Can cancer of the esophagus be found early?

Looking for a disease in someone without symptoms is called screening. The goal of screening is to find a disease like cancer in an early, more curable stage, in order to help people live longer, healthier lives.

In the United States, screening the general public for esophageal cancer is not recommended by any professional organization at this time. This is because no screening test has been shown to lower the risk of dying from esophageal cancer in people who are at average risk.

However, people who have a high risk of esophageal cancer, such as those with Barrett's esophagus, are often followed closely to look for early cancers and pre-cancers.

Testing for people at high risk

Many experts recommend that people with a high risk of esophageal cancer, such as those with Barrett's esophagus, have upper endoscopy regularly. For this test, the doctor looks at the inside of the esophagus through a flexible lighted tube called an endoscope (see "How is cancer of the esophagus diagnosed?"). The doctor may remove small samples of tissue (biopsies) from the area of Barrett’s so that they can be checked to see if they contain any abnormal cells (including cancer cells). They will also get tissue samples from any areas that look more abnormal.

Doctors are not certain how often the test should be repeated, but most recommend testing more often if areas of abnormal cells (called dysplasia) are found. This testing is repeated even more often if there is high-grade dysplasia (the cells appear very abnormal).

If the area of Barrett's is large and/or there are many different spots of high-grade dysplasia, surgery to remove the abnormal area is often advised because of the high risk that an adenocarcinoma is either already present (but was not found) or will develop within a few years. If treated with surgery, the outlook for these patients is relatively good.

Surgery may not be an option for some patients if they are in poor health and aren't able to withstand the operation. Other treatment options for high-grade dysplasia include endoscopic mucosal resection (EMR), photodynamic therapy (PDT), and radiofrequency ablation. These are discussed in the "Endoscopic treatments for cancer of the esophagus" section of this document.

Careful monitoring and treatment (if needed) may help prevent some esophageal cancers from developing. It may also detect some cancers early, when they are more likely to be treated successfully.