Skip to main contentLast updated: 17-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Stomach Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.89 from 216 reviews (Gota clinic) · 4.94 from 18 reviews (Apollo, Bhat)
In short
Stomach cancer is confirmed by endoscopy with several biopsies. Scans and a keyhole look inside then show how far it has spread.
A CT scan of the chest, abdomen and pelvis is done for everyone. EUS and PET-CT are added only for chosen patients.
Small deposits on the abdominal lining often hide from CT. A staging laparoscopy with a saline wash finds them before a big operation.
Stomach cancer rarely gives a clear warning early on. Most people first notice vague changes. The signs below are reasons to have an endoscopy. They are not proof of cancer.
| What the person notices | What it can point to |
|---|---|
| Weight loss, poor appetite, or feeling full after a few bites. | A tumour anywhere in the stomach. A stiff, shrunken stomach makes a large meal impossible. |
| Upper belly pain or indigestion that does not settle with acid tablets, after the age of 45. | A tumour or an ulcer that needs a biopsy. |
| Tiredness from low blood, or black stools. | Slow bleeding from a tumour. |
| Food sticking on the way down. | A tumour in the upper stomach, near the food pipe. |
| Vomiting after meals. | A tumour in the lower stomach that blocks the outlet. |
| A hard gland above the left collarbone, or a lump at the navel. | Late spread. The tests then show how far it has gone. |
In India, many people wait months before the first endoscopy. So the cancer is often larger when it is found. That is one reason the later tests look so hard for spread.
A good first endoscopy records exactly where the tumour sits. That distance later decides whether part of the stomach or all of it is removed.
A thin tube with a camera is passed through the mouth. The doctor looks at every part, from the top of the stomach to its outlet and the first part of the bowel. Special light settings show the tumour’s edges more clearly.
Several biopsies are taken from different parts of the tumour, including its base. A few more come from other areas of the stomach. These show the state of the lining around the tumour. The report notes the size of the tumour. It also notes its distance from the teeth, from the food pipe junction and from the outlet. Photographs are kept.
Two situations need extra care:
Before surgery, the surgeon who will operate repeats the endoscopy. This confirms the site. A small ink mark may be placed to guide the cut edge.
The pathologist first confirms the type of cancer. Most stomach cancers are adenocarcinoma. The report says whether it is the intestinal type or the diffuse type. Signet-ring cancer belongs to the diffuse group.
The same tissue is then tested for markers that guide medicines. These are HER2, PD-L1, MMR (also called MSI) and Claudin-18.2. If the cancer has already spread, a wider gene test may be added.
Every patient needs a contrast CT of the chest, abdomen and pelvis. It shows the tumour, the nearby glands, and spread to the liver, lungs or abdominal lining.
You drink water just before the scan, so the stomach is stretched. Dye is given by injection, and pictures are taken in two phases. The radiologist checks the tumour and the glands near it and far from it. The liver, lungs, bones and the lining of the abdomen are checked too. In women, the ovaries are also checked, because stomach cancer can spread there.
CT has limits. Very small deposits on the abdominal lining often do not show. Tiny spread to the ovaries can be missed. In linitis plastica, the tumour can look less deep than it is if the stomach is not well stretched.
| Test | Who needs it | What it answers |
|---|---|---|
| EUS (endoscopic ultrasound) | A very early tumour. A tumour at the food pipe junction. A suspected hidden linitis plastica. | How deep the tumour has gone into the wall, and whether nearby glands look involved. A needle sample of a doubtful gland can be taken. It is less reliable for very deep tumours. |
| PET-CT | Selected patients, mostly with the intestinal type. Anyone whose CT shows a doubtful distant spot. | Spread to distant glands or bone. It helps less in diffuse and signet-ring cancers. It can also check for growth during long chemotherapy. |
| Tumour markers (CEA, CA 19-9, CA 72-4) | Often done at the start. | They do not diagnose cancer. If they are raised at the start, they help follow the disease later. A normal result does not rule out spread. |
For a very early tumour, EUS settles one key question. If the cancer is only in the inner layer, it may be removed through the endoscope. If it has reached the next layer, an operation is usually needed.
Small deposits on the abdominal lining often hide from CT. A keyhole look inside, with a saline wash, finds them before any major operation.
The surgeon makes three small cuts and passes in a camera. Every surface is checked. This includes the abdominal wall, the fat apron, the bowel, the space behind the stomach and the liver surface. In women, the ovaries are checked too. Warm saline is washed through the upper abdomen and the pelvis. The fluid goes to the laboratory to look for cancer cells. Any doubtful spot is biopsied.
Who needs it:
It is optional for a smaller tumour in the lower stomach with clear glands. It is not needed for a very early tumour.
Sometimes the wash shows cancer cells but nothing is seen. This still counts as spread. Chemotherapy then comes first. After it, the keyhole look and the wash are repeated. Surgery is considered only if the wash has become clear.
Blood tests check the blood count, iron, vitamin B12, sugar control, liver and kidney function, and clotting. An ECG is done. Older patients, and those with heart disease, have a heart echo. People with lung disease have breathing tests. Nutrition is assessed, including grip strength. The CT also shows muscle bulk, which helps predict how well a person will cope with surgery.
Preparation often starts at this point:
Every stomach cancer that has reached the muscle layer or beyond is discussed at a tumour board before treatment. The surgeon, the medical oncologist, the pathologist and the radiologist meet. A radiation oncologist joins for junction tumours. Nutrition and palliative care doctors join when needed. Together they decide whether the operation or chemotherapy comes first. When chemotherapy comes first is explained on the chemotherapy before surgery page.
No. A CT scan is done for everyone. PET-CT is added for selected patients, mostly when the CT shows a doubtful spot.
The surgeon confirms the site and plans the cut edge. A small ink mark may be placed to guide the operation.
Linitis plastica can hide under a normal lining. Deeper biopsies or EUS are needed before cancer is ruled out.
No. Markers do not diagnose cancer or rule out spread. They help follow the disease if they are raised at the start.
No. It is a keyhole procedure through three small cuts. It finds spread that would make a large operation unhelpful.
Treatment choices are covered on the stomach cancer treatment page. For questions before you travel, call +91-63555-64601.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of endoscopy, biopsy and scan reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Bhat, Gandhinagar. Endoscopy, staging laparoscopy, surgery and inpatient care.
Has an endoscopy shown a growth in the stomach? The endoscopy, biopsy and CT reports can be sent ahead on WhatsApp, so the consultation starts with them already read. Which tests you still need is decided at the consultation, after examination. Call +91-63555-64601 Send reports before your visit
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