Diagnosis

When you go to see your doctor, explain your symptoms in full. It may help to write everything down before you go to ensure you tell them everything, including which symptoms you have noticed, when they started, when they happen and how often they happen.

Tell your doctor about any existing illnesses you have (particularly GERD and H. pylori infection, if known) and any family history of cancer.

Take a trusted relative or friend along for support if needed. Sometimes it’s hard to remember all the questions you wanted to ask or to take in everything the doctor is telling you and having someone there can really help.

Also remember, there is no need to be embarrassed. Doctors are very used to discussing intimate problems and everything you tell them is completely confidential.

Your doctor might do a general examination, particularly any areas that may be swollen or painful, such as the abdomen. They may refer you for tests or to a specialist.

Tests

If oesophagus or gastric cancer are suspected, various tests will be needed to confirm the diagnosis. If cancer is found, further tests will be done to help determine the extent (stage) of the cancer.

Imaging tests

For oesophageal or gastric cancer, imaging tests are usually the first step. Imaging tests take pictures of the inside of your body.

• Barium swallow test: In this test, you will be asked to swallow a thick, chalky liquid called barium to coat the walls of the oesophagus. X-rays are then taken. The barium outlines the oesophagus and allows your doctor to see it more clearly to determine if there are any abnormal areas.
• Computed Tomography (CT) scan: uses X-rays to take detailed pictures of your body, revealing any abnormal areas in your oesophagus.
• Magnetic Resonance Imaging (MRI) scan: creates pictures using magnetism and radio waves, revealing any abnormal areas in your oesophagus.
• Positron Emission Tomography (PET) scan: a slightly radioactive (but harmless) form of sugar (known as FDG) is injected into the blood and collects mainly in cancer cells. These areas of radioactivity can be seen on a PET scan using a special camera.

Endoscopy/gastroscopy

After having an imaging test(s), it is likely you will have an endoscopy to make the diagnosis. An endoscope is a flexible, narrow tube with a tiny video camera and light on the end that is used to look inside the body.

• Endoscopy/gastroscopy: During an endoscopy/gastroscopy, you may be sedated, or receive a local anaesthetic throat spray to numb the area. Then the doctor passes an endoscope down your throat and into the oesophagus and stomach. The endoscope’s camera is connected to a monitor, which lets the doctor see any abnormal areas clearly. The doctor can use special instruments through the scope to remove tissue samples (a biopsy) from any abnormal areas to be tested.
• Thoracoscopy and laparoscopy: These procedures are done in an operating room, while you are under general anaesthesia. A small incision is made in the side of the chest wall (for thoracoscopy) or the abdomen (for laparoscopy). The doctor then inserts a scope (a thin, lighted tube with a small video camera on the end) through the incision to view the space around the oesophagus to see lymph nodes and other organs near the oesophagus inside the chest.

Biopsy

Sometimes it’s necessary to remove a piece of tissue for laboratory testing in order to make a definitive diagnosis of oesophageal or stomach cancer.

A biopsy can be taken during an endoscopy, thoracoscopy or laparoscopy.

This will then be examined under a microscope and a definitive diagnosis can be given.