If a physician suspects that a patient has esophageal cancer, a diagnosis can be made (or ruled out) through various types of testing. If these tests detect cancer, then additional testing will be done to stage the cancer. Esophageal cancer is most commonly diagnosed when a person has been having symptoms; however, since esophageal cancer doesn’t typically cause symptoms until later stages, it is sometimes found accidentally with testing for other medical issues.
Confirming an esophageal cancer diagnosis may involve any of the following tests, which are further detailed below:
- A medical history and physical exam
- One or more types of imaging tests
- Blood testing
Medical history and physical exam
Your doctor will likely begin by asking questions about your medical history and then performing a physical exam. The physician will consider your risk factors, ask questions about your symptoms and look for physical signs of cancer, focusing extra attention on your neck and chest. If the exam raises any concerns for the doctor, he or she will recommend further testing.
Imaging tests used to look for esophagus cancer
Although the precise testing used may vary from patient to patient, imaging scans are typically the first step toward confirming an esophageal cancer diagnosis.
Your physician may order a set of X-rays to see the organs and bones inside your chest. Sometimes the X-rays are done following a barium swallow, or esophagram, which involves swallowing a chalky liquid (barium) that coats the walls of the esophagus. The barium will clearly show the outline of your esophagus so that abnormalities on its lining, including even early-stage cancer, can be easily seen.
CT (computed tomography) scans
A CT scan is similar to an X-ray, but is capable of providing more detailed images. It produces cross-sectional images of the body, which will help your physician determine not only if cancer is present but also if the cancer has spread outside of the esophagus. You might be asked to drink an oral contrast before the scan to help outline the esophagus.
MRI (magnetic resonance imaging) scans
Another test that may be used for esophageal cancer diagnosis is an MRI. An MRI is most often used to evaluate the spread of cancer. As opposed to X-rays, MRIs use radio waves and strong magnets to produce images of soft tissues in the body. Sometimes a contrast material is intravenously injected prior to the scan to capture a more detailed image.
PET (positron emission tomography) scans
During a PET scan, a radioactive sugar solution is injected into the bloodstream. Because cancer cells grow more quickly than normal cells, they absorb more of the solution, which can be easily seen with the PET scan’s special camera. While PET scans are not as detailed as CTs or MRIs, they can more definitively identify whether abnormalities are cancerous. A PET scan is especially helpful for detecting the spread of cancer.
Endoscopy is another method physicians can use to see inside the body and make an esophageal cancer diagnosis. “Endoscopy” refers to any testing that is done using an endoscope, which is a thin, flexible tube with a small camera and light on the end. The camera is connected to a monitor, where the physician can view the video feed.
During this test, an endoscope is inserted through the throat into the esophagus. This allows the physician to observe any abnormal patches in the esophageal lining. Upper endoscopy yields important information about a tumor’s size and the extent of its spread, and it also helps the physician determine if surgery could be a viable option for removing the tumor.
For this test, a probe that emits sound waves is connected to the tip of the endoscope. The probe converts the sound waves into detailed images, allowing the endoscope to get very close to the tumor for more precise information on tumor size and spread. Most often, an endoscopic ultrasound is done at the same time as an upper endoscopy.
A bronchoscopy involves inserting an endoscope through the mouth or nose into the lungs to determine if upper esophageal cancer has invaded the airway.
Thoracoscopy and laparoscopy
Similar to a bronchoscopy, these tests are done to determine if esophageal cancer has spread. The endoscope is inserted in the chest wall for thoracoscopy, or the abdomen for laparoscopy, to view the areas around the esophagus.
If your imaging scan or endoscopy shows something that might be esophageal cancer, your physician may need to take a small cell sample from the lesion for further testing. This procedure is known as a biopsy. The results can not only confirm an esophageal cancer diagnosis but also provide additional information about the type (adenocarcinoma or squamous cell) and grade of the cancer, as well as its molecular makeup. If undergoing endoscopy, the biopsy can usually be done at the same time using special instruments that are passed through the endoscope.
Certain blood tests can also be used to help a physician confirm an esophageal cancer diagnosis. For instance, a blood test can be used to detect anemia or check liver function; esophageal cancer can sometimes cause anemia if the tumor bleeds, and it may impact liver function if the cancer spreads.
Esophageal cancer diagnosis at Moffitt
Moffitt Cancer Center is a recognized leader in the diagnosis and treatment of esophageal cancer. No referral is needed to make an appointment with one of our experienced oncologists; complete a new patient registration form online or call 1-888-663-3488.