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Diagnosis of Esophageal Cancer

by Ricker Polsdorfer, MD

If you have symptoms, your doctor may conduct certain tests to identify abnormalities. These may include:

  • Upper GI endoscopy—A tube with a video lens is passed through the mouth and throat. The doctor will be able to look at the lining of the esophagus. They will be able to see areas of irritation or abnormal tissue.
  • Biopsy—a sample of abnormal tissue will be removed. It will be sent to a lab to look for cancer cells or other health issues. A biopsy of the esophagus will be done during an endoscopy. The tissue may also be tested for other things, such as genetic makeup. Certain genes will help to guide treatment.
  • Blood tests —Certain substances are released into the blood when a tumor develops. These tumor markers will be higher if cancer is present.

Other tests will help the doctor learn more about the cancer. They will look for tumors and affected tissue. Tests may include:

Staging of Esophageal Cancer

Completed tests and new tests will help determine the stage of cancer. Staging helps to find characteristics of the cancer that will help to make a treatment plan. Tumor spread, lymph nodes changes, spread to other tissue, and microscopic cellular details will all be tested.

Stages of Esophageal Cancer

The esophagus is made up of 4 layers, the innermost mucosa, the submucosa, a thicker muscle layer, and a thin layer of connective tissue called the adventitia. The location and depth of the tumor is important in staging. Esophageal cancer is staged from 0-IV.

  • Stage 0—High grade dysplasia —Abnormal cells are found only in the innermost 2 linings of the esophagus, the mucosa and submucosa.
  • Stage IA —Grade 1 (less aggressive) cancer cells are found in the mucosa OR submucosa.
  • Stage IB —Grade 2 and 3 cancer cells (more aggressive) are found in the mucosa or submucosa OR grade 1 cancer cells are found in the mucosa or submucosa AND have spread TO the muscle layer or adventitia. The tumor location may be unknown or in the lower esophagus.
  • Stage IIA —Grade 1 cancer cells have spread TO the muscle layer or adventitia. The tumor is in the middle or upper esophagus OR Grade 2 and 3 cancer cells have spread TO the muscle layer or adventitia. The tumor location may be unknown or in the lower esophagus.
  • Stage IIB —Cancer has spread TO the muscle layer or adventitia. The tumor is in the middle or upper esophagus OR cancer from the mucosa or submucosa has spread TO the muscle layer AND to 1-2 nearby lymph nodes.
  • Stage IIIA —Cancer in the mucosa or submucosa MAY spread into the muscle layer AND to 3-6 nearby lymph nodes OR has spread TO the adventitia AND to 3-6 nearby lymph nodes OR has spread TO the diaphragm (separates the abdominal and chest cavities), pleura (tissue that lines the lungs), or the pericardium (the sac that surrounds the heart).
  • Stage IIIB —Cancer has spread INTO the adventitia AND to 3-6 nearby lymph nodes.
  • Stage IIIC —Cancer has spread INTO the diaphragm, pleura, or pericardium AND to 1-6 nearby lymph nodes OR nearby organs OR to 7 or more nearby lymph nodes.
  • Stage IV —Cancer has spread to other parts of the body through the lymph and blood streams. The most common sites for metastatic esophageal cancer are lymph nodes in other parts of the body, the lungs, liver, kidney, and bones.
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References:

Esophageal and esophagogastric junction cancer. EBSCO DynaMed website. Available at: http://www.dynamed.... Accessed January 3, 2020.
Esophageal cancer. Merck Manual Professional Version website. Available at:
...(Click grey area to select URL)
Accessed January 3, 2020.
Esophagus cancer. American Cancer Society website. Available at
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Accessed January 3, 2020.
General information about esophageal cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/all. Accessed January 3, 2020.
Stages of esophageal cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/_129. Accessed January 3, 2020.
Last reviewed January 2020 by EBSCO Medical Review Board Nicole S. Meregian, PA
Last Updated: 11/4/2020