Advanced Gastric Cancer: The Importance of a Diagnostic Laparoscopy

“Gastric cancer has some additional tools to diagnosis, such as what’s called a diagnostic laparoscopy, when a surgery is performed [to see] if cancer has spread from the lining of the stomach,” Dr. Nicholas Hornstein, a Medical Oncologist at Northwell Cancer Institute in Manhattan, tells SurvivorNet.

“This is critical for some patients with potentially more advanced disease. In some studies, as many as 30% of patients were shown to have higher stage disease based on a diagnostic laparoscopy as compared to other tools alone in patients with early-stage disease.

“An endoscopy and a CT scan may be enough information to say that they don’t need to go on to these other modalities. However, for patients with potentially more advanced disease, it’s important to have a full workup to ensure that you’re getting the appropriate treatment to help ameliorate your disease or cure it,” Dr. Hornstein explains.

How is Staging Laparoscopy Performed?

According to experts from Memorial Sloan Kettering Cancer Center, staging laparoscopy, a minimally invasive procedure, is done with small incisions (cuts) through which a laparoscope—a thin, flexible tube equipped with a light and camera—is inserted.

It is performed under general anesthesia, so patients won’t feel pain during the procedure. Doctors carefully inspect areas like the liver, diaphragm, stomach, and intestines for any signs of cancer spread. They may also collect fluid samples to test for cancer cells, helping refine the staging of the disease.

This procedure typically has a low risk of complications, offering a safe and effective way to gain deeper insights into the disease.

Procedure Overview

Patients undergoing staging laparoscopy should expect the following:

1. Anesthesia: The procedure is typically performed under general anesthesia.
2. Incisions: A small incision is made near the navel (belly button), and carbon dioxide gas is introduced to inflate the abdomen for better visibility.
3. Insertion of the camera: The laparoscope is inserted through the incision to transmit images to a video monitor.
4. Additional Instruments: If necessary, other small incisions are made to insert surgical tools for tissue sampling or minor surgical interventions.
5. Examination and Biopsy: The surgeon examines the organs and may take tissue samples for biopsy.
6. Completion: After the examination, instruments are removed, the gas is released, and incisions are closed with stitches or surgical tape.

Why is Staging Laparoscopy Essential?

Staging laparoscopy allows doctors to check for signs of cancer spread, especially within the peritoneum, which is the membrane lining the abdominal cavity.

This is critical because imaging tests, like CT scans, can sometimes miss subtle signs of spread in this area. Research has shown that up to 30-50% of cases with undetected spread on CT scans are identified through staging laparoscopy​. Identifying these signs early can prevent unnecessary surgeries and help doctors focus on treatments that offer the best quality of life.

This accuracy is crucial for patients with advanced-stage cancer, especially when they’re considering whether surgery is appropriate. In cases where the cancer has spread extensively, chemotherapy and other supportive therapies may be more beneficial than surgery, reducing surgical risks and allowing patients to start treatments sooner​.

How Staging Laparoscopy Influences Treatment

The information from diagnostic laparoscopy can change the course of treatment. If the cancer hasn’t spread to areas outside the stomach, surgery combined with chemotherapy might be pursued. However, if the laparoscopy detects widespread cancer, the focus often shifts toward therapies aimed at controlling symptoms and improving quality of life.

Knowing the extent of the disease enables doctors to recommend the most compassionate and effective care, empowering patients and their families to make informed decisions together with their healthcare team​.

Questions to Ask Your Doctor

If you or a loved one has been diagnosed with gastric cancer and you are unsure of the benefits of undergoing staging laparoscopy, consider asking your doctor the following questions.

• How can staging laparoscopy help determine the best treatment for my cancer?
• Are there risks associated with staging laparoscopy, and how likely are they?
• If staging laparoscopy reveals that my cancer has spread, what are my treatment options?
• How soon after staging laparoscopy can I start treatment?

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