Diagnosis

Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
  
  
• The type of cancer suspected
  
  
• Severity of symptoms
  
  
• Previous test results

Routine screening tests to detect early esophageal cancer are not used in the United States. People with Barrett's esophagus may be advised to have endoscopic examinations (looking inside the esophagus through a flexible, lighted tube) and biopsies (removal of a small amount of tissue for examination under a microscope) on a regular basis to help detect cancer early.

In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:

Barium swallow (also called an esophagram). The patient swallows a liquid containing barium and then a series of x-rays (pictures of the inside of the body) are taken. Barium coats the surface of the esophagus, making tumors or other abnormalities easier to see on the x-ray. If there is an abnormality, doctors may order an upper endoscopy and biopsy to determine if cancer is present.

Upper endoscopy (also called esophagus-gastric-duodenoscopy, or EGD). This test allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus. If an abnormality is found, a biopsy will be performed to determine if it is noncancerous or cancerous. An endoscopy can also help expand the blocked area, so that food can temporarily pass through until treatment can begin.

Endoscopic ultrasound. This procedure is often done at the same time as the upper 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 the esophagus through the mouth. The ultrasound can identify if the tumor invades the wall of the esophagus, how deep the tumor is, and whether lymph nodes are involved.

Bronchoscopy. Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a patient’s tumor is located in the upper two-thirds of the esophagus to determine if the tumor is invading the person’s airway, including the trachea (windpipe) and bronchial tree (area where the windpipe branches out into the lungs).

Biopsy. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The tissue sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.

To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed.