Unfortunately, cancer of the stomach is discovered late, due to few and unspecific symptoms. At time of diagnosis 35% have metastasis to the lymph nodes and 40% have distant metastasis.
The clinical examination will only indicate the disease in an advanced stage, like palpable tumor in the epigastrium, in the peritoneum or lymph nodes in the supraclavicular bone. Ascites and jaundice are late symptoms.
There are no specific tumor markers in the blood. CEA, CA 19-9 and CA 125 can be taken. Blood tests in general do not show much apart from anemia, decreased albumin and elevated liver enzymes and bilirubin levels.
- Gastroscopy, based on visual understanding and biopsies for pathological examinations, provides diagnosis in nearly 100% of the cases.
- When malignancy is confirmed, gastroscopy with endoscopic ultrasound is the best method for determining infiltration into the stomach and metastasis to local lymph nodes. This is of practical importance for the further handling.
- Preoperative laparoscopy is used to diagnose peritoneal carcinosis or superficial liver metastasis. Laparoscopy can determine inoperability criteria in up to 20-30%.
- Spiral CT scan of thorax and upper abdomen (stomach and liver protocol) is done at confirmed disease. The examination is sensitive towards metastasis in lung parenchyma and mediastinum, and can identify tumors smaller than 5 mm in the liver.
- The liver can also be examined with dedicated MRI.
- Ultrasound-guided liver biopsy is an important supplement by uncertainty.
- Ultrasound of liver with contrast also helps when the diagnosis is uncertain.
- PET scan has a higher sensitivity towards distant metastases than CT/MRI.
- Skeletal scintigraphy is now less used if there is suspicion of spread to the bone.