Diagnosis
The first diagnostic study in a patient with the symptoms noted above is usually a radiographic examination of the stomach, preferably using a double-contrast technique and multiple projecÂtions for adequate demonstration of mucosal deÂtail. The radiographic appearance of the tumor may vary considerably, from an ulcerated or non-ulcerated exophytic mass to simply a thickened, nondistensible gastric wall. There are certain characteristics that suggest malignancy in an ulceran irregular ulcer base, an ulcer within a mass, the type of convergent foldsbut the true differentiation can only be made by biopsy.
Endoscopic examination with multiple biopÂsies of a suspicious area is now the standard means of diagnosing carcinoma of the stomach. This should be supplemented with brush cytology obtained at the time of endoscopy, since cytology will sometimes (about 15 per cent) be positive even when the biopsy specimens do not reveal carcinoma. No other laboratory studies are diagÂnostic.