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.
Before an endoscopy, some specialists may spray the throat with a local anaesthetic to numb it, but more commonly you will be given a sedative into a vein to make the procedure more comfortable. A long, flexible tube with a light and small camera on the end (endoscope) will then be passed into your mouth, down your throat and oesophagus, and into your stomach and small bowel.
An endoscopy takes about 10 minutes. You will need to have someone take you home after the procedure, as you may feel drowsy or weak. You may have a sore throat afterwards and feel a little bloated.
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 5–7 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.
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. 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. For oesophageal cancer, a PET–CT scan is most commonly used to see if the cancer has spread to other parts of the body. A PET–CT scan is not useful in finding some types of stomach cancers.
- 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. This procedure may help your doctor work out whether the cancer has spread to the lymph nodes. For some people, the resection also treats the cancer and further treatment is not needed.
- Molecular testing – if you are diagnosed with advanced cancer in the stomach 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.
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. 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 or call us on 13 11 20.
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.Download now
Expert content reviewers:
Dr Spiro Raftopoulos, Gastroenterologist, Sir Charles Gairdner Hospital, WA; Peter Blyth, Consumer; Jeff Bull, Upper Gastrointestinal Cancer Nurse Consultant, Cancer Services, Southern Adelaide Local Health Network, SA; Mick Daws, Consumer; Dr Steven Leibman, Upper Gastrointestinal Surgeon, Royal North Shore Hospital, NSW; Prof Michael Michael, Medical Oncologist, Lower and Upper Gastrointestinal Oncology Service, and Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Royal Brisbane Hospital, QLD; Rose Rocca, Senior Clinical Dietitian: Upper Gastrointestinal, Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, VIC; Letchemi Valautha, Consumer; Lesley Woods, 13 11 20 Consultant, Cancer Council WA.
Page last updated:
The information on this webpage was adapted from Understanding Stomach and Oesophageal Cancers - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in April 2022.