Because stomach cancer isn’t often detected until its advanced stages, it’s important to look out for symptoms and be aware of any risk factors you may have. Factors like diet, lifestyle habits and a family history of stomach or other gastrointestinal cancers may increase your risk of developing stomach cancer.
The stomach cancer experts at the OSUCCC – James are committed to researching and developing new screening methods to help find stomach cancer as early as possible. Early detection means better outcomes and more effective treatments.
Screening for stomach cancer
Early detection is among the most critical factors to best treat stomach cancer. Most stomach cancer diagnoses don’t occur until the cancer becomes advanced or has spread, in part because symptoms often don’t show until later stages.
While there is no current routine screening test recommended for detecting stomach cancer, the most important thing is to understand possible related symptoms and risk factors, and to notify your doctor when there is concern.
If your doctor determines that you should undergo additional testing, they may recommend one or more of the following:
Physical exam and personal medical history
Doctors may perform blood work or other exams before proceeding with further screening for stomach cancer.
Following an initial exam, further tests may be recommended if your doctor suspects stomach cancer is present.
Upper endoscopy
Doctors use an endoscopy to screen for stomach cancer in people who may be at an elevated risk. Family history (including genetics), smoking or excess alcohol consumption, or hereditary conditions like Lynch syndrome and Peutz-Jeghers syndrome can increase your risk of stomach cancer.
An upper endoscopy is among the most effective screenings to detect stomach cancer. Your doctor will use a small camera on the end of a small, flexible tube (an endoscope) to look through your upper digestive tract and into the stomach, looking in each area for any signs of cancer. During this procedure, areas of tissue that may appear abnormal or concerning may be sampled for biopsy.
Endoscopic ultrasound
Combining endoscopy and ultrasound procedures, the endoscopic ultrasound is used to both detect stomach cancer (and other gastrointestinal cancers) and determine the extent of cancer, if present. During an endoscopic ultrasound, an ultrasound probe on the end of the endoscope is inserted into your upper digestive tract.
Your doctor will look for areas affected by cancer and, if cancer is detected, will be able to determine how invasive the cancer is, and if it has spread to nearby lymph nodes or other organs.
Biopsy
During the screening process, your doctor may remove a small sample of tissue to be examined under a microscope to look for cancerous cells. A biopsy of the stomach is often conducted during an endoscopy.
Imaging tests for stomach cancer
Different types of imaging tests will provide your doctor with detailed images of the inside of your body and help identify areas of concern. These tests can help determine the type of cancer and its stage, which also helps inform how your cancer will be treated.
Computed tomography (CT) scan
A CT scan is an X-ray test that produces detailed and cross-sectional images of your body, helping your doctor identify areas where cancer may be present.
Positron-emission tomography (PET) scan
A PET scan can help your doctor determine if cancer has spread to other parts of the body. Using a glucose map of your body, your doctor can see which cells contain more sugar than others, as cancer cells absorb sugar faster than healthy cells.
Upper gastrointestinal series (barium swallow)
Less invasive than an endoscopy, a barium swallow is an X-ray exam that takes a detailed look at the shape of the lining of the stomach, esophagus and small intestine. You will ingest a chalky solution that contains barium, a chemical alkaline-earth metal that helps doctors see any abnormalities in the lining of those organs.
Complete blood count and blood chemistry tests
Your doctor may take a blood sample to measure amounts of certain substances (such as antibodies) that have been released into the blood. When evaluating stomach cancer, doctors will look for higher or lower-than-normal amounts of chemicals or proteins. Abnormally high or low levels may signal disease is impacting the organ or tissue that produces the antibodies.
Following a diagnosis, doctors will work to determine the staging of your stomach cancer and if it has metastasized (spread) to other areas of the body.
Staging Stomach Cancer
If you are diagnosed with stomach cancer, staging is a way of determining the extent and spread of your cancer. After receiving a stomach cancer diagnosis, your doctor and team of cancer experts will conduct tests to determine if the cancer has spread (and if so, how far). This information helps the doctor plan the best treatment.
Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads. Cancer staging guides the best recommendations on how it will be treated.
The OSUCCC – James utilizes the TNM (tumor, node, metastasis) staging system, which was founded by the American Joint Committee on Cancer, and this system is used to stage most gastrointestinal cancers. A later-stage cancer (stage III or IV) will generally have larger tumors (T), spread to nearby lymph nodes (N), or metastasis/spread to other parts of the body (M).
To determine stage, your doctors will examine the tumor and determine how far it has grown into the stomach wall and if it has spread to nearby organs.
- Tumor (T): Your cancer care team will see if the tumor has spread or grown into your stomach wall. There are five layers of the stomach wall, starting with the innermost layer: mucosa, submucosa, muscularis propria, subserosa and serosa.
- Node (N): One of the first places stomach cancer may spread is to the lymph nodes. Abnormal lymph nodes can also be identified on different imaging modalities.
- Metastasis (M): This refers to the process of cancer spreading to other parts of the body. CT scans of the stomach and nearby organs are done to assess this. The stage of your stomach cancer is considered more advanced if the cancer has spread to other organs.
What are the stages of stomach cancer?
Following your TNM evaluation, your cancer will be grouped into a stage. Staging for stomach cancer ranges from stage I (earlier stage) to stage IV (more advanced stage).
Stomach cancer may be staged differently at various times during your treatment. There’s a clinical stage, which is the stage of your cancer after initial exams and biopsies, and then a pathological stage, which combines the clinical results with a further evaluation conducted postsurgery. Sometimes, your doctor and surgical team may find additional spread of cancer beyond their initial diagnosis once surgery is underway.
The four stages of care:
Stage I stomach cancer
There are two substages in stage I, stage IA and IB.
Stage IA stomach cancer: Cancer has been found in the mucosa and may have spread to the submucosa.
Stage IB stomach cancer: Cancer has formed in the mucosa and spread to the submucosa or up to two nearby lymph nodes. Cancer may also have spread to the muscle layer of the stomach.
Stage II stomach cancer
Stage II stomach cancer is also divided into two substages, stage IIA and stage IIB.
Stage IIA stomach cancer: Cancer has spread to the submucosa and three to six nearby lymph nodes. Cancer may also have spread to the muscle layer and one to two nearby lymph nodes, or to the subserosa layer.
Stage IIB stomach cancer: Cancer may have spread to the submucosa and to seven to 15 nearby lymph nodes, to the muscle layer and three to six lymph nodes, to the subserosa and one to two lymph nodes or to the serosa layer.
Stage III stomach cancer
There are three substages of stage III stomach cancer: stage IIIA, stage IIIB and stage IIIC.
Stage IIIA stomach cancer: Cancer has spread to the muscle layer and seven to 15 nearby lymph nodes, to the subserosa and three to six nearby lymph nodes, to the serosa and one to two lymph nodes, or has spread to nearby organs. These organs may include the spleen, colon, liver, pancreas, abdomen wall and more.
Stage IIIB stomach cancer: Cancer may have spread to the submucosa or the muscle layer as well as 16 or more nearby lymph nodes, to the subserosa or serosa and seven to 15 nearby lymph nodes, or to nearby organs and up to six lymph nodes.
Stage IIIC stomach cancer: Cancer has spread to the subserosa or serosa and up to 16 nearby lymph nodes, or it has spread to nearby organs, the back of the abdomen, and up to seven nearby lymph nodes.
Stage IV stomach cancer
Also known as metastatic stomach cancer, stage IV stomach cancer has spread to other parts of the body. Affected areas may include the lungs, liver, lymph nodes and tissue of the abdominal wall.
Even though stomach cancer has spread to other areas and organs, it is still classified as stomach cancer because it is made of stomach cancer cells. They have metastasized, typically through your blood or the lymphatic system, and grow as tumors in other parts of the body.
If you have received a stomach cancer diagnosis, we are here to help. Call The James Line at 800-293-5066 (toll free) or 614-293-5066 (Ohio) to make an appointment.
Related resources
Stomach Cancer Prevention
Stomach Cancer Treatment
Gastrointestinal Cancer Clinical Research