NCCN Guidelines for Patients
Stomach Cancer, Version 1.2016
Preparing for treatment
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.
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.