The most important prognostic factor of esophageal cancer is the stage at which it is diagnosed. Therefore, early detection of esophageal cancer is crucial in its treatment, especially since symptoms usually appear at an advanced stage of the disease.
Certain procedures and tests may be performed if an individual exhibits symptoms of esophageal cancer or if the person, despite the absence of symptoms, runs a high risk of developing the disease.
A physical examination and a review of an individual’s medical history are the first steps in detecting the possible presence of esophageal cancer. In these procedures, the doctor checks for symptoms and risk factors. The physician may then recommend other tests to determine the presence of the disease.
These tests include x-ray and various imaging tests.
X-ray
For people suspected of having esophageal cancer, especially those with symptoms of the disease, a barium swallow is often the first diagnostic test performed. It is a way of detecting cancer while it is still at an early stage. It is also useful in determining the extent to which cancer may have spread beyond the esophagus.
A barium swallow is a procedure using x-rays to study the esophagus and adjacent areas. It is used to find and describe the irregularities that may exist on the surface of the esophageal wall. A tumor or bump inside the esophagus could be an indication of cancer.
The procedure for a barium swallow involves the patient swallowing a barium mixture while a radiologist looks for indications of irregularity, blockage or narrowing in the esophagus. During this procedure, the ingested barium coats the esophagus wall. An x-ray is then taken. Barium does not allow x-rays to pass through it, thus showing as white areas on an x-ray study.
Normally, the surface of the esophageal wall is smooth. The ingested barium will coat abnormal areas unevenly. In cases of early cancer, the barium x-ray may reveal small round bumps, plaques, or flat raised areas. In cases of advanced cancer, the barium x-ray will reveal large irregular areas that cause the width of the esophagus to narrow.
Air can be used to help drive the barium to the esophagus. This leads to a better coating of the esophageal surface. This procedure is known as a double-contrast study.
In upper gastrointestinal x-rays, radiologists observe the barium mixture as it enters the stomach in order to look for ulcers or stomach problems.
A barium swallow may also be used to detect tracheosophageal fistula, which is a grave complication that may arise due to esophageal cancer. A tracheosophageal fistula occurs when the tissue between the esophagus and the trachea or windpipe is destroyed by the tumor. This can create a hole in the connection between the breathing and the swallowing tubes. A patient who develops this condition experiences frequent gagging and coughing. Surgery or an endoscopic procedure should be performed to repair this condition.
A computed tomography (CT) scan uses x-rays to compose a detailed, cross-section picture of any body part. It is not normally used to make the initial diagnosis of esophageal cancer. Its primary usefulness lies in providing information on the stage or extent of the disease.
Through CT scans, doctors can determine the location of the tumor. CT scans can also show the condition of the organs near the esophagus, as well as that of distant organs, to determine if the cancer has spread. The results of a CT scan can help doctors determine whether or not surgery should be recommended.
During a CT scan, the patient lies still on a table while being scanned by a machine that rotates around the patient in order to produce pictures showing “slices” of the body. Initial pictures are taken, after which the patient may be asked to drink one or two pints of a radiocontrast agent called a “dye”. The dye may also be injected through an intravenous line.
These radiocontrast agents make clearer pictures possible, particularly in helping doctors ascertain that some areas are not mistaken for tumors. A second set of pictures is then taken.
A CT scan is more inconvenient than a regular x-ray, but improvements in technology are making the procedure faster and less uncomfortable.
CT scans serve another important function. They can be used to guide a biopsy needle to the site of the tumor. Scans are made until the doctor feels that the needle has found the mass. A tissue sample is extracted and then examined under a microscope.
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Reviewed by:
Jiade J. Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology)
Medical Director
The Cancer Information Network
Date Modified: 06/10/04
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