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Diagnosis & Assessment

Initial assessment

If your doctor has concerns that you may have stomach cancer then he or she will usually examine you to look for any signs of a lump in the abdomen or for signs of anaemia.

Often physical examination is normal, especially if the cancer is at an early stage. Therefore, initial assessment usually involves a gastroscopy (endoscopy).

The gastroscope is a thin, flexible telescope which is passed through the mouth into the oesophagus and stomach. It contains fibreoptic channels down which light can be shone to visualise the lining of the stomach.


Biopsy to confirm diagnosis

A biopsy is a small sample of tissue taken through the gastroscope. The sample is examined under the microscope to look for any abnormal cells to help determine whether there is any evidence of cancer.


Assessing the extent and spread of cancer (staging)

If cancer of the stomach has been diagnosed then further tests may be needed to assess in more detail the size of the cancer and to determine whether the cancer may have spread to any other parts of the body. The extent to which the cancer has spread is described as “the stage” of the cancer. Tests used to determine the stage of the cancer are described as "staging investigations".

These assessments are intended to find out:

  • How much the cancer in the stomach has grown and whether it has grown partially or fully through the wall of the stomach
  • Whether the cancer has spread to local lymph nodes around the stomach
  • Whether the cancer has spread to other areas of the body (such as the lungs, liver, bones or distant lymph nodes)

A number of different investigations may be used to fully stage the stomach cancer and these might include:


CT scan (computerised tomography)

CT scans use x-ray beams and a computer to take cross sectional images of the chest and abdomen. This type of examination is useful in looking for evidence that cancer may have spread from the stomach to other parts of the body.


Endoscopic ultrasound (EUS)

Endoscopic ultrasound combines endoscopy and ultrasound to provide detailed information about the thickness of the cancer.

In many cases this is not needed when assessing stomach cancer. However, if the cancer affects the top part of the stomach where it joins to the oesophagus – then EUS can be used to assess whether there is any involvement of the oesophagus. This is important in planning further treatment.

Staging laparoscopy

This investigation involves passing a camera into the abdominal cavity under general anaesthetic. This allows direct visualisation of the outer surface of the stomach and lining of the abdominal cavity. It is used to assess whether there has been any spread of cancer beyond the stomach into the abdominal cavity.

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