chest X-ray to see if the cancer has spread to your lungs.
Laparoscopy: In this test, a thin, flexible tube is put into your abdomen through a small incision (cut). This tube has a camera on the end. It takes a picture of your inner organs and sends the picture to a video screen. Your doctor uses this to identify where cancer has spread and to see if all the cancer can be removed.
Digital Rectal Exam: This is to check your rectum for lumps or abnormalities. Your doctor will insert a lubricated gloved finger into your rectum. A rectal exam is particularly helpful if a test for occult blood is conducted at the same time.
Fecal Occult Blood Test: This test checks for blood in your stool (bowel movement). This blood could indicate cancer. It’s sometimes hidden and not obvious to you. Your stool may contain blood for many reasons. It does not always mean cancer. In this procedure, a small sample of stool is placed on a special card. A laboratory then tests it for hidden blood. If there is blood found in your stool, your doctor may want you to have a more specialized test like a colonoscopy.
Blood tests including: A complete blood count (CBC). This test checks for anemia. This is a low red blood cell count; it can be caused by bleeding. Blood chemistry tests to look for signs of cancer spread to your liver. If cancer is found, your doctor may want to do other tests, especially if you are going to have surgery. Your doctor may want to do a blood test to make sure your blood is clotting as it should. Or, you may need an electrocardiogram (EKG) to make sure your heart can handle surgery.
What “Stages” Mean
Once stomach cancer has been diagnosed, it’s important to know what stage of cancer you have. Knowing what stage your cancer is tells you how serious it is. The stage of stomach cancer depends on the size of the cancer, lymph node involvement and if there is any spread of the tumor. It helps your doctor plan the right course of treatment.
The TNM staging system is used for all types of cancer, not just stomach cancer. The letters TNM describe the amount and spread of cancer in your body.
- T: indicates how large the tumor is or how deep it has gone into stomach wall
- N: indicates whether the cancer has spread to surrounding lymph nodes
- M: indicates metastasis, which means that cancer has spread to other body parts
Stages are usually often labeled using Roman numerals 0 through IV (0-4). Higher numbers mean cancer has spread, and the cancer is more advanced.
Doctors often divide stomach cancers into 2 groups:
Resectable cancers: Stomach cancer your doctor thinks can be completely removed during surgery.
Unresectable cancers: Stomach cancers that can't be completely removed. This might be because:
- The tumor has grown into nearby organs or lymph nodes.
- The tumor has grown too close to major blood vessels.
- The cancer has spread to distant parts of the body.
How Stomach Cancer Spreads
There are 3 main ways that cancer spreads in your body. It can spread through:
- Tissue: Cancer invades nearby normal tissue.
- Lymph system: Cancer invades your lymph system and travels through your lymph vessels to other parts of your body.
- Blood: Cancer invades your veins and capillaries and travels through your bloodstream to other parts of your body.
The original tumor is called the primary tumor. When cancer cells break away from it and travel to other places in your body, a secondary tumor can form. The name for this spreading process is metastasis.
The secondary tumor is the same kind of cancer as the primary tumor. For instance, if the cancer cells in your stomach travel to your liver, it is called metastatic stomach cancer. It is not liver cancer.
The first step on the stomach cancer treatment journey is to find an oncologist (medical, radiation, or surgical) who inspires trust. It may seem overwhelming to choose an oncologist. First, start with referrals from your primary care physician, specialist, or insurance carrier. Talk to family and friends who may have recommendations.
Here are some things to consider when choosing an oncologist:
- Is the oncologist board certified?
- How much experience does he or she have in treating stomach cancer?
- Do you feel comfortable talking with this doctor? Does he or she listen well?
- Is the staff compassionate? Is the environment a good one or do you feel rushed?
- What hospital(s) does this oncologist see patients in?
- What are the office hours?
- What if you have an emergency? Can you call?
- Can this doctor be contacted after hours?
You will be spending a lot of time with the oncologist and staff nurses and technicians, so it’s important to feel comfortable with them.
As you and your doctor explore the treatment options open to you, make sure you find out the answers to the following:
- What are the chances my cancer will come back after this treatment?
- What do we do if the cancer comes back or the treatment doesn’t work?
- Will I lose my hair?
- Will it hurt?
- Will there be scars?
Questions for your Doctor
It is important to have honest, open discussions with your cancer care team. They want to answer all of your questions, no matter how trivial they might seem to you.
For instance, consider these questions:
- What kind of stomach cancer do I have?
- Where is the cancer in my stomach?
- What is the stage of my cancer?
- What treatment choices do I have?
- What do you recommend and why?
- Are there any clinical trials I should think about now?
- What risks or side effects are there to the treatments you suggest? How would treatment affect my daily life?
- How long will treatment last? What will it involve? Where will it be done?
- What are the chances of recurrence of my cancer with these treatment plans?
- What should I do to be ready for treatment?
- Based on what you've learned about my cancer, what is my prognosis (outlook)?
- What is the goal of my treatment? To cure or to ease symptoms?
- If I am to have surgery, what is your experience in this type of surgery for stomach cancer?
- What type of follow-up will I need after treatment?
Questions for Your Healthcare Team
If you’ve just been diagnosed with cancer, you may be confused and overwhelmed. You probably want answers, but you may not even know what questions to ask. As a cancer survivor, being able to talk openly and honestly with your healthcare team is very important. Use these must-ask questions as a guide to start talking with your healthcare team.
What is my diagnosis?
This question may seem like a no-brainer, but in the rush of appointments, you may not receive a clear answer. If you are unsure of your diagnosis, ask your oncologist. Sometimes more specific tests are needed to make an exact diagnosis.
What is my prognosis? What stage is my cancer?
Knowing your prognosis can help you better prepare for the future and select your best treatment plan. In order to know the stage of your cancer, your doctor will need to do tests. These may include scans, genetic testing, and/or a biopsy. The answer to these questions may be difficult to hear. You may consider having a family member or friend with you at this appointment.
What are my treatment options? What would you recommend?
Ask your oncologist to explain all your treatment options, including possible side effects and cost. Ask your oncologist which treatment he or she recommends. If you are unsatisfied with your options, do not be afraid to seek a second opinion.
Am I eligible for a clinical trial?
Clinical trials help improve the standard of care for all cancer patients. Based on your situation, a clinical trial may also be your best treatment option. Each trial has its own eligibility requirements.
What are the possible short-term and long-term side effects of treatment? How will these affect my normal activities?
Always ask about short-term and long-term side effects before beginning treatment so you are prepared. You should also consider short-term and long-term side effects when deciding which treatment plan is best for you.
How can I manage these side effects?
Some side effects can be easily managed through diet, exercise, or over-the-counter medication. Other side effects may require prescription medication, occupational therapy, or physical therapy which your oncologist can prescribe as needed.
Will my ability to have children be affected? Is there anything I can do to preserve my fertility?
Some cancers and cancer treatments can affect your fertility, but you do have options. Before treatment, you may be able to freeze eggs or bank sperm. There may be steps you can take during treatment to protect your reproductive system as well. For more information, visit Fertile Hope at http://www.fertilehope.org/.
How can I keep myself as healthy as possible during treatment?
Your own immune system plays a big part in your fight against cancer. It is important to stay as healthy as possible while undergoing cancer treatment.
Where can I find help with financial concerns?
Evaluate your financial situation as soon as possible. You will not want to deal with financial stress in the middle of treatment when you may not feel well.
Where can I find help with lodging or transportation?
When beginning cancer treatment, planning ahead is key. Some treatment centers have lodging coordinators or social workers to help you with the logistics of treatment.
What will my follow-up care plan include?
After you finish treatment, make sure you and your oncologist create a follow-up care plan. You will need to check for recurrence. You may also need follow-up care for long term side effects.
When can I call myself a survivor?
According to the National Cancer Institute’s definition of a cancer survivor, “a person is considered to be a survivor from the time of diagnosis until the end of life.