In the early stages of stomach cancer, many patients experience few or no symptoms. Because the lack of symptoms makes stomach cancer difficult to detect, doctors often diagnose the disease at more advanced stages. By that point, it is more challenging to treat.

Johns Hopkins gastroenterologist Saowanee Ngamruengphong, M.D., explains how doctors look at the stomach lining without performing surgery. The endoscopic procedure helps screen high-risk patients and diagnose this disease earlier.

Screening for Stomach Cancer

Unfortunately, there’s no recommended screening test for spotting early gastric cancer in the general population. However, Ngamruengphong says doctors use upper endoscopy to screen for — and detect — stomach cancer in people at high risk for developing the disease.

“There’s no standard guideline on who to screen for stomach cancer, so we base screening recommendations on patients’ risk for developing this cancer. Based on what we find, we determine how often patients should undergo follow-up screenings,” she says.

Factors that Ngamruengphong considers when identifying at-risk patients include:

• Ethnicity : First- and second-generation immigrants from East Asia, Russia and South America are considered higher risk. Those areas see more cases of stomach cancer than the United States.
• Family history : Having a family member with stomach cancer increases risk.
• Race : Non-Caucasians are at higher risk.
• Smoking history : Smoking increases the risk of stomach cancer.
• Physical health and genetics : Certain types of gastric infection and hereditary syndromes, such as Lynch syndrome and Peutz-Jeghers syndrome, also increase stomach cancer risk.

Diagnosing Stomach Cancer

Ngamruengphong says upper endoscopy is the gold standard test for diagnosing stomach cancer today.

During an upper endoscopy procedure:

1. Patients receive general sedation so they are asleep for the procedure and feel no pain.
2. A doctor routes a tube (with a camera attached to the end) down the mouth, through the esophagus and to the stomach.
3. As the scope moves, a doctor looks closely at the lining of the esophagus and stomach, carefully inspecting any suspicious areas that may be cancer.

What Makes Endoscopy So Effective

Even with an endoscope, it can be difficult to distinguish cancerous lesions from healthy or scarred stomach tissue.

Ngamruengphong explains why: “When we perform a screening endoscopy, we don’t see a large mass when cancer is present. Instead, we often see very small, very subtle lesions.”

Doctors with extensive experience using this screening tool can more easily spot the subtleties of very early stomach cancer. With the help of recent endoscopic technology advances such as high-quality images and dyes, doctors can detect cancer at even earlier stages.

The combination of experienced doctors and sophisticated technology advancements means people can get diagnosed — and treated — earlier. And the earlier cancer is treated, the higher the chance of a successful result.