| Stomach & oesophageal cancer | Diagnosing stomach or oesophageal cancer | Treatment for stomach and oesophageal cancer |
Reviewed by: Dr Stuart Roberts, Director Gastroenterology, The Alfred
Taken from 
Stomach & Oesophageal Cancer booklet (2.1MB)
On this page: Health professionals you may see | How stomach and oesophageal cancer is diagnosed | Further tests | ‘Staging' the disease
In their early stages, these cancers often don't cause any symptoms. This means that they're usually not diagnosed until the cancer is more advanced.
Symptoms of stomach cancer are like those of many other conditions. Signs of early stomach cancer include a painful or burning sensation in the abdomen, heartburn or indigestion (dyspepsia). If someone aged over 45 develops these symptoms, and they don't go away, they may need to be examined for stomach cancer.
Other symptoms can occur later, including:
Symptoms of oesophageal cancer include:
If you haven't been diagnosed with cancer and are just looking through this information, be aware that many of these symptoms occur without any serious disease being present. However, if you have any of the symptoms for more than 2 weeks, see your doctor for a check-up.
Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist. You may have further tests and then the specialist will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see list below). Ideally, your tests and treatments should be available at your hospital. This may not be possible in some non-metropolitan areas.
Specialists and other health professionals who care for people with stomach and oesophageal cancer include:
The common tests for these cancers are described in this section. You may not have all of the tests. When the tests are done, your doctor or doctors will tell you what they have learned and suggest the best treatment for you.
Before referring you for tests, your doctor will take a full medical history and examine you. You may also have a blood test and chest x-ray to check your general health.
In this test, a thin, flexible ‘telescope' (called an endoscope) will be passed down your throat so that the doctor can examine your oesophagus, stomach and the upper part of your bowel.
If anything unusual is seen, the doctor can put instruments down the endoscope and remove tissue to examine under a microscope-this is called a biopsy.
You'll have a sedative and a local anaesthetic to make you as comfortable as possible during the test. (Some people need to have a general anaesthetic.) You may even fall asleep. You'll be asked not to eat or drink anything for a period of time before the test. Following the test, because of the sedative, you shouldn't drive a car or operate machinery until the next day.
This test has some risks, including bleeding and a very small risk of perforation (where a hole is accidentally made in the stomach or oesophagus). A small number of people are affected (less than 0.1%). Your doctor should explain all the risks before you consent to having the procedure.
This test is less commonly done now that endoscopy is available.
If you have this test you will drink a thick, chalky liquid called barium. This will coat the lining of your oesophagus, stomach and the first part of your bowel. You will lie down on a couch and a radiologist will take x-ray pictures of your chest and abdomen. X-rays can't pass through the coating of barium, so anything unusual will be seen.
To look for stomach cancer, you may be asked to swallow a thin tube, through which air can be pumped into your stomach. This makes the barium coating very thin, so even small abnormalities will show up. (The tube will be taken out of your throat afterwards.)
You may be slightly uncomfortable as the couch is tipped in different ways to help the barium flow through your whole stomach. The test takes about an hour. You will be asked not to eat or drink for several hours beforehand.
This is similar to having an endoscopy. It may be used for people who may have oesophageal cancer and occasionally for people who may have stomach cancer. For this test, the endoscope has a small ultrasound probe on the end. The probe releases high-frequency sound waves and then detects the sound wave echoes that bounce off tissue of the oesophageal or stomach wall. A computer translates the pattern of echoes into a picture.
This test may show whether cancer has spread into the wall of the organ, nearby tissue and to nearby lymph nodes.
If you're diagnosed with stomach or oesophageal cancer, you may have some more tests to find out if the cancer has spread. These tests will help your doctor or doctors advise the best treatment for your cancer.
A CT scan is a type of x-ray that gives a two or sometimes three-dimensional (3-D) picture of organs and other structures (including any tumours) in your body. It is used to see if cancer has spread into the lymph nodes, liver, abdomen cavity or other parts of the body.
CT scans are usually done at a hospital or a radiology clinic. It usually takes 30 to 40 minutes to complete this painless test. You may be asked not to have a meal before the scan. You will have a liquid contrast before the scan, in a drink and in an injection. This dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly.
You'll be asked to lie on a table, which is moved into the CT scanner, which is large and round like a doughnut. Most people are able to go home as soon as their scan is over.
There is a small possibility of the injected dye causing an allergic reaction. You should tell your doctor if you are allergic to iodine or to contrast dyes, or if you are diabetic or have abnormal kidney function.
In this test, sound waves are used to create a picture of your internal organs, including your liver, to see if cancer has spread.
You will uncover your abdomen and lie on a table. Once you are comfortable, a gel will be spread on the skin over the area being scanned.
A small device called a ‘transducer' will be moved across your abdomen. It makes sound waves and receives echoes. A computer makes a picture of the echoes produced when the sound waves meet something dense, like an organ or a tumour. An ultrasound scan is mainly used to see if cancer has spread to the liver.
This is painless and takes 15 to 20 minutes.
This is a test that helps find out how far the tumour has advanced and whether it has spread to other parts of the body. It is often combined with a CT scan. You will be asked to not eat or drink anything before the PET scan. A small amount of radioactive material will be injected into a vein in your arm one hour before the scan. You will then be asked to lie or sit in a darkened room until the scan. For the scan, you will lie on a table and be moved through a large ring-shaped scanner. The tube may make some people feel claustrophobic. If you think you are likely to be affected in this way, please tell the treatment centre before your scan.
Only a few centres in Victoria offer this test, so you may have to travel to have this done.
This test is for people diagnosed with stomach cancer, and sometimes for people with oesophageal cancer.
You will be admitted to hospital and will have a general anaesthetic. Through small cuts in your abdomen, the doctor will use a tube to put gas into your abdomen, then put in a thin ‘telescope' called a ‘laparoscope'. Through this, the doctor can look for small amounts of cancer that may have spread into the liver or the lining of the abdomen.
A biopsy can be taken of any unusual tissue. This may be done as a separate procedure, or as a first step before major surgery.
This test is similar to endoscopy. A thin, lighted tube called a ‘bronchoscope' will be put into your mouth or nose and passed down your windpipe to look into the breathing passages.
You may have this test if there is concern that the oesophageal cancer has spread close to or involved the windpipe.
If the doctor suspects that your cancer has spread, they may order a bone scan. This can show whether cancer has spread to the bones.
A small amount of a radioactive substance will be injected into a vein. This travels through the body and collects in bone, especially where there is unusual growth. A scanner will then measure the radioactivity in these areas.
The tests described on previous pages show whether you have cancer and some can also show whether it has spread. The cancer may have spread into blood vessels or lymph nodes near the stomach or oesophagus, or into organs further away, like the liver. This is called metastasis. Knowing if and how far the cancer has spread is called 'staging' the disease. Staging helps your doctor to work out the best treatment for you.
‘Staging' is a way of describing whether a cancer has spread, and if so, how far. Stage 1 means it has not spread; Stage 4 means it has spread to distant organs such as the liver or lungs.
The staging system used for stomach and oesophageal cancer is known as the ‘TNM system' (T = tumour, N = lymph nodes, M = metastases).
Doctors combine this information to determine the stage of the cancer, from Stage 1 to Stage 4. For example, a stomach cancer staged as T3, N1, M0 (tumour spread through the stomach wall, some lymph nodes affected, no metastasis) is a Stage 3 stomach cancer.
Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your situation.
