Endoscopy permits direct inspection and biopsy of suspicious areas. A gastric ulcer should have multiple biopsies from the margins and brush cytology from the base and under the edges. Occasionally, a biopsy limited to the mucosa misses tumor tissue in the submucosa. In experienced hands, use of a brush together with biopsy improves results. X-rays are generally unreliable in finding small, early lesions.
Gastric analysis is of limited value.
Treatment Excision of the tumor when possible offers the only hope of cure. The prognosis is good if the tumor is limited to the mucosa and submucosa. In the USA, surgical results are poor because most patients present with more extensive cancer. Surgical results are better in Japan, where early cancers are detected by mass screening. Results with primary lymphoma of the stomach are better than those with gastric adenocarcinoma.