Diagnosing esophageal cancer

This page was reviewed under our medical and editorial policy by

Toufic Kachaamy, MD, Chief of Medicine, City of Hope Phoenix

This page was reviewed on January 13, 2022.

A thorough and accurate cancer diagnosis is the first step in developing an esophageal cancer treatment plan. Your care team will use a variety of tests and tools designed for diagnosing esophageal cancer, evaluating the disease and developing your individualized treatment plan. Imaging tests can help the care team track the size of the tumors, monitor your response to treatment, and modify your plan when needed.

Imaging tests for cancer of the esophagus

Imaging procedures used for diagnosing esophageal cancer include:

Barium swallow (esophagram) uses X-rays to take images of your esophagus after you swallow a thick, chalky liquid called barium. The X-rays can highlight any abnormal areas in the inner lining of your esophagus.

Computed tomography (CT) scan for esophageal cancer uses X-ray images to present detailed images of the esophagus and surrounding tissues. It also helps to identify the spread of cancer to other distant organs, such as the liver.

Magnetic resonance imaging (MRI) may be useful in detecting esophageal tumors and metastases. This diagnostic technique offers greater soft tissue contrast than a CT scan. An MRI scan uses magnetic fields, not X-rays, to create internal images of the body. You may be given an injection with a contrast medium so that the images are clearer.

PET/CT scans are combined to detect cancer and whether it has spread throughout the body. You’ll be injected with a small amount of radioactive sugar to visualize areas of high activity that could be cancer, as the cells take up this substance.

Endoscopy for cancer of the esophagus

Upper endoscopy is one of the most common ways of diagnosing esophageal cancer. It may be used as a biopsy, as well as to determine the extent of the tumor. The camera on the end of the endoscope allows doctors to see the lining of the esophagus and detect abnormalities. The procedure is performed while the patient is under sedation. The doctor reviews the images on a monitor, looking for any abnormal areas in your esophagus wall.

Some esophageal cancers grow so that they block the opening of the esophagus. If this is the case, your doctor would be able to use instruments that are designed to help enlarge the opening, allowing food and liquid to pass through.

Endoscopic ultrasound (EUS) allows doctors to see the esophagus and surrounding tissues on an ultrasound machine. This test for esophageal cancer is designed to detect abnormalities in the surrounding tissue and lymph nodes. An EUS also helps stage esophageal cancer, which guides treatment decisions and prognosis assessments. This procedure is often done at the same time as an upper endoscopy. The test requires an endoscopic probe to be placed in your esophagus through your mouth. Ultrasound is attached to the probe. Sound waves from the ultrasound create images to show whether you have a tumor in the walls of your esophagus and, if so, how deep it’s grown and how far it’s spread. Ultrasound may also be used to take samples from nearby lymph nodes to determine whether cancer has spread there.

Bronchoscopy is much like an endoscopy in that your doctor threads a thin, flexible tube with a light on the end into the area where your trachea, or windpipe, branches out into your lungs. The tube enters through your nose or mouth and is directed down your windpipe and into the area known as the bronchial tree. Your doctor may order a bronchoscopy if the tumor is in the upper part of your airway or is suspected to be growing into your airway.

Biopsy and lab tests for cancer of the esophagus

Biopsy may not only be used to help diagnose cancer, but it also may help differentiate an adenocarcinoma from squamous cell carcinoma, which are two types of esophageal cancer with very different treatments and prognosis. Other tests can help find cancer, but a biopsy is needed to make a definitive diagnosis. During a biopsy, tissue is taken from the suspicious area and sent to a pathology laboratory, where a pathologist will examine the tissue under a microscope.

Advanced genomic testing examines a tumor to look for DNA alterations that may be driving its growth and other behaviors. Your doctors are looking for tumor markers or biomarkers—mutations in genes, proteins and other substances—that are unique to the cancer. By identifying the mutations that occur in a cancer cell’s genome, your care team may be able to tailor your treatment based on these findings.

Nutrition panel is used to evaluate patients for deficiencies in nutrients, such as vitamin D and iron. The test may help identify the nutrients patients need replaced or boosted to support their quality of life.

Learn more about our nutrition therapy program.

Blood tests

No blood test alone can diagnose esophageal cancer. However, your care team may order blood tests to provide more information about what’s happening inside your body when diagnosing cancer of the esophagus.

Complete blood count (CBC) measures different cells found in your blood. If you have too few red blood cells, for example, it could indicate that you’re anemic. One possible cause of a low red blood cell count is that the tumor is bleeding.

A liver panel is a blood test that measures enzymes, proteins and other substances that your liver makes. If your numbers are outside the normal range, it could indicate that esophageal cancer has spread to your liver.

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