Do you want to know what happens after endoscopy? It’s a surreal moment in a lot of ways, because there you are with symptoms, have a test and expect to be told that you have an ulcer, but then you are told that you have stomach cancer.
From that moment on, your whole life changes and will never be the same again. You have questions that need answers, but those answers aren’t forthcoming to you at this moment in time, and I will explain why.
What happens after endoscopy then? First of all, you will be given a time to recover from the procedure.
This varies from one person to another and is dependant on the drugs you have been given.
After you recover, you will likely be told the endoscopic diagnosis. But, this isn't all that you want to know.
What you also want to know is….
1) What Sort Of Stomach Cancer Is It?
2) What stage do I have? Is it in my stomach only or has it gone elsewhere?Most people know if it has gone elsewhere, the chances of survival are lessened, so this is a significant statement to know.
3) Will I need an operation?
4) Will I need chemotherapy?
5) Will I need radiotherapy?
6) Will I lose my hair?
7) And The Most Important Thing You Want To Know Is This – Am I Going To Die?
The problem is this, the test that you have just had is a diagnostic test, it tells the doctor (or endoscopist) that you have a tumor in the stomach, nothing more nothing less.
It doesn’t tell the endoscopist the answers to the what, will and am I going to die questions and, in some ways, I think that is a good thing!
Why? Because when you are first told that you have stomach cancer, you may react in one of three ways.
1) Stare In To Thin Air – The Denial
The first way is to stare in to space, to not take in any information and totally deny what you have heard.
This is why I always insist on, and is good practice, having someone with you when you are first told the diagnosis.
Inevitably there will be questions, but for the first reaction, these will be somewhere on the way to Mars rather than in your head.
2) I Have The Big C and I'm Going To Die
This second reaction is not uncommon. The fact is, at this point, no one knows whether you are going to live or die of this disease in the same way that you don’t know whether you are going to win the lottery or not.
In fact, a doctors mission in life is to not to allow anyone to die and so this reaction is almost irrational to the doctor although a perfectly sensible (and rational) one for the person concerned.
Giving someone information overload at this point is not a good idea. You need time to think about what has been said and to come to terms with this fact.
3) Cool, Methodical Questioning Approach
This final reaction is surprisingly common given the momentous thing that you have just been told. It not only comes from the person concerned, but can equally come from the third party in the room with you, whether that is a relative or friend.
Interestingly, it is sometimes the third party that takes on the OMG approach, whereas the sufferer is the cool one!
To me, the cool one is the most difficult to handle. Why? Because those 7 questions are likely to be asked and there is no answer to give at this point.
This almost makes the doctor seem like a fool, which they clearly are not.
Endoscopy tests only show what’s within the upper gastrointestinal tract, not what is outside of it, a concept that a lot of people can’t quite grasp.
I suspect you recognise yourself in one of these reactions; I certainly do when I was told my father had stomach cancer.
So, why do I think its a good thing not to know everything at once? Because, you really do need that time to come to terms with the diagnosis, before being hit with a ton of further information.
So at this point, what happens after endoscopy is that you will go home and wait for the next step in your journey.
So, what happens after endoscopy, having been told you have stomach cancer?
Well, a period of time occurs when further investigations need to be done and biopsies (tissue samples) need to be analysed.
The 'waiting time' varies from one hospital to another, but where I work, biopsy results usually take about a week to come through.
In this time, you are likely to receive, and may already have had, appointments for further tests, the most common of which is a CT or computerised tomography scan.
This is a special scan that produces fantastic x-ray pictures of your inner organs, as if you have been sliced in to sections.
These scans, referred to as ‘staging scans’, allow the doctor to see how extensive the problem is, hence the ‘stage’.
There are other tests that you may need, but these are the opening investigations that everyone has.
So, now you have been staged, what happens next?
In the UK, everyone with cancer (regardless of type) needs to be discussed in a multidisciplinary meeting or MDT for short. What happens after endoscopy is that a referral is made to the MDT team.
An MDT is usually made up of radiologists (x-ray doctors), physicians (medical doctors such as gastroenterologists like myself), oncologists (doctors that deal with chemotherapy and radiotherapy), UGI surgeons who operate on stomach cancers, histopathologists (who diagnose the type of cancer you have under the microscope) and specialist nurses who have an interest in this particular form of cancer.
The sole purpose of an MDT is to confirm the cancer diagnosis, stage the disease and decide on the best way of managing it, whether this is surgery, chemotherapy, radiotherapy or a combination of these therapies.
To make this decision, they look at you as a whole in terms of risk, benefit and likelihood of a successful outcome.
So now you know what happens after endoscopy and the steps that you will or have taken since.
But now those 7 questions have answers and you will likely have partly come to terms with your diagnosis and the questions are on the table for answers.
Likely, you will be called to a clinic where I would always recommend you come with a third party (family or friend) who can provide support, have an extra memory to take in the detail and also have the opportunity to ask their own questions too.
So what are the answers to those 7 questions? Well, the simple answer is I can’t tell you, because I don’t know your situation, but the doctor telling you will be able to answer them for you or at least 6 of them.
The only question they probably won't be able to answer is whether you are going to die of stomach cancer.
The reason is, that whatever stage of cancer you have, be it stage 1 or 4, there is a probability of survival. I will deal with the 'am I going to die question later on in this site.
After your meeting in clinic, it is usually a very short time before your treatment will start and the journey really does take a big step forwards at this point.