Rosalyn Carson-DeWitt, MD
The diagnosis and prognosis of stomach cancer includes the following:
Your doctor will ask you about the symptoms you’ve been experiencing, as well as:
Your doctor will perform a complete physical examination, concentrating on the abdominal exam. He or she will check whether you have any of the following:
Further testing to help with the diagnosis includes the following:
This is a simple test that can be done in your doctor's office. After a rectal exam (the insertion of one gloved, lubricated finger into the rectum to feel for abnormalities), the doctor wipes a small sample of stool onto a slide. Chemicals are added, which will reveal if there is any blood in your stool. This test does not definitively diagnose the presence of stomach cancer because several other conditions can cause blood to appear in the stool. But, if there is blood in the stool, it should increase your doctor's suspicion and should prompt him or her to order more tests.
After you drink a thick, chalky solution containing barium, a series of x-rays are taken. The barium helps outline your gastrointestinal tract, making any abnormalities stand out more clearly.
In this test, a thin, flexible scope is passed through your mouth, down your esophagus, and into your stomach and the first part of your small intestine (duodenum). Your doctor can then examine your gastrointestinal tract for abnormalities. Tiny tools can also be passed down this scope to take biopsy samples (samples of tissue). These samples are examined under a microscope to check for the presence of cancer cells.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
In the case of stomach cancer, cytology involves looking at cells in fluid or from a thin needle biopsy, under the microscope. The pathologist may be able to make the diagnosis of cancer with this small sample and may be able to tell your doctor the specific type of cancer and how aggressive it may look.
Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (eg, surgery or chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0-1) imply a favorable prognosis, whereas high staging classifications (4-5) imply an unfavorable prognosis.
Staging of stomach cancer cells considers several factors:
Tests used to stage stomach cancer include the following, which may be done in your doctor's office or at an outpatient clinic:
Once all the information has been collected, your healthcare provider will put it all together to determine the stage of your cancer. A common system used for staging is called the TNM system. This system characterizes three aspects of stomach cancer: information about the tumor (T), the lymph nodes (N), and the presence of distant metastasis (M). The higher numbers reflect a greater degree of abnormality and spread.
Evaluation of the stomach tumor determines which layers of the stomach have been invaded by cancer cells. There are five layers to the stomach. From the most interior layer to the most exterior layer, the layers of the stomach are: the mucosa (which lines the inside of the stomach), the submucosa, the muscularis (the largest, muscular layer), the subserosa, and the serosa (the outermost layer that lines the outside of the stomach).
The T stages are as follows:
The N stages are as follows:
The M stages are as follows:
Once the T, N, and M categories have been determined, the information is grouped together to determine your stage. The groupings are described in this table.
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages.
Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available. Prognoses provided in this monograph and elsewhere should always be interpreted with this limitation in mind. They may or may not reflect your unique situation.
Most patients (about 66%) are at Stage III or Stage IV at the time of diagnosis. The remaining 34% are evenly divided between Stages I and II. Because stomach cancer is usually at a relatively advanced stage at the time of diagnosis, only about 22% of patients with stomach cancer survive for five years after diagnosis.
Survival rates for patients who are diagnosed in the earlier stages of stomach cancer depend in part on the location of the stomach cancer. The five-year survival rate for patients who have cancer in the part of their stomach closest to the esophagus is 10% to 15%. The five-year survival rate for patients who have cancer in the part of their stomach closest to the intestine is about 50%.
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http://www.cancer.org/. Accessed December 2002.
What you need to know about stomach cancer. National Cancer Institute website. Available at
http://www.cancer.gov/cancerinfo/wyntk/stomach. Accessed December 2002.
Last reviewed September 2012 by Mohei Abouzied, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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