Diagnosing stomach or oesophageal cancer

Sunday 1 November, 2015

Download PDF Order FREE booklet

On this page: Endoscopy (gastroscopy) | Endoscopic ultrasound | Further tests | Staging and grading | Prognosis | Which health professionals will I see? | Key points


Your GP will examine you and refer you for further tests. The diagnostic blood tests, procedures or scans you have will vary depending on your symptoms. Most tests can be performed on an outpatient basis and will not require an overnight stay in hospital.

Endoscopy (gastroscopy)

An endoscopy (also called a gastroscopy, upper GI endoscopy or oesophagoscopy) is the most common diagnostic test.

Before undergoing an endoscopy you will probably be given a light anaesthetic. A thin, flexible tube with a camera on the end (endoscope) will then be passed into your mouth, down your throat and oesophagus, and into your stomach. You will be asked not to eat or drink (fast) for about 4–6 hours before undergoing this procedure.

The doctor will use the endoscope to look at your digestive tract and may remove a small amount of tissue in a procedure known as a biopsy. The removed tissue will later be examined under a microscope by a pathologist to check for signs of disease. Biopsy results are usually available within a few days.

An endoscopy takes about 10 minutes. You may have a sore throat afterwards.

Endoscopies have risks, such as bleeding or getting a small tear or hole in the oesophagus or stomach (perforation). Your doctor should explain all the risks before you consent to having the procedure.

Endoscopic ultrasound

In this test, an endoscope with a probe on the end is put down the throat. The probe releases soundwaves, which echo when they bounce off anything solid such as an organ or tumour. This procedure is less common than an endoscopy.

This test shows the layers of the stomach wall, as well as nearby lymph nodes and other parts of the body directly outside the stomach. It can show whether the cancer has spread into the oesophageal or stomach wall, nearby tissues or lymph nodes.

During the scan, tissue samples may be taken (by biopsy) from the oesophagus, stomach, and nearby organs.

Before undergoing this test you will be given an anaesthetic. You will also be asked not to eat or drink (fast) for about 4–6 hours beforehand.

Further tests

Most people have scans or other imaging tests to see if the cancer has spread from its original site.

CT scan

A computerised tomography (CT) scan uses x-ray beams to take pictures of the inside of your body. Unlike a standard x-ray, which takes a single picture, a CT scan uses a computer to compile many pictures. These scans are usually done at a radiology clinic or hospital.

You may have an injection or be asked to drink a medical dye before the scan. The dye will help make the scan pictures clearer and may make you feel flushed or hot for a few minutes. Rarely, more serious reactions to the dye can occur, such as low blood pressure or breathing difficulties. The treatment centre will have staff and equipment to treat any problems if they occur.

You will need to lie still on a table while the CT scanner, which is large and round like a doughnut, slowly moves around you. The scan itself is painless and takes only a few minutes, but preparation time can take 10–30 minutes.

The dye used for a CT scan is called contrast solution and may contain iodine. If you have any allergies, let the person performing the scan know in advance. You should also tell the doctor if you’re diabetic, have kidney disease or are pregnant.

PET/CT scan

This scan is often used for oesophageal cancer and sometimes used for stomach cancer. For this scan, a PET scan is performed at the same time as a CT scan using a special machine that can do both scans. This allows the two results to be compared in order to provide more detailed and accurate information about the cancer.

A PET (positron emission tomography) scan is a specialised imaging test that is able to detect very small cancer cells that may not have been detected on a CT scan, and is available at most major hospitals. 

A PET scan shows ‘hot spots’ in the body where there are active cells, such as cancer cells. Not all PET hot spots indicate cancer.

Before the scan, you will be injected with a glucose solution that contains some radioactive material. You will be asked to wait for 30–90 minutes as the solution spreads through your body. You will need to lie still during this time. The glucose solution gathers in the cells, including cancer cells, which are using more energy. The scan itself takes around 30 minutes.

Laparoscopy

A laparoscopy is usually done as part of the diagnostic tests for stomach cancer and less commonly for oesophageal cancer. A laparoscopy is also sometimes used before major surgery.

You will be admitted to hospital and given a general anaesthetic for this procedure. The doctor will inflate your abdomen with gas and make small cuts in your abdomen. A thin tube called a laparoscope will be inserted into your body. Through this tube, the doctor can look for small amounts of cancer that may have spread into the liver or lining of the abdomen, which are too small to be seen on CT or PET scans. It’s also possible to take tissue samples for biopsy during this procedure.

Less common tests

Some people have other tests, such as an ultrasound scan, bone scan or bronchoscopy. These are not commonly used. For information about these tests and scans, talk to your health care team or call Cancer Council 13 11 20.

Staging and grading

Your doctor will assign a staging and grading category to the cancer, which will help your health care team decide the best treatment for you. These categories are worked out using information from the diagnostic tests and tissue biopsy.

Stage

The stage describes the extent of the cancer and whether it has spread from the original site to other parts of the body. Doctors commonly use the TNM staging system to describe the different stages of oesophageal and stomach cancers.

TNM system

T (Tumour) 0–4 Indicates how far the tumour has grown into the oesophagus or stomach wall. The higher the number, the deeper the tumour and the greater the risk of spread.
N (Nodes) 0–3 Shows whether the cancer has spread to nearby lymph nodes. 0 indicates no nodes affected. 1, 2 or 3 indicate increasing node involvement.
M (Metastasis) 0–1 Indicates whether the cancer has spread (metastasised) to other organs (1) or it hasn’t (0).
Grade

This gives an idea of how quickly the cancer cells may be growing. This is assessed by the pathologist based on information from the biopsy. Low-grade cancer cells tend to grow slowly, while high-grade cancer cells may grow quickly.

If you are having trouble understanding staging and grading, ask someone in your medical team to explain it to you in a way that makes sense to you. You can also call Cancer Council 13 11 20 to clarify the information you have been given and what it means.

Prognosis

Prognosis means the predicted outcome of a disease. Generally, the earlier that oesophageal or stomach cancer is diagnosed, the better the prognosis.

You will need to discuss your prognosis with your doctor. However, it is not possible for any doctor to predict the exact course of your illness.

The following factors are important in assessing your prognosis:

  • test results
  • the rate and depth of tumour growth
  • whether the cancer has spread
  • how well you respond to treatment
  • age
  • level of fitness
  • medical history, including other medical conditions.
"I had surgery for stomach cancer, which is hard because my stomach is now so much smaller. I have good days and bad days, but I’m back at work and I exercise every week. My prognosis for the future is good." – Tim

Which health professionals will I see?

Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist doctor who will arrange further tests and advise you about treatment options.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team (MDT). This team will meet regularly to design and discuss the most appropriate treatment plan for you, and will support you on an ongoing basis. The team may include some or all of the health professionals listed below. 

Health professional

Role

endoscopist a specialist doctor (surgeon or gastroenterologist) who diagnoses and treats diseases of the gastrointestinal tract
upper gastrointestinal surgeon a specialist doctor who treats disorders of the digestive system using surgery
medical oncologist a specialist doctor who prescribes and coordinates the course of chemotherapy
radiation oncologist a specialist doctor who prescribes and coordinates the course of radiotherapy
nurse practitioner
senior clinical nurse involved in assessing, diagnosing, treating and managing disease
cancer nurse coordinator or clinical nurse consultant
provides ongoing education, liaises with other care providers, and supports you throughoutdiagnosis, treatment and recovery
dietitian recommends an eating plan for your nutritional needs while you are in treatment and recovery
physiotherapist assists in physical rehabilitation and restoring movement after surgery
speech pathologist helps with your rehabilitation if the cancer or treatment has affected your ability to talk or swallow
social worker helps provide emotional support and practical assistance to you and your carers
psychologist or counsellor helps you manage your emotional wellbeing and cope with changes to your life as a result of cancer or treatment
palliative care physician offer a range of services for people with advanced cancer to improve their quality of life and ensure their physical, practical, emotional and spiritual needs are met

Key points

  • A range of tests are used to diagnose oesophageal and stomach cancers.
  • Endoscopy is the main diagnostic test. This allows doctors to look inside the digestive tract and take tissue samples (biopsies).
  • An endoscopic ultrasound (EUS) can show how far the cancer has spread into the oesophageal or stomach wall.
  • Biopsied tissue is examined under a microscope to find out more about the cells. This shows if cancer is present, how far the cancer has spread (its stage), and how quickly it is growing (its grade).
  • You may also have scans including a CT scan or PET/CT scan, which show pictures of the inside of your body.
  • Other procedures, such as a laparoscopy, can show if the cancer has spread to the liver or abdomen.
  • Based on the test results and your general health, your doctor can provide some information about your prognosis (the predicted outcome of your disease). Your prognosis is also affected by the treatment you choose and how successful it is.
  • You will be cared for by a range of health professionals who work together in a multidisciplinary team (MDT).

Reviewed by:Prof Mark Smithers, Director, Upper GI/Soft Tissue Unit, Princess Alexandra Hospital, Professor, Discipline of Surgery, The University of Queensland; Katie Benton, Dietitian and Nutritionist, Upper Gastrointestinal Unit, Department of Nutrition and Dietetics, Princess Alexandra Hospital, QLD; Jeff Bull, Upper GI Cancer Clinical Practice Consultant, Cancer Services, Flinders Medical Centre, SA; Prof Bryan Burmeister, Senior Radiation Oncologist, Princess Alexandra Hospital, Dept Chair MSAC, Cancer Council Queensland; Frank Hughes, 13 11 20 Nurse, Cancer Council Queensland; June Leijon, Consumer; Dr Julia Maclean, Clinical Specialist, Speech Pathology, Cancer Care Centre, St George Hospital, NSW; A/Prof Euan Walpole, Medical Director, Cancer Services, Princess Alexandra Hospital & Southern Area Health Service, QLD.

Updated: 01 Nov, 2015