Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of the disease. 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.
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 Tests for Esophageal Cancer.) The doctor may remove small samples of tissue (biopsies) from the abnormal area so that they can be checked for dysplasia (pre-cancer cells) or cancer cells.
Doctors aren’t certain how often the test should be repeated, but most recommend testing more often if areas of 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 is high-grade dysplasia, treatment of the abnormal area might be advised because of the high risk that an adenocarcinoma is either already present (but was not found) or will develop within a few years. Treatment options for high-grade dysplasia might include surgery to remove part of the esophagus with the abnormal area, endoscopic mucosal resection (EMR), photodynamic therapy (PDT), or radiofrequency ablation (RFA). See Endoscopic Treatments for Esophageal Cancer. The outlook for these patients is relatively good after treatment.
People with inherited syndromes (sometimes called hereditary syndromes) that put them at increased risk of developing esophageal cancer, might also need frequent endoscopies to look for cancer or pre-cancer. For example, people with tylosis or Bloom syndrome should consider screening with an upper endoscopy after turning 20 years old. People who have family members with familial (inherited) Barrett’s esophagus should consider screening with an upper endoscopy after 40 years old. If you have one of these inherited syndromes, it is best to speak with your doctor about cancer screening and what is right for you.
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.
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Last Revised: March 20, 2020
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