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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Preparing for treatment

Cancer tests

Your doctor may obtain a sample of the tumor. This

is called a biopsy. Also, samples from tissue that

is at high risk for cancer and tissue with possible

cancer may be collected. The presence of Barrett’s

metaplasia or dysplasia increases the likelihood of


Biopsy samples are removed with small forceps

that are inserted through the open channel of the

endoscope. Six to eight biopsy samples may be

removed. Biopsy samples will be sent to a pathologist

for testing. After the endoscopy, you may feel some

swelling and sound hoarse.








ound) uses both imaging

and an endoscope to see how deep the tumor has

grown into the stomach wall. Also, signs of cancer

within lymph nodes and other nearby organs can be


Like EGD, you will likely be sedated for EUS. The

EUS endoscope will be guided down your esophagus.

The ultrasound device bounces sound waves off

organs to make pictures.

If it looks like the cancer has spread, the endoscope

can be used to do an FNA (







An FNA is a type of biopsy. A needle will be inserted

through the wall of your stomach or esophagus and

into nearby tissue to get samples. Samples may be

obtained from lymph nodes or organs next to your

stomach, such as your liver. An FNA may be done

as long as the needle doesn’t go through the primary

tumor or major blood vessels.

After the FNA, the endoscopist will provide clinical

staging information. He or she will report the depth of

tumor growth (T stage) and whether cancer is present

in your lymph nodes (N stage). This information will

help your doctor plan the best treatment for you.

Endoscopic resection

Instead of a diagnostic tool, endoscopic resection is

more often used as treatment of tumors that haven’t

grown deep into the stomach wall. Read Part 4

for more details. Briefly, your doctor may be able

to remove tumor(s) and high-risk tissue with tools

inserted through an endoscope.

Laparoscopy with biopsy

This test is a type of surgery that allows your doctor

to look for diseases inside your belly area (abdomen).

Laparoscopy is advised for stomach cancer that

1) has spread beyond the first layer of the stomach

wall (T1b and higher scores), 2) is not detected in

distant sites (M0 score) by other tests, and 3) may be

treated with chemoradiation or surgery. Laparoscopy

may detect distant metastases in the tissue lining of

the abdomen (peritoneum) or liver.

Laparoscopy is done under general anesthesia. It

involves the use of a tool called a laparoscope, which

is much like an endoscope. The tube-like part of the

laparoscope will be inserted through a tiny cut in your

abdomen. Your doctor will be able to look for signs of

cancer and obtain fluid for cancer testing (peritoneal


Laparoscopy is done in an operating room and takes

about 30 minutes. After the surgery, you may feel

tired and may have some pain. You may also have a

small scar after the cut has healed. You will be able

to go home about one hour after the procedure is

completed and can go back to work the next day.

Biopsy of distant sites

An M1 score is defined as cancer spread to sites

distant from the stomach. If imaging suggests a rating

of M1, a biopsy of the distant site may be needed to

confirm the presence of cancer. The type of biopsy

used depends on the site and other factors.