Stomach (Gastric) Cancer: Diagnosis & Staging

Getting the right diagnosis and an accurate staging of stomach cancer is crucial for determining the best treatment approach for you. At Memorial Sloan Kettering, radiologists, pathologists, surgical oncologists, and other members of your multidisciplinary cancer care team use tests such as endoscopy, endoscopic ultrasound, barium x-ray, and laparoscopy to diagnose and determine the stage (extent) of your stomach cancer.

Diagnosing Stomach Cancer

Our doctors may recommend that you have one or more tests to get important information about your condition and to design a treatment plan.

Endoscopy

During this test, a gastroenterologist inserts a thin, lighted tube called an endoscope through your mouth and esophagus and into the stomach (while you are sedated or under anesthesia) to examine the inner lining of the stomach wall. The endoscope is also commonly used to remove a small tissue sample, in a procedure called a biopsy, of any concerning areas.

Barium X-Ray

In this test, you drink liquid containing barium, a silver-white metal that helps doctors see a clear image of the stomach and potential abnormalities on an x-ray. The test may be performed in a doctor’s office or in Memorial Sloan Kettering’s radiology department.

Staging Stomach Cancer

Once a diagnosis has been made, imaging tests can help to determine if the cancer is confined to the stomach or if it has metastasized (spread) to other layers of the stomach, nearby organs, or lymph nodes. This process is called staging, and it is an important step in deciding which treatment will benefit you the most.

Our doctors use the TNM (tumor, node, metastasis) system to describe the stage of a cancer. This abbreviation summarizes the depth of penetration of the tumor (T) into the stomach wall, whether it has spread to nearby lymph nodes (N), and whether it has metastasized (M) to other parts of the body.

We determine the stage of a stomach tumor by performing one or more of the following tests:

  • Computed Tomography (CT) Scan — This type of imaging is used to determine the exact location and extent of a stomach tumor. The approach combines three-dimensional images to provide a cross-sectional view of the stomach. Contrast dye, given intravenously or by mouth, is sometimes used to enhance the image.
  • PET Scan — This type of imaging test uses a tiny amount of a radioactive substance, given by injection, which is then absorbed by any cancerous tissue that may be present. Imaging reveals tissues that contain cancer cells.
  • Endoscopic Ultrasound — This procedure is similar to endoscopy. At the tip of the endoscope is an ultrasound probe that bounces sound waves through the stomach walls to produce a highly detailed picture of the stomach and surrounding areas, including nearby lymph nodes and organs such as the liver. Endoscopic ultrasound is also sometimes used to determine whether laparoscopy, in which gastroenterologists may also remove very early-stage tumors in a procedure called endoscopic mucosal resection, is necessary(1).
  • Biopsy — In this test, a pathologist uses a microscope to examine a small sample of tissue that has been taken from your stomach with an endoscope and determine whether it contains cancer cells. If you have had this procedure done before coming to Memorial Sloan Kettering, our pathologists will review the biopsy slides as part of your initial evaluation to confirm the diagnosis. A second biopsy may be needed to confirm your diagnosis and determine if you are a candidate for surgery.
  • Laparoscopic Staging — During this minimally invasive surgical procedure, a laparoscope — a thin, lighted tube with a camera on its tip — is inserted into the abdomen through a small incision. The image is projected onto a large viewing screen. The surgeon inspects the inside of the abdomen and removes tissue samples using specially designed surgical instruments. The surgeon can also inspect the outside wall of the stomach, examine lymph nodes, and evaluate the surfaces of other abdominal organs to determine if the cancer has spread to those areas.
  1. Power DG, Schattner MA, Gerdes H, et al. Endoscopic ultrasound can improve the selection for laparoscopy in patients with localized gastric cancer. J Am Coll Surg. 2009 Feb;208(2):173-8.