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How are stomach and oesophageal cancers diagnosed?

There is no national screening program for the early detection of stomach or oesophageal cancer. If your GP suspects that you have stomach or oesophageal cancer, they will examine you and refer you to a specialist for further tests. The main tests are endoscopy and biopsy (the removal of a tissue sample). You may have other 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.

Endoscopy and biopsy

An endoscopy (also called a gastroscopy, oesophagoscopy or upper endoscopy) allows your doctor to look inside your digestive tract to examine the lining. This procedure is usually performed as day surgery.

Most people are told not to eat or drink (fast) for 6 hours before an endoscopy. In some cases, you can continue drinking clear fluids until two hours before the procedure. Your doctor will advise you about this. Before the procedure, your throat may be sprayed with a local anaesthetic, which can taste very bitter, and you will usually be given a sedative into a vein to ensure you are comfortable during the procedure. 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.

If the doctor sees any suspicious-looking areas, they may remove a small amount of tissue from the stomach or oesophageal lining. This is known as a biopsy. A pathologist will examine the tissue under a microscope to check for signs of disease. Biopsy results are usually available within 5–7 days. This waiting period can be an anxious time. It may help to talk to a supportive friend, relative or health professional about how you are feeling. You can also speak to a cancer nurse by calling Cancer Council 13 11 20.

An endoscopy takes about 15 minutes. You will need to have someone take you home after the procedure, as you may feel drowsy or weak. You could have a sore throat afterwards and feel a little bloated. 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 (consent) to the procedure.

Endoscopic ultrasound (EUS)

You may have this test at the same time as a standard endoscopy. The doctor will insert an endoscope with an ultrasound probe on the end. The probe releases soundwaves, which echo when they bounce off anything solid, such as an organ or tumour. This procedure helps determine whether the cancer has spread into the oesophageal wall, nearby tissues or lymph nodes. During the EUS, your doctor may use the ultrasound to guide the needle into the area of interest and take further tissue samples.

Further tests

If the biopsy shows you have stomach or oesophageal cancer, you will have some of the following tests to find out whether the cancer has spread to other areas of your body. This is called staging. Some of the tests may be repeated during or after treatment to check your health and see how well the treatment is working.

You might have blood tests to assess your general health, look for signs of anaemia, and see how well your liver and kidneys are working. Blood tests can also help identify nutritional problems.

A computerised tomography (CT) scan uses x-ray beams to create detailed, cross-sectional pictures of the inside of your body. It helps determine how far the cancer has spread from the primary tumour site. You may have a CT scan of your:

  • chest, abdomen and pelvis for stomach cancer
  • neck, chest, abdomen and pelvis for oesophageal cancer.

Before a CT scan, you may have an injection of dye and/or be asked to drink a liquid dye. This dye, known as the contrast, helps ensure that anything unusual can be seen more clearly. The dye might make you feel hot all over and leave a strange taste in your mouth for a few minutes. Rarely, more serious reactions can occur.

The CT scan machine is large and round like a doughnut. You will need to lie still on a table while the scanner moves around you. The scan itself is painless and takes only a few minutes, but the preparation can take 10–30 minutes.

A positron emission tomography (PET) scan combined with a CT scan is a specialised imaging test. The two scans provide more detailed and accurate information about the cancer than a CT scan on its own. A PET–CT scan is most commonly used to help determine whether oesophageal cancer has spread to other parts of the body. Only some people need this test. As PET scans do not detect some stomach cancers, Medicare does not currently cover the cost.

To prepare for a PET–CT scan, you will be asked not to eat or drink for a period of time (fast). Before the scan, you will be injected with a glucose solution containing a small amount of radioactive material. Some cancer cells may show up brighter on the scan because they take up more glucose solution than normal cells do.

You will be asked to sit quietly for 30–90 minutes as the glucose spreads through your body, then you will be scanned. The scan itself will take around 30 minutes. Let your doctor know if you are claustrophobic, as you need to be in a confined space for the scan.

A laparoscopy is usually done as day surgery under general anaesthetic. This procedure allows your doctor to look inside your abdomen and examine the outer layer of the stomach for signs that the cancer has spread. A laparoscopy is used to stage:

  • stomach cancer to see whether it involves the lining of the abdomen (peritoneum) or other organs
  • oesophageal cancer that is located in the gastro-oesophageal junction and also involves the upper part of the stomach.

The doctor will make small cuts in your abdomen and pump in gas to inflate your abdomen. A tube with a light and camera attached (a laparoscope) will then be inserted into your body. The camera projects images onto a TV screen so the doctor can see cancer cells that are too small to be seen on CT or PET–CT scans. The doctor may take more tissue samples for biopsy. Your doctor will explain the risks before asking you to agree to the procedure.

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 assess the risk that cancer has spread to the lymph nodes and needs further treatment.

If you are diagnosed with advanced cancer in the stomach or gastro-oesophageal junction, your doctor may order extra tests on the biopsy sample to look for particular features that can cause the cancer cells to behave differently. These tests may look for mutations in the HER2 gene or specific proteins linked with the growth of cancer cells. Knowing whether the tumour has one of these features may help your treatment team decide on suitable treatment options.