Diagnosis & Staging
The diagnosis of esophageal cancer is made by biopsying the tumor at the time of an upper endoscopy exam (see exam description below). Endoscopy involves the use of a fiber optic scope that allows the gastroenterologist or surgeon to directly view the inside of the esophagus. Small biopsies (tissue samples) are usually taken during the endoscopy exam.
If the biopsy indicates the presence of cancer, patients will undergo a variety of tests to determine the extent of cancer. These tests help show whether the cancer is "localized" (has not spread beyond the tissue where it originated) or if it has spread to nearby lymph nodes or other parts of the body. In many cases, the true extent of the spread of the cancer can only be determined through surgery.
Some or all of the following tests may be used to determine your stage of cancer:
Endoscopy: An endoscopy is an exam performed through an endoscope, a flexible tube inserted through the esophagus that allows the physician to visualize, photograph and biopsy the cancer. All patients diagnosed with esophageal cancer will undergo an esophagoscopy (a type of endoscopic exam) with biopsy. This exam may be also referred to as a gastroscopy, esophagoscopy or EGD.
Endoscopic Ultrasound (EUS): EUS refers to an ultrasound test performed through an endoscope. Ultrasound tests utilize sound waves to detect different densities of tissue, including cancer. This test is used to determine which layer of the esophagus or stomach the cancer has grown into, and whether or not the lymph nodes are involved.
Computed Tomography (CT) Scan: CT scans of the chest and abdomen are usually obtained to determine if the cancer has spread to the lungs, lymph nodes, liver and other organs. A CT scan may be combined with a PET scan to provide even more information.
Positron emission tomography (PET): Positron emission tomography (PET) scanning is used to improve the detection of cancer in lymph nodes and other organs. Prior to a PET scan, a special substance is injected into the patient's vein. It reacts with electrons in the cancer cells to create gamma rays. The gamma rays are then detected by the PET machine, which transforms the information into a picture. If no gamma rays are detected in the scanned area, it is unlikely that the mass in question contains living cancer cells.
Endoscopic Mucosal Resection: EMR is a new technique allowing for larger and deeper biopsies of the esophagus and is done using an endoscope. For early esophageal cancers or Barrett's esophagus, EMR is much better at determining the depth of invasion by the cancer.
Thoracoscopy: A thoracoscopy is another procedure performed through an endoscope to examine the chest and determine to what extent cancer has spread in the chest.
Laparoscopy: This procedure involves the insertion of an endoscope through a small incision in the abdomen. It is an important tool for staging and has proven to be more reliable than CT scanning in detecting the spread of cancer to the liver and the lining of the abdomen (peritoneum).
Bronchoscopy: Bronchoscopy is an examination of the lungs and can be helpful in identifying involvement of the trachea when the primary cancer is advanced and located in the upper part of the esophagus.
When these tests are completed, your physician will be able to tell you what stage of esophageal cancer you are likely to have.
Staging of Esophageal Cancer
Learn more on stage information at the National Cancer Institute website.