Making the Diagnosis
If other causes for the symptoms have been ruled out and esophageal cancer is suspected, your doctor may review your medical history, perform a physical exam, and do some of the following tests:
- barium swallow: This involves swallowing barium, which is then tracked by an X-ray. This test can show whether there are any structural changes or blockages in your esophagus, stomach, and small intestine.
- endoscopy: This involves inserting an endoscope (a tube with a light and camera) into the throat so that your doctor can see the lining of the esophagus. Your doctor will likely use some local freezing or give you some medication to make the procedure more comfortable. You may have a sore throat afterwards, but it will go away on its own in a couple of days.
- biopsy: While using the endoscope, your doctor may take some tissue from inside the esophagus to send it for microscopic evaluation.
If a diagnosis of cancer has been made, the next step is to discover the stage (i.e., how far the cancer has progressed). This will involve:
- blood tests
- a chest X-ray
- computed tomography (CT) imaging scans of the chest and liver, which will show any tumors or other abnormalities
- endoscopic ultrasound to evaluate how deeply the cancer has penetrated the wall of the esophagus
- positron emission tomography (PET) scans can define the local extent of the cancer and evaluate whether it has spread or metastasized (spread from one part of the body to another)
The stages are:
- stage 0: very early cancer, found only in the first layer of the lining
- stage 1: cancer is still early in development, is in a small part of the esophagus but hasn't spread
- stage 2: cancer has spread deeper into the esophagus and may have invaded the lymph nodes near the esophagus
- stage 3: cancer has spread even deeper in the esophagus wall or has spread to nearby tissues and lymph nodes
- stage 4: cancer has spread to other parts of the body (usually the lungs or liver, although it may spread to other areas of the body as well)
- recurrent: cancer that has returned after treatment