If a person is suspected to have stomach cancer due to the presence of signs and symptoms, stomach cancer investigations are required to confirm the diagnosis of the disease.
Further, these investigations can help in determining the stage of the disease, which in turn help in choosing an appropriate treatment option.
Following are some commonly used diagnostic tools for gastric cancer:
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- Barium swallow: In this test, a thick, viscous liquid containing barium (a heavy element that reflects x-rays) is first swallowed. Then, x-rays are obtained for the upper gastrointestinal system where any abnormal area is detected by the irregular barium coating.
- Endoscopy: Endoscopy is a diagnostic technique which uses an endoscope – a long, flexible, slender tube usually equipped with a camera, a light source, and some special instruments for biopsy or surgery. This enables the doctors to look inside the body parts such as the esophagus, stomach, and duodenum to determine the abnormalities.
Upper Endoscopy: This is generally the first diagnostic test performed on a patient presented with the symptoms of gastric cancer. In this technique, the doctor examines for any abnormal areas in the wall of the stomach using an endoscope.
Biopsy samples are generally collected from abnormal areas using a special biopsy instrument in conjunction with the endoscope.
Endoscopic Ultrasound: In this technique, an ultrasound device is used along with an endoscope, to determine location and extent of tumor invasion in the stomach wall and nearby lymph nodes.
It can also signal the spread of disease to nearby organs; however, it cannot accurately determine the extent of disease spread to distant organs such as lungs or bones.
- Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected.
Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.
Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium.
It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells.
The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose spread of disease to distant body parts. It is usually combined with CT scan (PET/CT).
Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
- Laboratory Tests for Biopsy Samples: Biopsy samples contain a small number of cells or a tiny piece of tissue collected from the affected area or lymph node with the help of a biopsy needle or other biopsy instrument.
Biopsy samples are generally collected from abnormal areas using a special biopsy instrument in conjunction with the endoscope. These samples provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved, and the presence of specific defective genes or proteins.
- Laparoscopy: In this technique, incisions are made at appropriate places and a hollow flexible device equipped with a camera and a light source is inserted through the incision. This technique can be utilized to collect biopsy samples from the affected areas, and are very useful in the diagnosis of radiographically occult disease and in determining the extent of disease spread to the liver or peritoneum.
Watch the video below to understand the INVESTIGATIONS required for diagnosis and staging of stomach cancer.
CancerBro, what are the investigations required to confirm the stomach cancer diagnosis.
Most important investigation to confirm the stomach cancer diagnosis is upper GI endoscopy, which also helps us to take a biopsy and do the endoscopic ultrasound.
Once the diagnosis is confirmed, imaging help us to assess the spread of the tumor to local sites and distant metastasis.
In some cases, laparoscopy may be required to explore the spread of disease into the peritoneum and other parts of the abdomen.
Upper GI endoscopy is the first and the most important test to be done, when we are suspecting a patient to have stomach cancer.
As we have discussed previously, it help us to take a biopsy from the mass.
And also to do a endoscopic ultrasound, to look for the depth of the infiltration of the tumor into the esophageal wall and the local structures, and to look for the involvement of regional lymph nodes.
Once the diagnosis of the stomach cancer is confirmed, the next step is to do a CT scan of the abdomen and preferably thorax, to look for local extension and distant spread of the tumor.
PET CT scan may also be done rarely.
Sometimes, the tumor spread to peritoneum or abdominal structures may not be diagnosed accurately on imaging.
So laparoscopic exploration of the abdomen and collection of peritoneal fluid for cytology may be required.
So these were the investigations required to confirm the diagnosis of stomach cancer and stage the disease.