Esophageal Cancer Diagnosis

After your doctor has given you a thorough examination, you may need several tests to help diagnose esophageal cancer: flexible endoscopy, imaging tests, and blood tests.

Flexible Endoscopy

For this test you are sedated (given medicine to make you sleepy and relaxed). A tube called an endoscope is inserted into your mouth or nose and down into your esophagus. The endoscope has a light and a tiny camera on the end that takes close-up images of esophageal tissue. These images are projected onto a video monitor in the exam room.

An endoscopy gives the best information about the structure of your esophagus. It shows complications of reflux, such as esophagitis (irritation of the esophagus), so that they can be diagnosed. It also shows tissues that may have cancer.

During endoscopy, instruments can be used to take a tissue sample (biopsy). The sample is examined under a microscope to determine if cancer is present and what type of cancer it is. One procedure, called endoscopic mucosal resection, can be used to diagnose and in some cases treat esophageal cancer.

Imaging Tests

If your doctor finds cancer or believes you may have cancer, you will likely have imaging tests to better understand your cancer and determine whether it has spread beyond the esophagus.

  • Computed tomography (CT) scan. A CT scan creates a three-dimensional picture of the inside of your body with an X-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. A contrast medium (a special dye) may be injected into one of your veins to provide better detail. A CT scan can check for the spread of cancer in your lungs, liver, and other organs.
  • Positron emission tomography (PET) scan. A PET scan creates pictures of organs and tissues inside your body using a radioactive substance that is injected into and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by the scanner, which produces the images.
  • Endoscopic ultrasound. This procedure may be done at the same time as the flexible endoscopy. During an ultrasound, sound waves provide a picture of structures inside the body. During an endoscopic ultrasound, a transducer (the machine that produces the sound waves) is inserted into your esophagus through your mouth. The ultrasound can show whether the tumor has invaded the wall of your esophagus, how deep the tumor is, and whether lymph nodes in the area are involved.

Blood Tests

Your doctor may ask you to have a blood test called a complete blood count (CBC) to determine how many blood cells of each type are circulating in your blood stream. Low levels of red blood cells (anemia) may be a sign of internal bleeding, which sometimes happens with esophageal cancer (as well as with other conditions).