Esophagus cancers are usually found because of signs or symptoms a person is having. If esophagus cancer is suspected, exams and tests will be needed to confirm the diagnosis. Tests and procedures used to diagnose esophageal cancer include:
Endoscopy
This is one of the first tests you will have to help confirm a diagnosis of cancer of the oesophagus. Endoscopy is a medical procedure that allows doctors to see inside the body. During this procedure a thin, flexible instrument called an endoscope is passed through your mouth and down towards your stomach. The endoscope has a light attached to the end and feeds back the images of your oesophagus to a monitor. This will allow your doctor to look for any signs of abnormal cells or tumours.
Before having an endoscopy you should avoid eating for several hours, as food can obstruct the view of the endoscope. An endoscopy should not cause you any pain, although it may feel uncomfortable. Before the endoscopy takes place you will normally be given a local anaesthetic or sedative to help you relax and to help make the procedure less uncomfortable. The endoscopy itself will usually take about 15 minutes, although you should allow approximately two hours for your visit.
• Bronchoscopy
This exam may be done for cancer in the upper part of the esophagus to see if it has spread to the windpipe (trachea) or the tubes leading from the windpipe into the lungs (bronchi). For this test, a lighted, flexible fiber-optic tube (bronchoscope) is passed through your mouth or nose and down into the windpipe and bronchi. The mouth and throat are sprayed first with a numbing medicine. You may also be given medicine through an intravenous (IV) line to make you feel relaxed. If abnormal areas are seen, small instruments can be passed down the bronchoscope to take biopsy samples.
• Endoscopic ultrasound
Once cancer of the oesophagus has been diagnosed your doctor will need to assess how far the cancer has spread and how large the tumour has grown. An endoscopic ultrasound will help your doctors assess how far your oesophageal cancer has progressed. It involves having a very small ultrasound probe passed into your oesophagus using an endoscope. This test produces sound waves that can penetrate the surrounding tissues. These waves are then used to produce an image of your oesophagus so your doctor can see if the cancer has spread to the surrounding tissue.
• Thoracoscopy and laparoscopy
These exams let the doctor see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube. These procedures are done in an operating room while you are under general anesthesia (in a deep sleep). A small cut (incision) is made in the side of the chest wall (for thoracoscopy) or the abdomen (for laparoscopy). Sometimes more than one cut is made. The doctor then inserts a thin, lighted tube with a small video camera on the end through the incision to view the space around the esophagus. The surgeon can pass thin instruments into the space to remove lymph node and biopsy samples to see if the cancer has spread. This information is often important in deciding whether or not a person is likely to benefit from surgery.
• Upper endoscopy
This is an important test for diagnosing esophageal cancer. During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes the endoscope down the throat and into the esophagus and stomach. The camera is connected to a monitor, which lets the doctor see any abnormal areas in the wall of the esophagus clearly. The doctor can use special instruments through the scope to remove (biopsy) samples from any abnormal areas. These samples are sent to the lab so that a doctor can look at them under a microscope to see if they contain cancer.
If the esophageal cancer is blocking the opening (called the lumen) of the esophagus, certain instruments can be used to help enlarge the opening to help food and liquid pass. Upper endoscopy can give the doctor important information about the size and spread of the tumor, which can be used to help determine if the tumor can be removed with surgery.
Imaging tests
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons both before and after a diagnosis of esophageal cancer, including:
A barium swallow is a test that involves drinking a thick white liquid called barium. Once you have swallowed the barium you will undergo a series of X-rays. The barium coats the lining of your oesophagus so that it shows up on the X-ray. These X-rays are able to show your doctor whether there is an obstruction in your oesophagus, which may be an indication of a tumour.
You may have to undergo this test if your cancer has already been diagnosed, as it will help your doctor to assess the size of your tumour. A barium swallow usually takes about 15 minutes to perform. After the procedure you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. Esophageal Cancer Diagnosis
• Computed tomography (CT or CAT) scan
A CT scan takes a series of X-ray images of your body and uses a computer to put them together. This then creates a very detailed picture of the inside of your body. This will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours in any other places within the body. A CT scan will also allow your doctors to work out which type of treatment will be most effective and appropriate for you.
• Magnetic resonance imaging (MRI) scan
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected into a vein. This contrast is different than the one used for CT scans, so being allergic to one doesn’t mean you are allergic to the other.
MRI scans are very helpful in looking at the brain and spinal cord, but they are not often needed to assess spread of esophageal cancer. MRI scans take longer than CT scans – often up to an hour – and are a little more uncomfortable. You have to lie on a table that slides inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special, more open MRI machines can sometimes help with this if needed, although the images may not be as sharp in some cases. MRI machines make buzzing and clicking noises that you may find disturbing. Some centers provide earplugs to help block this noise out.
• Positron emission tomography (PET) scan
A positive emission tomography (PET) scan can produce a detailed, three-dimensional picture of the inside of the body. During a PET scan a substance known as a radiotracer is passed into your body. A radiotracer is a radioactive chemical that releases tiny particles called positrons. A PET scan may be used to find out whether the cancer has spread. It may also be used for follow-up examinations after treatment to check for scar tissue or any remaining cancer cells.
Lab testing of biopsy samples
An area seen on endoscopy or on an imaging test may look like cancer, but the only way to know for sure is to do a biopsy. For a biopsy, the doctor removes small pieces of tissue from an abnormal area. This is most often done during an endoscopy exam. A doctor called a pathologist then looks at the tissue under a microscope to see if it contains cancer cells. If there is cancer, the pathologist will determine the type (adenocarcinoma or squamous cell) and the grade of the cancer (how abnormal the patterns of cells look under the microscope).
HER2 testing: If esophageal cancer is found but is too advanced for surgery, your biopsy samples may be tested for the HER2 gene or protein. Some people with esophageal cancer have too much of the HER2 protein on the surface of their cancer cells, which helps the cells grow. A drug that targets the HER2 protein, known as trastuzumab (Herceptin®), may help treat these cancers when used along with chemotherapy. Only cancers that have too much of the HER2 gene or protein are likely to be affected by this drug, which is why doctors may test tumor samples for it.
Medical history and physical exam
If you have symptoms that might be caused by esophageal cancer, the doctor will ask about your medical history to check for possible risk factors and to learn more about your symptoms. Your doctor will also examine you to look for possible signs of esophageal cancer and other health problems. He or she will probably pay special attention to your neck and chest areas. If the results of the exam are abnormal, your doctor probably will order tests to help find the problem. You may also be referred to a gastroenterologist (a doctor specializing in digestive system diseases) for further tests and treatment. Esophageal Cancer Diagnosis
Endoscopy
This is one of the first tests you will have to help confirm a diagnosis of cancer of the oesophagus. Endoscopy is a medical procedure that allows doctors to see inside the body. During this procedure a thin, flexible instrument called an endoscope is passed through your mouth and down towards your stomach. The endoscope has a light attached to the end and feeds back the images of your oesophagus to a monitor. This will allow your doctor to look for any signs of abnormal cells or tumours.
Before having an endoscopy you should avoid eating for several hours, as food can obstruct the view of the endoscope. An endoscopy should not cause you any pain, although it may feel uncomfortable. Before the endoscopy takes place you will normally be given a local anaesthetic or sedative to help you relax and to help make the procedure less uncomfortable. The endoscopy itself will usually take about 15 minutes, although you should allow approximately two hours for your visit.
• Bronchoscopy
This exam may be done for cancer in the upper part of the esophagus to see if it has spread to the windpipe (trachea) or the tubes leading from the windpipe into the lungs (bronchi). For this test, a lighted, flexible fiber-optic tube (bronchoscope) is passed through your mouth or nose and down into the windpipe and bronchi. The mouth and throat are sprayed first with a numbing medicine. You may also be given medicine through an intravenous (IV) line to make you feel relaxed. If abnormal areas are seen, small instruments can be passed down the bronchoscope to take biopsy samples.
• Endoscopic ultrasound
Once cancer of the oesophagus has been diagnosed your doctor will need to assess how far the cancer has spread and how large the tumour has grown. An endoscopic ultrasound will help your doctors assess how far your oesophageal cancer has progressed. It involves having a very small ultrasound probe passed into your oesophagus using an endoscope. This test produces sound waves that can penetrate the surrounding tissues. These waves are then used to produce an image of your oesophagus so your doctor can see if the cancer has spread to the surrounding tissue.
• Thoracoscopy and laparoscopy
These exams let the doctor see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube. These procedures are done in an operating room while you are under general anesthesia (in a deep sleep). A small cut (incision) is made in the side of the chest wall (for thoracoscopy) or the abdomen (for laparoscopy). Sometimes more than one cut is made. The doctor then inserts a thin, lighted tube with a small video camera on the end through the incision to view the space around the esophagus. The surgeon can pass thin instruments into the space to remove lymph node and biopsy samples to see if the cancer has spread. This information is often important in deciding whether or not a person is likely to benefit from surgery.
• Upper endoscopy
This is an important test for diagnosing esophageal cancer. During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes the endoscope down the throat and into the esophagus and stomach. The camera is connected to a monitor, which lets the doctor see any abnormal areas in the wall of the esophagus clearly. The doctor can use special instruments through the scope to remove (biopsy) samples from any abnormal areas. These samples are sent to the lab so that a doctor can look at them under a microscope to see if they contain cancer.
If the esophageal cancer is blocking the opening (called the lumen) of the esophagus, certain instruments can be used to help enlarge the opening to help food and liquid pass. Upper endoscopy can give the doctor important information about the size and spread of the tumor, which can be used to help determine if the tumor can be removed with surgery.
Imaging tests
- To help determine if the treatment has been effective
- To help find a suspicious area that might be cancer
- To learn if and how far cancer has spread
- To look for possible signs of cancer coming back after treatment
A barium swallow is a test that involves drinking a thick white liquid called barium. Once you have swallowed the barium you will undergo a series of X-rays. The barium coats the lining of your oesophagus so that it shows up on the X-ray. These X-rays are able to show your doctor whether there is an obstruction in your oesophagus, which may be an indication of a tumour.
You may have to undergo this test if your cancer has already been diagnosed, as it will help your doctor to assess the size of your tumour. A barium swallow usually takes about 15 minutes to perform. After the procedure you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. Esophageal Cancer Diagnosis
• Computed tomography (CT or CAT) scan
A CT scan takes a series of X-ray images of your body and uses a computer to put them together. This then creates a very detailed picture of the inside of your body. This will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours in any other places within the body. A CT scan will also allow your doctors to work out which type of treatment will be most effective and appropriate for you.
• Magnetic resonance imaging (MRI) scan
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected into a vein. This contrast is different than the one used for CT scans, so being allergic to one doesn’t mean you are allergic to the other.
MRI scans are very helpful in looking at the brain and spinal cord, but they are not often needed to assess spread of esophageal cancer. MRI scans take longer than CT scans – often up to an hour – and are a little more uncomfortable. You have to lie on a table that slides inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special, more open MRI machines can sometimes help with this if needed, although the images may not be as sharp in some cases. MRI machines make buzzing and clicking noises that you may find disturbing. Some centers provide earplugs to help block this noise out.
• Positron emission tomography (PET) scan
A positive emission tomography (PET) scan can produce a detailed, three-dimensional picture of the inside of the body. During a PET scan a substance known as a radiotracer is passed into your body. A radiotracer is a radioactive chemical that releases tiny particles called positrons. A PET scan may be used to find out whether the cancer has spread. It may also be used for follow-up examinations after treatment to check for scar tissue or any remaining cancer cells.
Lab testing of biopsy samples
An area seen on endoscopy or on an imaging test may look like cancer, but the only way to know for sure is to do a biopsy. For a biopsy, the doctor removes small pieces of tissue from an abnormal area. This is most often done during an endoscopy exam. A doctor called a pathologist then looks at the tissue under a microscope to see if it contains cancer cells. If there is cancer, the pathologist will determine the type (adenocarcinoma or squamous cell) and the grade of the cancer (how abnormal the patterns of cells look under the microscope).
HER2 testing: If esophageal cancer is found but is too advanced for surgery, your biopsy samples may be tested for the HER2 gene or protein. Some people with esophageal cancer have too much of the HER2 protein on the surface of their cancer cells, which helps the cells grow. A drug that targets the HER2 protein, known as trastuzumab (Herceptin®), may help treat these cancers when used along with chemotherapy. Only cancers that have too much of the HER2 gene or protein are likely to be affected by this drug, which is why doctors may test tumor samples for it.
Medical history and physical exam
If you have symptoms that might be caused by esophageal cancer, the doctor will ask about your medical history to check for possible risk factors and to learn more about your symptoms. Your doctor will also examine you to look for possible signs of esophageal cancer and other health problems. He or she will probably pay special attention to your neck and chest areas. If the results of the exam are abnormal, your doctor probably will order tests to help find the problem. You may also be referred to a gastroenterologist (a doctor specializing in digestive system diseases) for further tests and treatment. Esophageal Cancer Diagnosis