Diagnosing Stomach Cancer

About Stomach Cancer

At Penn Medicine, patients with stomach cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Stomach cancer, also called gastric cancer, is cancer that forms in tissues that line the stomach. The stomach is a hollow organ in the upper abdomen, just under the ribs. Its primary function is to receive food from the esophagus, digest it and turn it to liquid/semi-liquid and send it through the lower digestive tract.

The stomach has five layers:

  • Inner layer: lining of the stomach
  • Submucosa: support tissue for inner layer
  • Muscle layer: muscles of the stomach
  • Subserosa: support tissue for the outer layer
  • Outer layer: outer lining, also called serosa

The most common type of stomach cancer is called adenocarcinoma. Adenocarcinoma is cancer that starts in cells that have gland-like properties within the tissues that line the inside of the stomach.

Other types of stomach cancer include:

  • Lymphoma
  • Leiomyosarcoma
  • Stromal Tumor (GIST)

These types of stomach cancer are relatively uncommon.

Stomach cancer is relatively uncommon in the United States, and its rate of incidence has declined over in the past decades. Experts believe this decline may be due, in part, to the reduced intake of salted, cured and smoked foods.

Penn Medicine’s multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN.

Read more About Stomach Cancer

Diagnosing Stomach Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first and crucial step in getting personalized treatment options to treat stomach cancer.

Patients who choose Penn’s Abramson Cancer Center, benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and joined with radiation oncologist and medical oncologists to have an appropriate treatment plan custom designed for each patient with stomach cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing stomach cancer and are actively researching better and more precise ways to detect stomach cancer.

Because an accurate diagnosis is a critical step in planning cancer treatment, it’s important patients know that when they come to Penn Medicine’s Abramson Cancer Center, they are taking an important step in getting the best cancer treatment.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right person. Penn Medicine’s contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN.


Screening for Stomach Cancer

Because stomach cancer is relatively uncommon in the United States, there are no general screening tests recommended for stomach cancer like mammograms for breast cancer or colonoscopies for colon cancer. For patients at high risk, GI genetics program at Penn Medicine can help determine if screening tests are needed.

Diagnostic Tools for Stomach Cancer

When physicians suspect stomach cancer, they may order several tests to make a diagnosis and/or stage the disease.

  • Medical history and physical exam. The physician feels the abdomen for swelling, fluid or other changes. The physician also checks for swollen lymph nodes.
  • Imaging tests. Pictures of the inside of the body can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working.
    • Endoscopy. Endoscopy allows the doctor to see the lining of the upper digestive system with a thin, lighted, flexible tube called an endoscope. The patient is sedated as the tube is inserted through the mouth, down the esophagus, and into the stomach and small bowel. If an abnormality is found, a biopsy is performed.
    • Endoscopic ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This procedure is often done at the same time as the upper endoscopy. The endoscopic ultrasound can show enlarged lymph nodes, which may indicate a tumor or advanced disease.
    • Computed tomography (CT). A CT scan creates a three-dimensional X-ray of the inside of the chest, abdomen and pelvis. A computer combines the images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (dye) is used to provide better detail.
    •  Laparoscopy. This minimally invasive procedure allows the physician to view the lymph nodes and other organs to see if cancer has spread. Biopsies may be taken of the organ tissue.
    • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. The tumor absorbs the radioactive substance, and a scanner detects this substance to produce images.
  • Biopsy. When other tests find a change that is possibly cancer, a sample of the suspicious area is removed and viewed under a microscope. A biopsy or fine-needle aspiration is the only way to tell if cancer is really present.
  • Lab tests. A physician may order lab tests to check levels of carcinoembryonic antigen (CEA), protein and enzyme levels that may indicate cancer.

Staging Stomach Cancer

Staging systems provide doctors with a common language for describing tumors. After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started. Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment. By understanding the stage of their cancer, patients can make informed decisions about their treatment.

The stomach has five layers:

  • Inner layer: lining of the stomach
  • Submucosa: support tissue for inner layer
  • Muscle layer: muscles of the stomach
  • Subserosa: support tissue for the outer layer
  • Outer layer: outer lining, also called serosa

Staging stomach cancer also involves discovering how many layers of the stomach the cancer has invaded.

  • Stage 0. The tumor is found only in the inner layer of the stomach. Stage 0 is also called carcinoma in situ.
  • Stage I. One of the following:
    • Tumor has only invaded submucosa, and cancer cells may have spread up to six lymph nodes.
    • Tumor has invaded muscle layer or subserosa. Cancer cells have not spread to lymph nodes.
  • Stage II. One of the following:
    • Tumor has only invaded submucosa. Cancer cells have spread to seven to 15 lymph nodes.
    • Tumor has invaded muscle layer or subserosa. Cancer cells have spread to one to six lymph nodes
    • Tumor has penetrated outer layer of stomach with no spread.
  • Stage III. One of the following:
    • Tumor has invaded muscle layer or subserosa. Cancer has spread to seven to 15 lymph nodes.
    • Tumor has penetrated the outer layer. Cancer has spread to one to six lymph nodes.
    • Tumor has spread to nearby organs. Cancer has not spread to lymph nodes or distant organs.
  • Stage IV. One of the following:
    • Cancer has spread to more than 15 lymph nodes.
    • Tumor has spread to nearby organs and at least one lymph node.
    • Cancer has spread to distant organs.

Stomach Cancer Treatments

Following the diagnosis and staging of stomach cancer, cancer specialists at Penn Medicine’s Abramson Cancer Center develop a personalized treatment plan. Penn’s treatment options for stomach cancer include:

  • Surgery
    • Partial gastrectomy
    • Total gastrectomy
  • Radiation therapy
    • 3-D conformal radiation therapy
    • Intensity-modulated radiation therapy (IMRT)
    • Proton therapy
    • Volumetric-modulated arc therapy (VMAT)
  • Chemotherapy and biologic therapies
    • Biologic (targeted) therapy
    • Chemoradiotherapy
    • Chemotherapy
  • Clinical trials
  • Other treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

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Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN.

Read more Stomach Cancer Treatments

Stomach Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of stomach cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle. There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Stomach Cancer Survivorship


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