context: Your doctor may identify signs of stomach cancer, such as enlarged lymph nodes or liver, increased fluid in the abdomen (ascites), or bumps (nodules) in or under the skin of the abdomen during a physical exam. These signs typically indicate an advanced cancer. If you complain of vague symptoms such as persistent indigestion, pain, difficulty swallowing, weight loss, nausea, vomiting, and loss of appetite, your doctor should order tests. These may include: Upper GI series. These are X-rays of the esophagus (food tube) and stomach, which is called the upper gastrointestinal ( GI) tract. You drink a barium solution, which outlines the stomach on the X-ray, helping the doctor see tumors or other abnormalities. Endoscopy and biopsy. This test examines the esophagus and stomach using a thin, lighted tube called an endoscope, which is passed through the mouth to the stomach. Through the endoscope, the doctor can look directly at the inside of the stomach. If an abnormal area is found, the doctor will remove some tissue to be examined under a microscope (called a biopsy). A biopsy is the only sure way to diagnose cancer. Endoscopy and biopsy are the best methods of identifying stomach cancer. CT scan. A computed tomography ( CT) scan can give your doctor detailed pictures of structures inside of the body using X-rays. This test is used after a stomach cancer is diagnosed in order to determine the stage of the cancer. To evaluate whether the tumor has spread to the lymph nodes or other organs, the chest, abdomen, and pelvis are scanned. The CT scan can also detect fluid in the abdomen (ascites) as well as abdominal and pelvic nodules. Endoscopic ultrasound. This test can determine the depth of invasion of the tumor and evaluate lymph nodes around the cancer. Additional staging tests. In order to determine the severity of stomach cancer, other tests such as a bone scan, PET scan, or laparoscopy may be performed. Treatments for stomach cancer may include one or more of the following: Surgery, called gastrectomy, removes all or part of the stomach, as well as some of the tissue surrounding the stomach. Lymph nodes near the stomach are also removed and biopsied to check for cancer cells. For stage zero through stage 3 stomach cancer, surgery provides the only real chance for a cure at this time. Chemotherapy is the use of anticancer drugs. This may be used before and after surgery or for cancers that have spread to other organs. Prior to surgery, chemotherapy -- with or without radiation -- is sometimes used to shrink the tumor or to make an inoperable tumor suitable for surgery (known as neo-adjuvant therapy). Radiation therapy is the use of ionizing X-rays to kill cancer cells and shrink tumors. This is used with chemotherapy before or after surgery and sometimes both. It can also be used to relieve symptoms in those with localized cancer (cancer that hasn't spread to other parts of the body) or to relieve localized symptoms in persons whose cancer has metastasized (spread to another part of the body). If treated at an early stage before it spreads, stomach cancer may be associated with a long survival. A patient whose tumor is removed completely has a good chance of surviving at least five years. Unfortunately, by the time most cases of stomach cancer are diagnosed, the cancer has spread to local lymph nodes or other organs. Only about one in five patients diagnosed with stomach cancer that has spread to other organs or lymph nodes will survive five years.