Esophageal Cancer: Diagnosis
How is esophageal cancer diagnosed?
If your healthcare provider thinks you have esophageal cancer, tests are done to help
diagnose it. Diagnosing this cancer starts with your healthcare provider asking you
questions. They will ask you about your health history, symptoms, risk factors, and
family history of disease. They will also do a physical exam.
You may be sent to a specialist called a gastroenterologist. This is a healthcare
provider with extra training on treating diseases in the digestive system. They will
do tests to look at the problem in your esophagus and find out what's causing it.
What tests might I need?
You may have one or more of the following tests:
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Imaging tests. These may include:
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Endoscopy. This may include:
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Biopsy. This may be done during an upper endoscopy.
Imaging tests
Barium swallow
For this test, you’ll swallow a chalky liquid called barium. Then your healthcare
provider will take a series of X-rays of your esophagus. The barium coats the inside
of your esophagus. This makes it easier to see it on the X-rays.
The X-rays can show if part of your esophagus is too narrow. Or if it has any other
changes in it that might be due to cancer. These may include bumps or masses. A healthcare
provider who specializes in X-rays (called a radiologist) looks at the images.
Sometimes this test is done as part of a series of X-rays that includes the stomach
and part of the intestine. This is called an upper GI (gastrointestinal) series.
Used alone, a barium swallow can't diagnose cancer. But it can show abnormal areas
that might need to be biopsied.
Endoscopy
Upper endoscopy or EGD
Endoscopy is when your healthcare provider uses a thin, flexible, lighted tube with
a video camera on the end (endoscope) to look inside your body.
An upper endoscopy is sometimes also called an EGD. During this procedure, your provider
looks at the lining of your esophagus. It also can be used to look at your stomach
and the first part of your small intestine.
Before the test, your throat will be sprayed with a local anesthetic to numb it. You
may also get a sedative to help you relax. Your provider then puts the endoscope in
through your mouth. It goes down your throat into your esophagus. Your provider sees
pictures on a monitor as the scope is moved in your esophagus. These pictures show
any tissue that isn’t normal.
An upper endoscopy takes about 30 minutes. You’ll need to stay in the testing area
for a few hours until the sedative wears off.
This test can be used to find out if you have cancer in the esophagus. It can also
show the size of the tumor.
Endoscopic ultrasound
An endoscopic ultrasound can be done through the endoscope during an upper endoscopy.
A special probe is put in through the scope. It gives off sound waves at the end of
the scope. These help find out how big the tumor is and how far it has grown into
tissues near the esophagus. It can also show if nearby lymph nodes are swollen. These
are small sacs of immune system cells. When they're swollen, they may contain cancer
cells that have spread from where they first started.
Biopsy
Your healthcare provider can also put tools through the endoscope to take out small
pieces of tissue for testing. This is called a biopsy. The tissue is sent to a lab.
There, it’s looked at under a microscope by a special healthcare provider called a
pathologist. The pathologist can see if there are cancer cells in the tissue sample.
If so, other tests are done to learn more details about the cancer. These include
how fast it's growing and if there are certain gene changes in the cancer cells.
Getting your test results
Your healthcare provider will contact you with your test results. Other imaging tests
and blood tests will likely be needed if cancer is found. Make sure you understand
your results and what happens next.