Beginning with your first appointment at the Center for Esophageal and Gastric Cancer at Dana-Farber Brigham Cancer Center, 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.
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.