The doctor will ask about your symptoms, and medical and family history. The head, neck, throat, and abdominal areas will be carefully examined. Your doctor may look for other possible causes of your symptoms. If cancer or other gastrointestinal conditions are suspected, a specialist may be recommended.
Suspicion of Esophageal Cancer
If you have symptoms, your doctor may conduct certain tests to identify abnormalities. These may include:
Blood tests —Certain substances are released into the blood when a tumor develops. These tumor markers may be elevated in the presence of cancer.
Barium swallow —Contrast material is swallowed and x-rayed. The barium makes it easier to see abnormalities.
Imaging tests —To assess internal structures for the presence and location of tumors. Imaging tests may include:
Upper GI endoscopy —A tube with a lighted tip and camera is inserted through the mouth and throat. The scope is threaded down the esophagus and into the stomach and first part of the small intestine to look for any abnormalities. Any abnormal tissue will be removed and examined under a microscope.
Diagnosis of Esoghageal Cancer
Diagnosis of esophageal cancer is confirmed with a biopsy. A biopsy is a tissue sample that is removed from the esophagus, often during an endoscopy. After removal, the sample is examined under a microscope. This is the only way to confirm a diagnosis.
The tissue may also be tested for other factors, such as genetic characteristics (human growth factor receptor or HER2). Certain genetics will provide guidance for prognosis and treatment.
Staging of Esophageal Cancer
If esophageal cancer is confirmed, results from completed tests and new tests will help determine the stage of cancer. Staging is used to identify characteristics of the tumor that will help determine the prognosis and treatment plan. Factors that play a role in staging include how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue, and microscopic cellular details.
Tests that may help determine esophageal cancer stage:
Microscopic evaluation of tissue samples—To look for genetic characteristics.
Imaging tests—To help determine how deep the tumor has moved into the layers of the esophagus or nearby structures. They may also help to determine if there are any metastatic growths in other areas of the body. Imaging tests may include:
Endoscopy, bronchoscopy (to examine lungs), and thoracoscopy (to examine chest cavity)—To carefully look for and remove any suspicious tissue for closer examination under a microscope.
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.
Esophageal cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/esophageal-cancer. Updated July 2014. Accessed January 3, 2017.
Esophagus cancer. American Cancer Society website. Available at http://www.cancer.org/acs/groups/cid/documents/webcontent/003098-pdf.pdf. Accessed January 3, 2017.
General information about esophageal cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/all. Updated July 19, 2016. Accessed January 3, 2017.
Stages of esophageal cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/_129. Updated July 19, 2016. Accessed January 3, 2017.
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