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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Preparing for treatment

Cancer tests

PET/CT scan

Sometimes CT is combined with another imaging test

called PET (






omography). When

used to together, they are called a PET/CT scan.

PET/CT is advised when there may be metastases

but a CT scan didn’t detect any.

PET/CT may be done with one or two machines

depending on the cancer center. Before PET, you

must fast for 4 hours or more. There may be other

limits to your diet. About an hour before the scan, you

will be injected with a sugar radiotracer.

The radiotracer emits a small amount of energy that

is detected by the imaging machine. Cancer appears

brighter in the pictures because cancer cells use

sugar more quickly than normal cells. PET can show

even small amounts of cancer because the images

are based on the cells’ use of sugar (cell metabolism).

Upper GI endoscopy

An upper GI endoscopy allows your doctor to see

inside your esophagus and stomach. It is also called

an EGD (






uodenoscopy). For this test,

a tool called an endoscope is used.

Part of the endoscope will be guided down your

mouth. This part looks like a thin, long tube that is a

little thicker than a pencil.

See Figure 7

. You will

likely be sedated and thus unaware while the test is


At the tip of the endoscope is a light and camera that

allows your doctor to see. Your doctor will record

where the tumor is in your stomach or esophagus. If

the tumor is near the esophagus, the distance from

the EGJ may also be recorded.


Preparing for treatment

Cancer tests

CT scan with contrast

CT (computed tomography) is used to help stage the

cancer. It is an imaging test that makes pictures of the

insides of your body. The pictures are called images.

CT takes many pictures of a body part from different

angles using x-rays. A computer combines the x-rays

to make detailed pictures.

A CT scan of your chest, abdomen, and pelvis is

advised. A contrast dye should be used to make the

pictures clearer. The dye will be injected into your

vein and mixed with a liquid you drink.

The dye may cause you to feel flushed or get hives.

Rarely, serious allergic reactions occur. Tell your

doctor and the technicians if you have had bad

reactions in the past.

Before the scan, you may need to stop taking some

medicines, stop eating and drinking for a few hours,

and remove metal objects from your body. During

the scan, you will need to lie face up on a table that

moves through the machine.

See Figure 6


As the machine takes pictures, you may hear

buzzing, clicking, or whirring sounds. You will be

alone, but a technician will operate the machine in a

nearby room. He or she will be able to see, hear, and

speak with you at all times. One scan is completed in

about 30 seconds.

You will likely be able to resume your activities right

away unless you took a sedative. You may not learn

of the results for a few days since a radiologist needs

to see the pictures. A radiologist is a doctor who’s an

expert in reading the images.

Figure 7.

Upper GI endoscopy

“Scopes” are tools that are

inserted into your body to let your

doctor see live video of inside

your body. An endoscope is one

such tool that is guided down your

mouth into your stomach. It allows

your doctor to see the inner wall

of your stomach and esophagus.

If ultrasound is used, your doctor

will be able to see the deeper wall

layers and nearby organs.

Illustration Copyright © 2016 Nucleus Medical Media, All rights reserved.

Figure 6.

CT machine

Pictures of the insides of your body

can be made with an imaging test.

No devices will be inserted into

your body. However, you may be

injected with and have to drink a

contrast dye. During the test, you

will lie on a table that will move into

the tunnel of the imaging machine.

The pictures will be viewed by a

doctor who will look for signs of