How Esophageal Cancer is Diagnosed

Learn about the 9 tests that determine esophageal cancer stages

An illustration of esophageal cancer.
An illustration of esophageal cancer. PIXOLOGICSTUDIO/SCIENCE PHOTO LIBRARY/Getty Images

After esophageal cancer has been diagnosed, what's next? More tests, unfortunately, because it is time to figure out whether cancer cells have spread within the esophagus or to other parts of the body. Knowing this information will determine the stage of the disease and help determine your treatment plan.

The Staging Process for Esophageal Cancer

The process used to find out if cancer cells have spread within the esophagus or to other parts of the body is called staging.

The following nine tests help gather the information needed to determine what stage your cancer is in.

Barium swallow: We hope you like chalk, because as the name of this test suggests, you are swallowing barium, a thick, chalky liquid. It coats the walls of the esophagus. X-rays of the esophagus, which the barium makes easy to see, are taken. It shows any abnormalities that may have disturbed the smooth surface of the esophagus's inner lining. This test can detect small, early cancers, as well as more advanced tumors within the esophagus.

Bronchoscopy: This procedure looks inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.

Chest x-ray: You're probably most familiar with this test and it is the least invasive. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

For this x-ray, doctors are looking at the organs and bones inside the chest.

Laryngoscopy: With a mirror or with a laryngoscope, which is a thin, lighted tube, your doctor examines your larynx or voice box.

CT scan (CAT scan): This test is also called computed tomography, computerized tomography, or computerized axial tomography.

Basically, a dye may be injected into a vein, or you may swallow it. Then, using a computer linked to an x-ray machine, a series of detailed pictures of your insides are taken from different angles. And that dye in your body? It helps the organs or tissues show up more clearly.

Endoscopic ultrasound: A thin, lighted tube called an endoscope is inserted into the body. There the endoscope make echoes by bouncing high-energy sound waves, known as ultrasound, off internal tissues or organs. The echoes form a sonogram — a picture of body tissues. This procedure is also called endosonography.

Thoracoscopy: During this surgical procedure, an incision or cut is made between two ribs and a thoracoscope, which is a thin, lighted tube, is inserted into the chest. Doctors use this to look at the organs inside the chest and check abnormal areas for cancer. Tissue samples and lymph nodes may be removed for biopsy. In some cases, this procedure may be used to remove portions of the esophagus or lung.

Laparoscopy: Small incisions or cuts are made in the wall of the abdomen during this surgical procedure.

A laparoscope, which is a thin, lighted tube, is inserted into the body through one of the incisions to look at the organs inside the abdomen and check for signs of disease. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.

PET scan: This procedure is also known as a positron emission tomography scan and is used o find malignant tumor cells in the body. A small amount of radionuclide glucose, bascially sugar, is injected into a vein. Then, a PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

The Stages of Esophageal Cancer

After undergoing the procedures above, your physician will determine which of the following stages your esophageal cancer will fall into.

Stage 0: Cancer is found only in the innermost layer of cells lining the esophagus. Stage 0 is also called carcinoma in situ.

Stage I: Cancer has spread beyond the innermost layer of cells to the next layer of tissue in the wall of the esophagus.

Stage II: Depending on where the cancer has spread, Stage II esophageal cancer is divided into stage IIA and stage IIB.

  • Stage IIA: Cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus.
  • Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes.

Stage III: Cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.

Stage IV: Depending on where the cancer has spread, Stage IV esophageal cancer is divided into stage IVA and stage IVB.

  • Stage IVA: Cancer has spread to nearby or distant lymph nodes.
  • Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

Sources:

Lightdale, M.D., Charles J. "Esophageal Cancer." Vol. 94, No. 1, 1999. The American Journal of Gastroenterology.

"What You Need to Know About Cancer of the Esophagus - Staging." National Cancer Institute.

"How is Cancer of the Esophagus Diagnosed" National Cancer Institute.

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