Esophageal Cancer Screening and Diagnosis
To help find the cause of your symptoms, your doctor will take a complete medical history and perform a physical exam. You're also likely to have a chest X-ray and other diagnostic tests, such as:
A barium swallow (esophagram). A diagnostic test often given to people who have difficulty swallowing, a barium swallow uses a series of X-rays to examine the esophagus. During the test, you'll drink a thick liquid (barium) that temporarily coats the lining of your esophagus so that the lining shows up clearly on the X-rays. You may also have air blown into your esophagus, to help push the barium against the esophagus walls. Although a barium swallow can help diagnose cancer, it may not show whether a tumor has spread beyond the esophagus. After the test you can eat normally and resume your daily activities, although you'll need to drink extra water to help flush the barium from your system and prevent constipation.
A barium swallow briefly exposes you to ionizing radiation. Although the danger from this exposure is small, care is taken to produce the best images with the lowest amount of radiation and the fewest possible X-rays.
Esophagoscopy (upper endoscopy). During this procedure, your doctor examines the inside of your esophagus using an endoscope — a thin, lighted tube with a tiny camera on the end that sends images to a TV monitor. Your throat will likely be sprayed with a topical anesthetic before you're asked to swallow the tube, and you may also receive medication through your veins (intravenously) to make you more comfortable. The endoscope allows your doctor to clearly see any masses in the wall of your esophagus as well as to take a tissue sample (biopsy) of any abnormalities. The samples are then sent to a laboratory for analysis. Risks of the procedure include a reaction to the medication and bleeding at a biopsy site. If your doctor needs to make a wider opening in your esophagus because of a stricture or narrowing, there's also a small risk of creating a hole in your esophagus (esophageal perforation).
Screening tests
Screening tests check for a disease in its early stages, before you develop symptoms. If you're at high risk of esophageal cancer, especially if you have Barrett's esophagus or tylosis, you're likely to have regular endoscopic examinations and biopsies. Many doctors recommend having these tests every two to three years if you don't have cell abnormalities (dysplasia). When cell abnormalities are present, you'll usually need tests more often.
Staging tests
If cancer is diagnosed, you're likely to have more tests to determine whether and where the cancer has spread (metastasized), a process known as staging. This step is especially important because it helps your doctor determine the most appropriate treatment. Esophageal cancers are staged using the numbers 0 through IV. In general, the higher the number the more advanced the cancer.
Stage 0 (carcinoma in situ). These cancers, also called noninvasive or in situ (in one place) cancers or high-grade dysplasia, don't have the ability to spread to other parts of your body. Still, it's important to have them followed closely or removed because they eventually may become invasive.
Stage I. This cancer occurs only in the top layer of cells lining your esophagus.
Stage II. At this stage, the cancer has invaded deeper layers of your esophagus lining and may have also spread to nearby lymph nodes.
Stage III. The cancer has spread even more deeply into the wall of your esophagus and to nearby tissues or lymph nodes.
Stage IV. At this stage, the cancer has spread to other parts of your body.
To help stage esophageal cancer, you may have one or more of these tests:
Bronchoscopy. In this procedure, which is similar to esophagoscopy, your doctor uses an endoscope to examine your windpipe (trachea) and the air passages leading to your lungs (bronchi) to determine whether cancer has spread to these areas.
Computerized tomography (CT) scan. This X-ray technique produces more detailed images of your internal organs than do conventional X-ray studies. That's because a computer translates information from X-rays into images of thin sections (slices) of your body at different levels. CT scans can confirm the location of a tumor within the esophagus and whether cancer has spread to nearby lymph nodes or other organs. A CT scan exposes you to more ionizing radiation than plain X-rays do and usually isn't recommended if you're pregnant.
Endoscopic ultrasound. This procedure may prove to be more accurate than either CT scans or upper endoscopy in determining how far an esophageal cancer has spread into nearby tissues. During the test, a tiny ultrasound probe is passed through an endoscope into your esophagus. The probe produces very sensitive sound waves that penetrate deep into tissues. A computer then translates the sound waves into close-up images of your esophagus and nearby tissues. Your doctor can also take biopsies of lymph nodes and other tissues during the procedure. Endoscopic ultrasound uses sound waves rather than X-rays to create images, and the risks of the procedure, such as bleeding or perforation of the esophagus, are slight.
Positron emission tomography (PET) scan. During this test, your doctor injects a small amount of a radioactive tracer — typically a form of glucose — into your body. All tissues in your body absorb some of this tracer, but tumors absorb greater amounts and appear brighter on the scan than healthy tissue does. A PET scan exposes you to a small amount of radiation, but because the radioactivity is short-lived, your overall exposure is low.
Esophageal Cancer Screening and Diagnosis
