Diagnosis of Esophageal Cancer

Diagnosing esophageal cancer

To help find the cause of symptoms, the doctor evaluates a person’s medical history and performs a physical exam. The doctor usually orders a chest x-ray and other diagnostic tests. These tests may include the following:

• A barium swallow (also called an esophagram) is a series of x-rays of the esophagus. The patient drinks a liquid containing barium, which coats the inside of the esophagus. The barium makes any changes in the shape of the esophagus show up on the x-rays.
• Esophagoscopy (also called endoscopy) is an examination of the inside of the esophagus using a thin lighted tube called an endoscope. An anesthetic (substance that causes loss of feeling or awareness) is usually used during this procedure. If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination under a microscope. This is called a biopsy. A biopsy can show cancer, tissue changes that may lead to cancer, or other conditions.

Staging the disease

If the diagnosis is esophageal cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the four stages of esophageal cancer.

• Stage I. The cancer is found only in the top layers of cells lining the esophagus.
• Stage II. The cancer involves deeper layers of the lining of the esophagus, or it has spread to nearby lymph nodes. The cancer has not spread to other parts of the body.
• Stage III. The cancer has invaded more deeply into the wall of the esophagus or has spread to tissues or lymph nodes near the esophagus. It has not spread to other parts of the body.
• Stage IV. The cancer has spread to other parts of the body. Esophageal cancer can spread almost anywhere in the body, including the liver, lungs, brain, and bones.

Some tests used to determine whether the cancer has spread include:

• CAT (or CT) scan (computed tomography). A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.
• Bone scan. This technique, which creates images of bones on a computer screen or on film, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein; it travels through the bloodstream, and collects in the bones, especially in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas.

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