Esophageal Cancer

Diagnosis

Esophageal cancer is usually diagnosed with an endoscopic examination of the esophagus (esophagoscopy) or a barium swallow X-ray. A computed tomography (CT) scan may also be performed to obtain an overall image of the esophagus and surrounding organs to determine whether the disease has spread.

Esophagoscopy involves the insertion of a thin, flexible, lighted tube down the throat through the esophagus and into the stomach. A video camera in the endoscope sends images of the esophagus to a monitor, allowing the physician to look for possible abnormalities. If necessary, a tissue sample (biopsy) can be collected for microscopic examination to determine the presence of cancer. Sometimes a biopsy may show changes in the esophagus that are not cancer but may lead to cancer.

A barium X-ray uses a chalky contrast fluid to produce a clearer X-ray image of the lining of the esophagus. Drinking a liquid containing barium makes the esophagus easier to see on the X-ray than would otherwise be possible. This image reveals the presence of any strictures or bumps in the esophagus wall.

Other diagnostic techniques may also be used to determine the extent of disease and to help plan treatment. These include:

• Endoscopic ultrasound, to indicate how deeply the tumor has invaded the esophagus wall or beyond and the status of lymph nodes. If nodal involvement is suspected, a biopsy of the node may be performed.
• PET scans, to determine whether the tumor has spread to other organs
• Bronchoscopy, to determine whether the tumor has spread to the windpipe and other respiratory organs
• Thorascopy and laparoscopy, to determine whether the cancer has spread to the lymph nodes of the chest