Diagnosing Esophageal Cancer

Esophageal cancer is a treatable disease if found in its early form. However, symptoms — difficulty swallowing, pain with swallowing, weight loss — may not appear until the cancer is in a more advanced stage. Virginia Mason in Seattle is about to start clinical testing on a new approach to diagnosing patients with Barrett’s Esophagus, currently the most common precursor of esophageal cancer.

Your physician has a number of excellent tests and procedures to choose from to diagnose this disease. He or she will first take your medical history and perform a physical exam. You may then undergo any one of several tests and procedures described below.

  • Barium swallow
    During this procedure, you will be asked to swallow a liquid containing barium, which coats the esophagus. Any changes in the shape of the esophagus will show up on x-rays.
     
  • Esophagoscopy or endoscopic examination
    An esophagoscopy is an examination of the inside of the esophagus using an endoscope, which is a thin tube with a light at its end. The endoscope also is able to take tissue samples (biopsy) for evaluation.
     
  • Endoscopic ultrasound
    This technique, which uses an endoscope that is connected to an ultrasound machine, sends images to a computer screen. Because it can visualize all of the layers of muscle and tissue in the esophagus, it is the best technique to determine the extent (depth) of the tumor and if there has been any spread to the lymph nodes in the neck.

The following tests and procedures may be performed to determine if the cancer has spread beyond the esophagus:

  • Chest x-ray
    A simple chest x-ray shows abnormalities in the lungs.
     
  • Bronchoscopy
    This procedure uses a broncoscope, which is a thin lighted tube that is inserted into the nose or down the throat and into the bronchial tubes of the lungs. It can pick up abnormalities in the trachea and lungs.
     
  • Laryngoscopy
    A procedure using a laryngoscope, which is a thin, lighted tube, to view the larynx or voice box.
     
  • CT scan
    A CT scan utilizes x-rays and a computer to show three-dimensional images of organs in the body.
     
  • PET scan
    A PET (positron emission tomography) scan shows cancer growth in other parts of the body by means of a substance called radionuclide glucose (sugar), which is injected into a vein. This substance is “taken up” by cancer cells because they use sugar more readily than normal cells do. In some instances both a PET scan and a CT scan will be used to determine if the cancer has spread beyond the esophagus.
     
  • Thoracoscopy
    During this procedure, an endoscope is used to examine the inside of the chest. The endoscope is inserted through an incision in the chest wall.
     
  • Laparoscopy
    This procedure uses a laparoscope, which is similar to an endoscope, to view internal organs and take tissue samples. It is inserted through an incision in the abdomen.

Related Links
Treating Esophageal Cancer
After Esophageal Cancer Treatment