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Stomach and oesophageal cancers

Diagnosing stomach and oesophageal cancers

Page last updated: March 2024

The information on this webpage was adapted from Understanding Stomach and Oesophageal Cancers - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in March 2024.

Expert content reviewers:

This information was developed based on international clinical practice guidelines, and with the help of a range of health professionals and people affected by these cancers:

  • Prof David I Watson, Matthew Flinders Distinguished Professor of Surgery, Flinders University, and Senior Consultant Surgeon, Oesophago-Gastric Surgery Unit, Flinders Medical Centre, SA
  • Prof Bryan Burmeister, Senior Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD
  • Kieran Cahill, Consumer;
  • Jessica Jong, Clinical Dietitian, Upper GI and Hepatobiliary Services, Peter MacCallum Cancer Centre, VIC
  • John Leung, Consumer
  • Prof Rajvinder Singh, Professor of Medicine, University of Adelaide, and Director, Gastroenterology Department and Head of Endoscopy, Lyell McEwin Hospital, SA
  • Dr Sarah Sutherland, Medical Oncologist, Chris O’Brien Lifehouse, NSW
  • Paula Swannock, Upper GI Cancer Nurse Consultant, St Vincent’s Hospital Melbourne, VIC
  • Rebecca Yeoh, 13 11 20 Consultant, Cancer Council Queensland

If your GP suspects that you have stomach or oesophageal cancer, they will examine you and refer you to a specialist for further tests. You may have tests to check your overall health and see if the cancer has spread.

Your specialist will combine the test results to work out the overall stage and prognosis of the cancer.

Your guide to best cancer care

A lot can happen in a hurry when you’re diagnosed with cancer. The  guide to best cancer care for oesophagogastric cancer can help you make sense of what should happen.

It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.

Read the guide

Endoscopy and biopsy

An endoscopy (also called a gastroscopy, oesophagoscopy or upper endoscopy) is a procedure that allows your doctor to look at the lining of your gastrointestinal tract. It is usually done as day surgery. 

Endoscopies have some risks, such as bleeding or getting a small tear or hole in the stomach or oesophagus (perforation). These risks are very uncommon. Your doctor should explain all the risks before asking you to agree to the procedure.

Having an endoscopy

You will be told not to eat or drink (fast) for six hours before an endoscopy. In some cases, you can drink clear fluids until two hours before the procedure. Your doctor will let you know about this.

To make the procedure more comfortable, you’re likely to be offered sedation to make you feel sleepy. A general anaesthetic is only needed for a small number of cases.

Once the sedative has taken effect, a long, flexible tube with a light and small camera on the end (endoscope) will be passed into your mouth, down your throat and oesophagus, and into your stomach and small bowel.

An endoscopy takes about 10 minutes. You may feel drowsy or weak after the procedure, so will need to have someone take you home. You may have a sore throat and feel a little bloated for some time afterwards.

Taking a biopsy

If the doctor sees any areas that look like cancer, they may remove a small amount of tissue from the stomach or oesophageal lining. This is known as a biopsy.

A specialist doctor called a pathologist will examine the tissue under a microscope to check for signs of cancer. Biopsy results are usually available in 2–3 days.


Endoscopic ultrasound (EUS)

You may have an EUS at the same time as a standard endoscopy. The doctor will use an endoscope with an ultrasound probe on the tip or with a built-in ultrasound device.

The probe releases soundwaves that echo when they bounce off anything solid, such as an organ or tumour.

This test helps work out whether the cancer has spread into the oesophageal or gastric wall, nearby tissues or lymph nodes.

During the EUS, your doctor may use the ultrasound to guide a needle into the area they want to look at and take tissue samples.

Further tests

If the biopsy shows you have stomach or oesophageal cancer, you will have further tests to work out whether the cancer has spread to other areas of your body. This is called staging.

Some of the tests may be repeated during or after treatment to check your health and see how well the treatment is working.

Types of further tests

  • Blood tests  – to assess your general health, check for a low red blood cell count (anaemia), and see how well your liver and kidneys are working.
  • CT scan  – uses x-ray beams to create detailed, cross-sectional pictures of the inside of your body. It helps show the size of the cancer and if it has spread. 
  • PET-CT scan – a specialised imaging test, whereby the CT scan helps pinpoint the location of any abnormalities found by the PET scan. A PET–CT scan can be used in staging stomach and oesophageal cancer, particularly in preparation for surgery.
  • Laparoscopy  – allows your doctor to look for signs that the cancer has spread to the outer layer of the stomach and the lining of the wall of the abdomen, which are known as the peritoneum.
  • Endoscopic resection – if you are diagnosed with very early cancer in the stomach or oesophagus, you may have an endoscopic resection, which aims to remove the whole tumour during the endoscopy. For some people, the resection not only helps in diagnosis and staging, but also may treat the cancer and further treatment is not needed.
  • Molecular testing  – if you are diagnosed with advanced cancer in the stomach, oesophagus or gastro-oesophageal junction, your doctor may test the biopsy sample to see whether one of the available targeted therapy or immunotherapy drugs would be suitable for you. The test will look for particular features within the cancer.

Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant or breastfeeding.

“I had surgery for stomach cancer, which is hard because my stomach is 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.” Brian


Tests help show whether you have stomach or oesophageal cancer and whether it has spread. Working out how far the cancer has spread is called staging. It helps your doctors recommend the best treatment for you.

The TNM staging system is the method most often used to stage stomach and oesophageal cancers. TNM stands for "tumour, node, metastasis".

The specialist gives numbers to the size of the tumour (T1–4), whether or not lymph nodes are affected (N0–N3), and whether the cancer has spread or metastasised (M0 or M1). The lower the numbers, the less advanced the cancer.

The TNM scores are combined to work out the overall stage of the cancer, from stage 1 (early or limited cancer) to stage 4 (metastatic or advanced cancer). Ask your doctor to explain what the stage of the cancer means for you.

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Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease.

Instead, your doctor can give you an idea about the general prognosis for people with the same type and stage of cancer.

To work out your prognosis and advise you on treatment options, your doctor will consider:

  • your test results
  • the type of cancer
  • the size of the cancer and how far it has grown into other tissue
  • whether the cancer has spread to the lymph nodes
  • how it might respond to treatment
  • your age, level of fitness and medical history.

Generally, the earlier stomach or oesophageal cancer is diagnosed, the better the outcome of treatment. If cancer is found after it has spread, it may not respond as well to treatment. 

Understanding Stomach and Oesophageal Cancers

Download our Understanding Stomach and Oesophageal Cancers booklet to learn more.

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