Understanding Esophageal Cancer: The Diagnosis

The first step in diagnosing esophageal cancer is to take a medical history and do a physical exam. Your doctor will ask about symptoms, like difficulty swallowing. These symptoms might indicate esophageal cancer.

The next diagnostic step will be to do some imaging tests such as:

Barium swallow or upper GI X-rays: This series of X-rays are taken after you drink barium. This is a thick liquid that coats the surface of your esophagus. This makes lumps on the esophageal lining show up on the X-ray. Doctors usually ask for a barium swallow test first when they suspect esophageal problems.

CT scan (CAT scan or computed tomography): This type of X-ray takes many pictures of different angles of your esophagus. Before the X-ray, you will have to drink 1 to 2 pints of liquid dye. This helps outline your esophagus and intestines. If it’s difficult for you to swallow, you may instead get an IV (intravenous) line. The contrast dye can be delivered through the IV.

You may experience a warm feeling and some redness from the injection. This may be uncomfortable, but it is not painful. A CT scan takes longer than a regular X-ray. You will have to lie very still on a table. This table will slide in and out of the scanner. Some people complain that they feel restless and confined. There are newer CT scanners in many hospitals and clinics that are faster and less confining.

The CT scan can help locate the cancer and determine how big it is. Your doctor will also use the CT scan to decide whether surgery is a good option for you.

MRI (magnetic resonance imaging): MRI scans are similar to CT scans except that they use radio waves and strong magnets to take pictures. MRIs are a little more uncomfortable than CT scans, because they involve an enclosed space. They also take longer. An MRI usually takes about an hour.

PET scan (positron emission tomography): This scan requires a special radioactive sugar to be injected in your vein. The cancerous tissues then take up the sugar. That enables a scanner to easily see those areas. PET scans are useful for finding cancer that has spread.

Endoscopy: Is a general term referring to a procedure that uses an endoscope, which is a thin, flexible tube with a light and video camera on the end. Your doctor will use it to examine the inside of your organs. If there are areas that look suspicious, a small piece of tissue can be removed through the tissue. This is called a biopsy.

Upper endoscopy: You will be given a sedative or anesthesia to make you sleepy. Then the endoscope will be passed through your mouth, down your esophagus, into your stomach, and into the upper part of your small intestine. This test lets your surgeon take a tissue sample if necessary. It also allows your doctor to make the opening bigger, if there is a cancerous mass blocking the opening of the esophagus. This will make food and liquids pass more easily.

Endoscopic ultrasound: An endoscopic ultrasound is the best way to evaluate an esophageal cancers depth of penetration into the layers of muscle. In this test, the wand is on the end of a long tube. This tube is put through your nose or mouth into your stomach. This produces a very good picture. An endoscopic ultrasound is better than CT scans for seeing small tumors. You will be given a sedative or anesthesia to make you sleepy or relaxed before you have this ultrasound.

Doctors use both kinds of endoscopy to determine whether surgery is appropriate.

Bronchoscopy: This procedure is similar to an upper endoscopy. The difference is that the doctor will look into your windpipe and tubes leading into your lungs. He or she will be looking to see if cancer has spread there. Before you have the procedure, your mouth and throat will be sprayed with a numbing medicine. You might also be given a sedative to relax you. During a bronchoscopy, it’s also possible to take a biopsy sample.

Thoracoscopy and laparoscopy: These procedures allow your doctor to see lymph nodes and other organs inside your chest or belly (abdomen). The test uses a thin, hollow, lighted tube. In these tests, your doctor can also remove lymph nodes and examine them for cancer. These procedures help your doctor determine whether surgery is appropriate.

Before you have either a thoracoscopy or laparoscopy, you will be put in the hospital and given general anesthesia. To insert the tube, the doctor will have to make a small incision (cut) either:

  • In the side of your chest wall (in a thorascopy) or
  • In your abdomen (in a laparoscopy).

Biopsy: A spot on endoscopy or on an X-ray may look like cancer. However, the only way to know for sure is to do a biopsy. In a biopsy, your doctor removes a small piece of tissue from the area that looks suspicious. Then the tissue is examined under a microscope. The goal is to determine:

  • If cancer cells are there and
  • What type of cancer cells they are.

It usually takes a few days to get the results of a biopsy.

Next: How is esophageal cancer staged? 

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