Detection and Diagnosis of Esophageal Cancer

Common symptoms associated with esophageal cancer include difficulty swallowing (dysphagia). This is the most common sign, where food may feel stuck in the throat or chest and often begins with solid foods before progressing to liquids.

Some people experience painful swallowing, which can cause a burning sensation. Other warning signs include unexplained weight loss, chronic or worsening heartburn and indigestion that do not improve with over-the-counter remedies, chest pain or pressure behind the breastbone, or a persistent cough or hoarse voice that lasts longer than two weeks.

If you experience symptoms of esophageal cancer, your doctor will conduct tests to confirm whether the cause is esophageal cancer or another condition.

The following tests and procedures can be used to detect and diagnose esophageal cancer:

Imaging Tests to Diagnose Esophageal Cancer

Your doctor may recommend several imaging tests, including:

Barium Swallow

This test uses X-rays and a chalky liquid called barium to outline the esophagus, making any abnormal areas more visible.

Computed Tomography (CT) Scan

This creates a 3-D image of the inside of the body using X-rays taken from different angles. It also helps determine whether esophageal cancer is affecting other areas of the body.

Positron Emission Tomography (PET) Scan

This test uses a small amount of radioactive material to create detailed images of the organs and tissues. A PET scan may be combined with a CT scan (PET/CT scan).

Magnetic Resonance Imaging (MRI)

This uses radio waves and strong magnets instead of X-rays to produce detailed images of soft tissues in the body.

Endoscopy

An endoscope is a specialized, flexible tube equipped with a tiny video camera and light, allowing the doctor to look inside the body. Endoscopic tests are incredibly helpful in diagnosing esophageal cancer and determining its spread:

Upper Endoscopy

This procedure involves guiding an endoscope through the mouth and down the esophagus into the stomach and duodenum (the first part of the small intestine) to identify abnormal areas.

Endoscopic Ultrasound

The procedure combines endoscopy with ultrasound technology to create images of the esophagus and nearby lymph nodes.

Bronchoscopy

Using a bronchoscope enables the GI specialist to check whether cancer in the upper esophagus has spread to the trachea (windpipe) or bronchi (the tubes leading from the windpipe into the lungs).

Thoracoscopy and Laparoscopy

These exams allow our specialists to view lymph nodes and the organs near the esophagus-thoracoscopically from within the chest and laparoscopically from the abdomen-using a hollow, lighted tube.

Biopsy to Confirm Esophageal Cancer

A biopsy is typically performed during an endoscopy and involves removing specific cells or tissues for analysis under a microscope. This process helps determine whether cancer is present and can also identify noncancerous changes that could potentially lead to cancer.

Testing Tissue Samples for Biomarkers

Following a biopsy, specific lab tests may be conducted on the tissue sample to see if targeted therapy or immunotherapy could be effective treatment options for you. These tests may include:

HER2 testing: For patients whose esophageal cancer is too advanced for surgery, biopsy samples may be tested for HER2 gene or protein expression, which is linked to cancer cell growth.
PD-L1 testing: This tests for the PD-L1 protein levels in certain esophageal cancers.
MMR and MSI testing: Esophageal cancer cells might be examined for high levels of microsatellite instability (MSI) or changes in mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2).

After testing the samples, the pathologist will prepare a detailed report of the findings. Your oncology team will review the results with you and use this information to help develop your treatment plan.

Blood Tests

If esophageal cancer is suspected, your doctor may recommend specific blood tests:

Complete Blood Count (CBC)

This test measures various blood cell types and can detect low red blood cell counts (anemia), a common concern in individuals with esophageal cancer due to potential tumor bleeding.

Liver Enzymes

Evaluating liver enzymes is essential, as esophageal cancer can sometimes spread to the liver.

Can Esophageal Cancer Be Found Early?

Currently, there is no screening for those at average risk of esophageal cancer. However, individuals at high risk—like those with Barrett's esophagus or certain inherited genetic mutations like tylosis or Bloom syndrome—should talk to their healthcare provider about more frequent monitoring with upper endoscopy screening.

I Have Esophageal Cancer: Now What?

If you've been newly diagnosed with esophageal cancer, your oncologist may suggest additional testing to determine the cancer’s extent, known as staging. Cancer staging often involves imaging tests that look for signs of cancer in your lymph nodes or other parts of your body. The results of these staging tests are essential for your care team in developing your comprehensive treatment plan.