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, there are no tests used to screen for esophageal cancer in the general population. However, people who have a high risk of esophageal cancer, such as those with Barrett esophagus, are often followed closely with endoscopy to look for early cancers and precancers. (Endoscopy is a test that allows the doctor to look at the inside of the esophagus through a flexible lighted tube called an endoscope.) This procedure is also used to look for signs of esophageal injury in many people who have chronic esophageal reflux.

Testing for people at high risk

Many experts recommend that people with a high risk of esophageal cancer have upper endoscopy regularly. If an abnormal area is seen, a small sample of tissue should be removed from that area and checked to see if it contains cancer cells.

Doctors recommend that people with Barrett’s esophagus have an upper endoscopy and biopsy done. Doctors are not certain how often the test should be repeated, but most recommend testing more often if abnormal cells are found (the presence of abnormal cells is called dysplasia). This testing is repeated even more often if there is high grade dysplasia (the cells appear very abnormal).

If a biopsy shows high-grade dysplasia (the cells appear very abnormal), the doctor may recommend surgery to remove the area of Barrett’s esophagus. Surgery is more often recommended when the area of Barrett’s is long and/or there are many different spots of high grade dysplasia. In these cases, surgery is advised because of the high risk that an adenocarcinoma is either already present (but was not found) or it will develop within a few years. If treated with surgery, the outlook for these patients is relatively good. For some patients, surgery is not an option because 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 more detail later in this document.

This monitoring and intervention strategy can help prevent cancer from developing and detect cancers early when they are more likely to respond to treatment.

Last Medical Review: 05/04/2009
Last Revised: 05/13/2009