• Stomach (Gastric) Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Diagnose Stomach Cancer

    Beginning with your first appointment at the Center for Esophageal and Gastric Cancer at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), our specialists care for you and manage your diagnosis as a team. Because we are a centralized center, your testing and care are coordinated from your first appointment. This translates to fewer appointments for you, since you're able to see different specialists on the same day, often at the same time.

    We are one of the few centers in the world with a team of pathologists and clinicians who focus on diagnosing and evaluating stomach cancer. Your pathologists play a critical role in identifying targets for oncologists to treat your stomach cancer. They confirm a diagnosis of cancer by examining a biopsy and then classifying it. They establish if there is a subtype of cancer, which could impact the choice of therapy.

    We provide evaluation and diagnostic services for people who: 

    • Receive a diagnosis of stomach cancer and want to be treated at our center
    • Are diagnosed with stomach cancer and want a second opinion or to consult on a treatment plan
    • Would like a second opinion, including referring doctors throughout the world
    Contact us

    877-442-3324 or 877-442-DFCI or 617-632-3476
    Or complete the online form.

    Rapid response

    We know the importance of making an early diagnosis. If a diagnosis is determined, your clinical team will work with you to create and oversee a personalized treatment plan.

    Initial diagnosis

    Your doctor will likely conduct or review these tests:

    Physical exam and history: Your doctor examines your body to check general signs of health, including checking for signs of disease, such as lumps and swollen lymph nodes.

    Blood chemistry studies: Your doctor takes a blood sample to check the amounts of certain substances released into the blood by organs and tissues in the body.

    Complete blood count (CBC): Your doctor takes a sample of blood to check for:

    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the sample made up of red blood cells.

    Fecal occult blood test: This test checks your stool for blood that can be seen only with a microscope.

    Barium swallow: For this series of X-rays of the stomach, you drink a liquid that contains barium (a silver-white metallic compound). The liquid coats your stomach, and we take X-rays of it. This procedure is also called an upper GI series.

    Endoscopy: Your doctor uses an endoscope (a thin tube) to look inside your stomach. You may receive medications to help you relax during the procedure.

    Biopsy: Using an endoscope, which has a tool for removing cells or tissues, your doctor takes a small sample that your pathologist will later view under a microscope.

    CT scan (CAT scan): Your doctor takes detailed pictures of areas inside your body, taken from different angles. The pictures are made by a computer linked to an X-ray machine. You may have dye injected into a vein or you may swallow it to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

    Staging stomach cancer

    The process used to find out if cancer has spread within the stomach area or to other parts of the body is called staging.

    The staging process is the most important factor in determining your treatment plan. The stage of cancer is carefully divided into categories based on the size and spread of cancer beyond the stomach and into other places in the body (metastasis). Currently, the most commonly used staging system for stomach cancer uses the depth of primary tumor invasion, number of regional lymph nodes with metastases, and distant metastasis.

    The stage is determined based on your team's estimate of the extent of the cancer, which comes from the results of physical exams, endoscopy, biopsies, and any imaging tests (such as CT scans). In order to get a more accurate understanding of the cancer and to precisely stage it, your surgeon will remove cells from the affected area and send them to your pathologist to study.

    Pathologists' findings are critical to determining the best treatment, and, at our center, pathologists are key members of your medical team. Our pathologists not only evaluate tissues in order to characterize your cancer, but they also investigate any unusual or unexpected findings, using microscopes and analysis to observe and test tissue.

    Pathologists also conduct a new test to evaluate whether the cancer has an expression of a certain protein, (HER2/neu) on the cells. About 15 percent of stomach cancers have this expression, and if it is present, we can consider a specific, promising course of therapy.

    To get the sample to study, your surgeon removes at least 15 lymph nodes from the affected area. Studies have shown that it is critical to get this many nodes in order to increase the possibility for the cancer to be correctly staged and to further reduce the risk of recurrence.

    A better way to stage cancer

    We've found that it's critical for pathologists to study tissue samples from the tumor bed that contain enough lymph nodes. When too few nodes are taken and examined, it can lead to under-staging and increase the risk of recurrence.

    We are careful to biopsy enough lymph nodes to be able to correctly stage your cancer and get you on the proper treatment plan. What's more, our team is working to standardize our approach nationally to improve the level of care for all patients with stomach cancer.

    Non-surgical tests and procedures may also be used in the staging process: 

    • Chest x-ray: An X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside your body.
    • Endoscopic ultrasound (EUS) or endosonography: A procedure in which a thin, tube-like instrument is inserted into your body, usually through the mouth or rectum. A probe at the end of the endoscope bounces high-energy sound waves (ultrasound) off internal tissues or organs and makes echoes. The echoes form a picture of body tissues called a sonogram..
    • Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions..
    • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into your vein. The PET scanner rotates around your body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

    Stages of stomach cancer

    Stage I 

    In stage I, cancer has formed in the inside lining of the mucosa (innermost layer) of the stomach wall. Stage I is divided into stage IA and stage IB, depending on where the cancer has spread.

    Stage IA: Cancer may have spread into the submucosa (layer of tissue next to the mucosa) of the stomach wall.

    Stage IB: Cancer:

    • may have spread into the submucosa (layer of tissue next to the mucosa) of the stomach wall and is found in one or two lymph nodes near the tumor; or
    • has spread to the muscle layer of the stomach wall

    Stage II 

    Stage II gastric cancer is divided into stage IIA and stage IIB, depending on where the cancer has spread.

    Stage IIA: Cancer:

    • has spread to the subserosa (layer of tissue next to the serosa) of the stomach wall; or
    • has spread to the muscle layer of the stomach wall and is found in one or two lymph nodes near the tumor; or
    • may have spread to the submucosa (layer of tissue next to the mucosa) of the stomach wall and is found in three to six lymph nodes near the tumor.

    Stage IIB: Cancer:

    • has spread to the serosa (outermost layer) of the stomach wall; or
    • has spread to the subserosa (layer of tissue next to the serosa) of the stomach wall and is found in one or two lymph nodes near the tumor; or
    • has spread to the muscle layer of the stomach wall and is found in three to six lymph nodes near the tumor; or
    • may have spread to the submucosa (layer of tissue next to the mucosa) of the stomach wall and is found in seven or more lymph nodes near the tumor.

    Stage III 

    Stage III gastric cancer is divided into stage IIIA, stage IIIB, and stage IIIC, depending on where the cancer has spread.

    Stage IIIA: Cancer has spread to:

    • the serosa (outermost) layer of the stomach wall and is found in one or two lymph nodes near the tumor; or
    • the subserosa (layer of tissue next to the serosa) of the stomach wall and is found in three to six lymph nodes near the tumor; or
    • the muscle layer of the stomach wall and is found in seven or more lymph nodes near the tumor.

    Stage IIIB: Cancer has spread to:

    • nearby organs such as the spleen, transverse colon, liver, diaphragm, pancreas, kidney, adrenal gland, or small intestine, and may be found in one or two lymph nodes near the tumor; or
    • the serosa (outermost layer) of the stomach wall and is found in three to six lymph nodes near the tumor; or
    • the subserosa (layer of tissue next to the serosa) of the stomach wall and is found in seven or more lymph nodes near the tumor.

    Stage IIIC: Cancer has spread to:

    • nearby organs such as the spleen, transverse colon, liver, diaphragm, pancreas, kidney, adrenal gland, or small intestine, and may be found in three or more lymph nodes near the tumor; or
    • the serosa (outermost layer) of the stomach wall and is found in seven or more lymph nodes near the tumor.

    Stage IV 

    In stage IV, cancer has spread to distant parts of the body.

    Next: How We Treat Stomach Cancer 

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    • Or complete the online form.
  • Gastrointestinal Cancer Treatment Center

    • Learn more about Dana-Farber/Brigham and Women's Cancer Center's treatment and support for patients with gastrointestinal cancers.
  • Find a Clinical Trial

    • Dana-Farber/Brigham and Women's Cancer Center offers clinical trials that provide eligible patients with innovative treatment option. Find a clinical trial for:
      esophageal cancer
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  • Researching better therapies for stomach cancer

    • Adam Bass, MDScientists, including researchers from Dana-Farber, have identified four subtypes of tumors for stomach cancer based on shared mutations and other molecular abnormalities. This new classification may lead to the development of improved therapies for the third-leading cancer killer worldwide.