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How do you diagnose it?
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Patients typically undergo a number of diagnostic tests before a definitive diagnosis of esophageal cancer can be made. John Muir Health offers the full spectrum of advanced technology used in diagnosing esophageal and other GI cancers. Typically, the first test ordered for symptomatic patients is an x-ray procedure known as a barium swallow (sometimes called a barium x-ray or esophagogram). The procedure uses a continuous x-ray technique known as fluoroscopy, which enables the physician to observe the esophagus real-time as the patient swallows a barium solution. Because barium is radiopaque - meaning x-rays cannot pass through - it outlines the digestive tract, enabling esophageal obstructions or anatomic defects to be viewed.
Endoscopy is an important diagnostic tool for examining the internal structure of the esophagus. During an endoscope - a flexible, lighted, fiber-optic viewing tube - is inserted in the patient's mouth and guided down the esophagus. A tiny camera at the end of the endoscope enables the physician to view the internal lining of the esophagus and determine if there are any areas of irritation, inflammation, or abnormal tissue growth. During endoscopy, physicians can also collect tissue samples, a process known as biopsy. The definitive diagnosis of esophageal cancer is made by microscopic evaluation of these tissue specimens by our board-certified pathologists.
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Endoscopic ultrasound is an innovative new test that brings together the technologies of endoscopy and ultrasound to provide important information on the extent of the cancer within the esophageal lining, as well as any spread to adjacent lymph nodes or organs. During the procedure, an endoscope bearing a small ultrasound probe is inserted into the esophagus. This probe bounces sound waves off the esophagus walls, which produces pictures of the internal organs and projects them onto a screen for analysis.
Physicians may also order a CT scan (computed tomography) to garner more information about any local or distant spread of the tumor. CT is a computer-enhanced x-ray procedure that provides a high level of structural detail by recording cross-sectional images from many different angles. A new, state-of-the-art diagnostic tool now available at John Muir Health is an integrated CT and PET scanner. PET (positron emission tomography) scanning entails the injection of a special radionuclide glucose that migrates to areas of high metabolic activity, suggestive of cancer. The combination of these two important diagnostic tools arms the physician with an unprecedented level of useful information.
Once a definitive diagnosis of esophageal cancer has been reached, your physician will need to "stage" your esophageal cancer -- or determine how far the tumor has spread - to devise the best treatment plan. Staging is based on information gathered from the diagnostic tests described above, or any other tests that may have been ordered, including blood work and other laboratory tests. Esophageal cancer staging is based on the TNM classification system, which assesses the extent of the primary tumor, lymph node involvement, and any distant metastases. Classification ranges from Stage 0 (early-stage cancer) to Stage IV (metastatic cancer). A detailed discussion of the various stages of esophageal cancer and the appropriate treatment options for each can be found at: www.cancer.gov/cancerinfo/pdq/treatment/esophageal/patient/.
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