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. Screening the general public 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 esophageal cancer in people who are at normal risk.

Testing for 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 document, Esophagus Cancer.

Signs and symptoms of cancer of the esophagus

In most cases, esophageal cancer is found because of the symptoms it causes. But often these symptoms don’t appear until the cancer is advanced, making a cure less likely. If esophagus cancer is suspected, tests will be needed to confirm the diagnosis.

Trouble swallowing (dysphagia)

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 dysphagia may switch to softer foods or even liquids to help with swallowing. To help the food go down, the body makes more saliva. This causes some people to have lots of thick mucus or saliva. If the cancer keeps growing, at some point even liquids will not be able to pass.

Chest pain

In some cases, pain in the mid-chest or a feeling of pressure or burning can be a sign of cancer. But these symptoms can also be caused by something else such as heartburn. Swallowing may become painful when 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. This is because they are not getting enough food since they have trouble swallowing. They may also find they don’t feel like eating.

Other symptoms

Other possible symptoms include hoarseness, constant cough, hiccups, pneumonia, bone pain, and bleeding into the esophagus, which can turn stools dark or black. Over time, this blood loss can lead to low red blood cell levels, which may make a person feel tired and weak.

These symptoms can be caused by other problems, too. 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 may have esophagus cancer, your doctor will use one or more tests to find out if the disease is really present. After asking questions about your health and symptoms and doing a physical exam, your doctor will tell you which of the tests below you will need. You may also be referred to a gastroenterologist (a doctor who is an expert in diseases of digestive tract).

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

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 surface of the esophagus and helps make a good picture. Any lumps on the lining of the esophagus show up on the x-ray. A barium swallow is often the first test to be done in people who have trouble swallowing.

CT scan (computed tomography)

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.

A CT scanner has been described as a large donut, with a narrow table in the middle “hole”. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

Before any pictures are taken, you may be asked to drink 1 to 2 pints of a liquid dye. This helps outline the esophagus and intestines so that certain areas are not mistaken for tumors. If you are having any trouble swallowing, you need to tell your doctor before the scan. You may also get an IV (intravenous) line through which you get a different kind of contrast dye (IV contrast).

The dye can cause some redness and warm feeling that may last hours to days. A few people are allergic to the dye and get hives. Rarely, more serious problems like trouble breathing and low blood pressure can happen. You can be given medicine to prevent and treat allergic reactions. Be sure to tell your doctor if you have any allergies or have ever had such a reaction.

A CT scan can be helpful in finding out the where and how big the cancer is. This test can help the doctor decide whether surgery is a good treatment option. CT scans can also be used to guide a biopsy needle (see below) into a place that might be cancer. The needle is used to remove a sample of tissue for study in the lab.

MRI (magnetic resonance imaging) scan

MRI scans use radio waves and strong magnets instead of x-rays to take pictures. They are a little more uncomfortable than CT scans. First, MRI scans take longer – often up to an hour. Also, you have to be placed inside a narrow, tube-like machine, which can upset people who fear enclosed spaces. Special, more open MRI machines can sometimes help with this if needed, although the pictures may not be as sharp in some cases.

A contrast material might be put into a vein. This contrast is different than the one used for CT scans, so being allergic to one doesn’t mean you are allergic to the other. The MRI machine makes thumping and clicking noises. Some places provide earplugs to block this out. MRI scans are very helpful in looking at the brain and spinal cord.

PET scan (positron emission tomography)

For this test, a special radioactive sugar is put into a vein. The tissues with cancer quickly take up the sugar. 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

Endoscopy is an important test for finding esophageal cancer. An endoscope is a thin, tube that can bend. It has a light and video camera on the end. The doctor uses it to look at the inside of the esophagus and the stomach. Several tests that use endoscopes can help find esophageal 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 the area is cancer. (This is called a biopsy.)

Upper endoscopy

You will first be given drugs to make you sleepy (a sedative) and then the back of your throat will be sprayed with something to numb it. Then the tube is passed through your mouth and down your esophagus into your stomach.

This test is useful because:

  • The doctor can see 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

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 (see above). This allows the probe to get very close to the cancer. The ultrasound can show how far the cancer has grown into the esophagus to help in making choices about surgery. It can also be used to guide the doctor when getting biopsy samples of nearby lymph nodes.

Bronchoscopy

This test is much like an endoscopy except that the doctor passes the scope into the windpipe (trachea) and the tubes leading into the lungs to see if the cancer has spread there. The 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 are methods that allow the doctor to see lymph nodes and other organs inside the chest or belly (abdomen) using a hollow lighted tube with a small camera. The doctor can also remove lymph nodes through the same tube to test them for cancer. This information is helpful in telling whether surgery is a good option. For these tests the patient is in the hospital and is put into a deep sleep (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 out a small piece of tissue from the area that looks like it could be cancer. The tissue is looked at under the microscope to see if cancer is present and to find out what type of cancer cells there are. It usually takes at least 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 for the HER2 gene or protein. Some people with esophageal cancer have too much of this gene or protein on the surface of their cancer cells, which helps the cells grow. But a drug that targets the HER2 protein may help treat these cancers when used along with chemotherapy.

Other tests

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

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


Last Medical Review: 12/26/2012
Last Revised: 12/26/2012