The diagnosis and prognosis of stomach cancer includes the following:

    
  • Review of medical history
  • Physical exam
  • Testing
  • Cytology
  • Staging
  • Prognosis
  • Testing

    Further testing to help with the diagnosis includes the following:

    Upper Gastrointestinal (GI) X-ray Study (Barium Swallow Study)

    After you drink a thick, chalky solution containing barium, a series of x-rays are taken. The barium helps outline your gastrointestinal tract, making any abnormalities stand out more clearly.

    Fiberoptic Esophagogastroduodenoscopy (Endoscopy)

    In this test, a thin, flexible scope is passed through your mouth, down your esophagus, and into your stomach and the first part of your small intestine (duodenum). Your doctor can then examine your gastrointestinal tract for abnormalities. Tiny tools can also be passed down this scope to take biopsy samples (samples of tissue). These samples are examined under a microscope to check for the presence of cancer cells.

    Staging

    Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (eg, surgery or chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0-1) imply a favorable prognosis, whereas high staging classifications (4-5) imply an unfavorable prognosis.

    Staging of stomach cancer cells considers several factors:

        
  • How deeply the cancer cells have penetrated the layers of the stomach
  • If cancer is present in the lymph nodes surrounding the stomach
  • If there are cancer cells in neighboring organs and tissue
  • If cancer has invaded distant organs or tissues within the body
  • Tests used to stage stomach cancer include the following, which may be done in your doctor's office or at an outpatient clinic:

        
  • Blood tests —Blood tests can reveal symptoms of cancer or its spread, such as a nemia or problems with liver function.
  • Chest x-ray —A chest x-ray is a series of standard x-ray images of your chest. It is important to examine the lungs for metastatic cancer.
  • Abdominal computed tomography (CT) scan —An abdominal CT scan can reveal the following:     
  • Presence of a tumor
  • Lymph node enlargement, which may be a sign of cancer spread
  • Abnormalities in other organs or tissues throughout the abdomen that might indicate metastases
  • Pelvic computed tomography (CT) scan —A pelvic CT can demonstrate metastatic spread of stomach cancer by identifying any of the following:     
  • Enlarged lymph nodes
  • Presence of tumors in the ovaries or other organs
  • Other tissue abnormalities
  • Endoscopic ultrasonography —An endoscope (thin, flexible, lighted scope) is passed through the mouth, down the esophagus, and into the stomach and intestine. A tiny ultrasound unit at the tip of the endoscope bounces sound waves off of the adjacent organs to generate ultrasound images of the intestinal tract and surrounding tissues.
  • Laparoscopy —Tiny incisions are made in the abdomen, allowing a scope to be passed into the abdomen. Your doctor can use this scope to examine the lining of your abdomen (peritoneum) and your liver, as well as other abdominal organs and tissue. Tiny tools can be passed through the laparoscope to take biopsy samples; the tissue samples will be checked for cancer cells.
  • Peritoneal lavage —Saline solution (salt water) is washed through your abdomen and then suctioned out. The saline is then examined under a microscope for the presence of cancer cells.
  • Staging Systems

    Once all the information has been collected, your healthcare provider will put it all together to determine the stage of your cancer. A common system used for staging is called the TNM system. This system characterizes three aspects of stomach cancer: information about the tumor (T), the lymph nodes (N), and the presence of distant metastasis (M). The higher numbers reflect a greater degree of abnormality and spread.

    Stomach Tumor (T)

    Evaluation of the stomach tumor determines which layers of the stomach have been invaded by cancer cells. There are five layers to the stomach. From the most interior layer to the most exterior layer, the layers of the stomach are: the mucosa (which lines the inside of the stomach), the submucosa, the muscularis (the largest, muscular layer), the subserosa, and the serosa (the outermost layer that lines the outside of the stomach).

    The T stages are as follows:

        
  • TX: Tumor cannot be evaluated.
  • T0: There is no evidence of tumor.
  • Tis: Cancer cells are present only in the mucosa.
  • T1: Cancer cells are present in the submucosa.
  • T2a: Cancer cells are present in the muscularis propria.
  • T2b: Cancer cells are present in the subserosa.
  • T3: Cancer cells are present all the way through to the serosa, but not in any adjacent tissues or organs.
  • T4: Cancer cells have invaded neighboring tissues or organs.
  • Lymph Nodes (N)

    The N stages are as follows:

        
  • NX: Nodes cannot be evaluated.
  • N0: There are no cancer cells in the lymph nodes surrounding the stomach.
  • N1: There are cancer cells in 1-6 of the lymph nodes surrounding the stomach.
  • N2: There are cancer cells in 7-15 of the lymph nodes surrounding the stomach.
  • N3: There are cancer cells in more than 15 of the lymph nodes surrounding the stomach.
  • Distant Metastasis (M)

    The M stages are as follows:

        
  • MX: Presence of metastasis cannot be evaluated.
  • M0: There is no distant metastasis.
  • M1: There is distant metastasis, such as to distant lymph nodes, or the liver, lungs, brain, and/or bone.
  • Overall Staging

    Once the T, N, and M categories have been determined, the information is grouped together to determine your stage. The groupings are described in this table.

    Stomach Cancer Staging Based on T, N, and M Categories
    StageT, N, and M categories
    STAGE 0Tis , NO, MO
    STAGE IAT1, N0, M0
    STAGE IBT1, N1, M0
    T2a or T2b, N0, M0
    Stage IIT1, N2, M0
    T2a or T2b, N1, M0
    T3, N0, M0
    Stage IIIAT2a or T2b, N2, MO
    T3, N1, M0
    T4, N0, M0
    Stage IIIBT3, N2, M0
    Stage IVT1-3, N3, M0
    T4, N1-3, M0
    Any T, Any N, M1