Your doctor examines your abdomen, gently feeling for fluid, swelling, or any unusual changes. They may also check the size of your lymph nodes, which are small glands that can swell during an immune system response.

An endoscopy allows the doctor to see the inside of your stomach. First, your doctor will administer a sedative to help you relax and minimize discomfort during the procedure. This sedation, often combined with a numbing medicine (anesthetic), will dull any feeling in your throat and help prevent gagging as the endoscope is inserted. Then, they will insert a lighted, flexible tube with a tiny camera into your mouth and down your throat (esophagus) to examine your stomach.

“An endoscopy allows the doctor to see the inside of your stomach. First, your doctor will administer a sedative to help you relax and minimize discomfort during the procedure. This sedation, often combined with a numbing medicine (anesthetic), will dull any feeling in your throat and help prevent gagging as the endoscope is inserted. Then, they will gently insert a lighted, flexible tube with a tiny camera into your mouth and down your throat (esophagus) to examine the area.”

Your doctor uses a long, flexible tube with a tiny camera and light at the end (endoscope) to take a small sample of your stomach tissue. A pathologist will then examine this sample under a microscope to check for cancer cells. Having a biopsy done is the only way to know for certain whether cancer cells are present in the tissue.

An x-ray machine captures detailed images of your organs and projects them to a computer screen. You might also get an injection of dye to enhance visibility of abnormal areas. Tumors that have spread to your liver, pancreas, or elsewhere in the body can show up on a CT scan.

A barium swallow is an X-ray test that is less invasive than an endoscopy. First, you swallow a chalky solution that contains barium, a silver-white metallic substance. The barium coats the inner lining of your stomach, esophagus, and small intestine. When the doctor views the X ray, the barium coating helps your doctors see any abnormalities in the lining of these organs.

Similar to a CT scan, this test involves using an x-ray machine to create a visual image of the inside of your chest. This can be used to determine if tumors have spread into your lungs.

Similar to an endoscopy, your doctor guides a thin, illuminated tube (endoscope) down your throat. However, in an endoscopic ultrasound, the endoscope has a small sensor on the end that releases inaudible sound waves, which bounce off your stomach tissues and organs. A computer then creates a picture from these echoes, revealing the depth of cancer invasion within the stomach wall. Your doctor might also use a needle to take tissue samples from your lymph nodes. Endoscopic ultrasounds are used for staging your condition.

A surgeon creates small incisions in your abdomen and uses a thin, lit tube (laparoscope) to explore and remove tissue samples for further examination. A laparoscopy test may be used for staging your condition.

A PET scan can be used to determine the extent of the cancer in the body. For this test, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body. The picture is not detailed like a CT or MRI scan, but a PET scan can look for possible areas of cancer spread in all areas of the body at once.

Many newer machines can do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor see areas that “light up” on the PET scan in more detail.

The tumor is found only in the inner layer of the stomach.

The cancer has only spread into the stomach wall’s inner layers or the outer muscle layers. It may have also spread to one or two lymph nodes.

The tumor has invaded only the submucosa (thick layer of loose connective tissue underneath the layer of the stomach that secretes mucus/acids). Cancer cells may be found in up to 6 lymph nodes. Or, the tumor has invaded the muscle layer or subserosa (layer of tissue between the outermost layer of the stomach wall and the muscle layer). Cancer cells have not spread to lymph nodes or other organs.

The tumor has grown into deeper layers of the stomach wall. Cancer has spread to some lymph nodes but not to other parts of the body.

The tumor has invaded only the submucosa (thick layer of loose connective tissue underneath the layer of the stomach that secretes mucus/acids). Cancer cells have spread to 7 to 15 lymph nodes.
Or, the tumor has invaded the muscle layer or subserosa (layer of tissue between the outermost layer of the stomach wall and the muscle layer). Cancer cells have spread to 1 to 6 lymph nodes.
Or, the tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other organs.

The tumor is larger, growing through layers of the stomach and into connective tissue outside the stomach. The cancer has spread to some lymph nodes but hasn’t spread beyond the stomach.

The tumor has invaded the muscle layer or subserosa (layer of tissue between the outermost layer of the stomach wall and the muscle layer). Cancer cells have spread to 7 to 15 lymph nodes.
Or, the tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes.
Or, the tumor has invaded nearby organs, such as the liver, colon, or spleen. Cancer cells have not spread to lymph nodes or to distant organs.

The cancer has spread to other organs beyond the stomach. It may have also spread to more than 15 lymph nodes.

Cancer cells have spread to more than 15 lymph nodes.
Or, the tumor has invaded nearby organs and at least 1 lymph node.
Or, cancer cells have spread to distant organs.