Stomach Cancer: Diagnosis

How is stomach cancer diagnosed?

If your healthcare provider thinks you might have stomach cancer, you’ll need certain exams and tests to be sure. Diagnosing stomach cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.

What tests might I need?

You may have one or more of the following tests:

  • Fecal occult blood test (FOBT)

  • Blood tests

  • Upper endoscopy

  • Upper GI series

  • Biopsy

Lab tests

Fecal occult blood test (FOBT)

This testis used to check for hidden blood in your stool. Your healthcare provider may place a small amount of your stool on a plastic slide or a special type of paper. Or you may do this test at home. Stomach cancer can sometimes cause small amounts of bleeding. This can be hard to see. However, other conditions that aren’t cancer can also cause this. Even if the test shows blood in your stool, you’ll likely need other tests to tell whether or not it’s due to cancer.

Blood tests

Blood tests can check if you have low red blood cell counts. This could be due to bleeding in your stomach. Blood tests can also be used to see how well certain organs are working and what overall health is like.

Endoscopic tests

Upper endoscopy

This test is also called an esophagogastroduodenoscopy (EGD). This procedure helps find most stomach cancers. It’s often the first test done. During this test, a healthcare provider looks at the inside of your stomach with a thin, flexible, lighted tube. This is called an endoscope. He or she guides the scope through your throat and down into your stomach. You’re sedated during this test.

An upper endoscopy also checks your esophagus and part of your duodenum, which is the first section of your small intestine. If your healthcare provider sees tissue that’s abnormal, he or she takes a small sample of the changed tissue out through the scope. This is done to check for cancer cells. This is called an endoscopic biopsy. 

Your healthcare provider may do an upper endoscopy with an endoscopic ultrasound (EUS) exam. The EUS uses sound waves to make a better picture of your stomach wall, nearby tissues, and lymph nodes.

Imaging tests

Upper GI series

This is also called a barium swallow. During this test, your healthcare provider can see even small abnormalities in your stomach lining. For this test, you’ll drink a thick, chalky fluid with barium in it. This fluid lines your stomach. This makes it easier to see on an X-ray. To see very early cancers, your healthcare provider may use a double contrast technique. For this, a small tube is placed in your stomach after drinking the barium. Air is then pumped through the tube into your stomach. This makes the barium coating thinner around the inside of your stomach. This helps your healthcare provider see small changes in your stomach.


A biopsy is when your healthcare provider removes a small sample of abnormal tissue from your stomach. A pathologist looks at the sample under a microscope. In addition to checking for stomach cancer, a biopsy can also show other conditions. These can include H. pylori bacterial infection, noncancerous diseases, or another type of cancer called a lymphoma.  A biopsy can show changes on the lining of your stomach.

A biopsy is needed to confirm a diagnosis of stomach cancer.

Laparoscopic surgery

This surgery is done by making a small incision in your skin. Then your healthcare provider puts an instrument in it to look at the inside of your abdomen. If he or she sees any suspicious areas, your healthcare provider can remove them and look at them under the microscope. This is called a laparoscopic biopsy.

Endoscopic stomach biopsy

This is the most common type of biopsy used. This is a procedure that uses an endoscope. During the procedure, you’ll receive medicine to help you relax. You’ll also receive a numbing medicine sprayed into your throat. This is to help prevent gagging. Once you’re relaxed, your healthcare provider puts the endoscope into your mouth and guides it down your throat and into your stomach. He or she looks at the lining of your stomach with the scope. Tools can be passed through the scope to take tissue samples from any abnormal areas.

Endoscopic ultrasound-guided needle biopsy 

This test also uses an endoscope. The scope has a special ultrasound tool at the tip. The ultrasound tip is put against your stomach walls to create images. This procedure may be used if a healthcare provider thinks the cancer is deeper in the wall of your stomach. You’ll receive medicine to help you relax. You’ll also receive a numbing medicine sprayed into your throat. This is to help prevent gagging. The endoscope is then put into your mouth and guided into your stomach.

The ultrasound tip is placed against your stomach walls. Your healthcare provider looks at the lining of your stomach with the scope. He or she can view images of the layers of your stomach, lymph nodes, and other nearby tissues. If he or she sees suspicious areas, your healthcare provider will pass a thin, hollow needle through the scope and into your stomach wall. This needle is used to take the tiny pieces of tissue to test in the lab.

Getting your test results

When your healthcare provider has the results of your biopsy, he or she will contact you with the results. Your provider will talk with you about other tests you may need if stomach cancer is found. Make sure you understand the results and what follow-up you need.