Esophagus Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is cancer of the esophagus found?

Looking for a disease in someone without symptoms is called screening. In the United States, screening everyone for esophageal cancer is not recommended at this time. This is because no screening test has been shown to lower the risk of dying from this cancer in people who are at normal risk.

Testing people at high risk

People at higher risk for esophageal cancer, such as those with Barrett’s esophagus, are often watched closely to look for signs that could mean that the cells lining the esophagus have changed. Many experts recommend that they have a test called upper endoscopy regularly (this test is discussed later in this section). Often, samples of tissue are removed (biopsies) and checked to see if they contain abnormal or even cancer cells. If they do, the patient may need to be treated. This is discussed in more detail in our full-length document on Esophagus Cancer.

Signs and symptoms of cancer of the esophagus

Esophagus cancer is often found because of the symptoms it causes. But often these symptoms don’t appear until the cancer is advanced, making a cure less likely.

Trouble swallowing

This is the most common symptom of cancer of the esophagus. It means you feel like food gets stuck in your throat or chest. This is often mild when it starts, and then gets worse over time. Solid foods like bread and meat often get stuck. People with trouble swallowing may switch to softer foods or even liquids. If the cancer keeps growing, at some point even liquids might be hard to swallow.

To help the food go down, the body makes more saliva. This makes some people have lots of thick mucus or saliva.

Chest pain

Sometimes, pain in the mid-chest or a feeling of pressure or burning can be a sign of cancer. But these symptoms are more often caused by something else such as heartburn. Swallowing may become painful if the cancer is large enough to limit the passage of food down the esophagus.

Weight loss

About half of people with esophageal cancer lose weight without trying. Trouble swallowing keeps them from getting enough food. They also might not feel like eating.

Other symptoms

Other possible symptoms of cancer of the esophagus can include:

  • Hoarseness
  • Constant cough
  • Vomiting
  • Hiccups
  • Pneumonia
  • Bone pain
  • Bleeding into the esophagus. This blood then passes through the stomach and intestines, which may turn stools black. Over time, this blood loss can lead to low levels of red blood cells, which can make a person feel tired.

Having one or more of these symptoms does not mean you have esophagus cancer. In fact, many of these symptoms are more likely to be caused by something else. Still, if you have any of these symptoms, especially trouble swallowing, have them checked by a doctor so that the cause can be found and treated, if needed.

If certain symptoms suggest that you have esophagus cancer, your doctor will use one or more exams or tests to find out for sure. After asking questions about your health and symptoms and examining you, your doctor will tell you which of the tests below you will need. You may also be referred to a doctor who is an expert in digestive system diseases (a gastroenterologist).

Imaging tests

Imaging tests use different methods to create pictures of the inside of your body. These tests may be done for a number of reasons both before and after a diagnosis of esophageal cancer:

  • To help find cancer
  • To learn if and how far cancer has spread
  • To help tell if treatment is working
  • To look for signs of cancer coming back after treatment

Barium swallow or upper GI x-rays

This is a series of x-rays taken after you swallow barium, a dense liquid that shows up on x-rays. Barium coats the inner surface of the esophagus and helps make a good picture. Any lumps on the inner lining of the esophagus show up on the x-ray. A barium swallow is often the first test done in people who have trouble swallowing.

CT (computed tomography) scan

A CT (or CAT) scan is a type of x-ray that takes many pictures of the part of your body being studied. These pictures are combined by a computer to give a detailed view of your insides.

CT scans are not often used to diagnose esophagus cancer, but they can help show where it is in the esophagus and if it has spread to other parts of the body. The scans can help show whether surgery is a good treatment option. If a biopsy is needed, a CT scan can be used to guide a needle into the mass to take a sample.

A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle hole. You will need to lie still on the table while the scan is being done.

Before any pictures are taken, you may be asked to drink a liquid called oral contrast. If you are having any trouble swallowing, tell your doctor before the scan. You may also get an IV (intravenous) line for a different kind of contrast dye. Some people are allergic to the contrast. Be sure to tell your doctor if you have any allergies or have ever had such a reaction.

MRI (magnetic resonance imaging) scan

MRI scans use radio waves and strong magnets instead of x-rays to take pictures. They are very helpful in looking at the brain and spinal cord, but they are not often needed to look for spread of esophagus cancer.

MRI scans take longer than CT scans, often up to an hour. Also, you have to lie inside a narrow, tube-like machine, which upsets some people. Special, more open MRI machines can sometimes help with this if needed.

PET (positron emission tomography) scan

For a PET scan, a special radioactive chemical (called a radiotracer) is put into a vein. Cancer cells quickly take up the tracer. Then a scanner can spot those areas. This test may be useful for finding cancer that has spread if nothing is found on other imaging tests. Special machines combine a PET scan with a CT scan.

Endoscopy

An endoscope is a flexible thin, tube with a tiny light and video camera on the end. The doctor uses it to look inside the body. Tests that use endoscopes can help find esophagus cancer or show how much it has spread. If there are any areas of concern, a small piece of tissue can be removed through the tube to see if cancer cells are in the area. (This is called a biopsy.)

Upper endoscopy

This is an important test for finding esophageal cancer. You will first be given drugs to make you sleepy. Then the doctor passes the tube through your mouth and down into your esophagus and stomach.

This test is useful because:

  • The doctor can see the inside of the esophagus clearly.
  • A tissue sample can be taken to find out if there is cancer.
  • If the cancer is blocking the opening of the esophagus, the opening can be made bigger to help food and liquids pass through to the stomach.
  • The doctor can learn more about whether the cancer can be removed with surgery.

Endoscopic ultrasound

This test is often done at the same time as the upper endoscopy, although it is actually a type of imaging test. Ultrasound tests use sound waves to take pictures of parts of the body. For an endoscopic ultrasound, the probe that gives off the sound waves is at the end of an endoscope, which is passed down into the esophagus. This lets the probe get very close to the cancer.

The ultrasound can show how far the cancer has grown into the esophagus. It can also be used to guide the doctor when getting biopsy samples of nearby lymph nodes. This can help in making choices about surgery.

Bronchoscopy

This test is much like an endoscopy except that the doctor passes the scope into the windpipe and the tubes leading from the windpipe into the lungs (bronchi) to see if the cancer has spread there. Your mouth and throat are sprayed first with a numbing medicine. You may also be given medicine into a vein line to make you feel relaxed. A biopsy sample might also be taken.

Thoracoscopy and laparoscopy

These tests let the doctor see lymph nodes and other organs inside the chest or belly (abdomen) using a hollow lighted tube with a small video camera on the end. The doctor can also remove lymph nodes through the same tube to test them for cancer. This information is helpful in deciding if surgery is a good option.

These tests are done in the operating room while you are in a deep sleep (under general anesthesia). A small cut is then made in the side of the chest wall (for thoracoscopy) or the belly (for laparoscopy) to insert the tube.

Lab testing of biopsy samples

A spot seen on endoscopy or on an imaging test may look like cancer, but the only way to know for sure is to do a biopsy. For a biopsy, the doctor takes a small piece from the area that looks like it could be cancer. It is then looked at under the microscope to see if cancer is present and to find out what type of cancer cells there are. It can often take a few days to get the results.

If esophageal cancer is found but is too advanced for surgery, your doctor might have your biopsy samples tested to see if the cells have too much of the HER2 gene or protein. If they do, a drug that targets the HER2 protein may help treat these cancers.

Other tests

A doctor may order a blood test called a complete blood count (CBC) to look for a low red blood cell count (which could be caused by bleeding inside the body). A stool sample may be checked to see if it contains unseen blood.

If esophageal cancer is found, the doctor may recommend other tests, especially if surgery is a treatment option.


Last Medical Review: 05/21/2014
Last Revised: 05/27/2014