How is oesophageal cancer diagnosed?
Diagnosis of oesophageal cancer
A diagnosis of oesophageal cancer is usually based on the results of a clinical examination, blood tests, an endoscopy (aka oesophagoscopy, upper gastrointestinal endoscopy or gastroscopy) procedure, imaging scans using magnetic resonance imaging (MRI) or computed tomography (CT), a biopsy and sometimes a barium swallow test.
Oesophageal cancer tests and investigations
The following tests and scans are used to confirm an oesophageal cancer diagnosis. Your doctors will use the test results to work out the best treatment for you. You may not need all the tests listed below. Your specialist will give you more detailed information about what tests are most appropriate for your condition.
If you have symptoms of oesophageal cancer, your doctor may carry out a general clinical examination. The doctor will ask about your medical history to learn about your symptoms and possible risk factors.
Your doctor may recommend that you have blood tests. These are to check your liver function (LFTs) and your overall health (FBE). An FBE test measures the different types of cells in your blood. It can show if you have anemia (too few red blood cells). Some people with oesophageal cancer have low red blood cell counts because the tumour has been bleeding. A blood test alone cannot provide a diagnosis.
If you are having trouble swallowing, sometimes a barium swallow is the first test done. In this test, you will be asked to swallow a thick, chalky liquid called barium to coat the walls of the oesophagus. When X-rays are taken, the barium outlines the oesophagus.
A barium swallow test can show any abnormal areas in the normally smooth inner lining of the oesophagus, but it can’t be used to determine how far a cancer may have spread outside of the oesophagus.
During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes an endoscope down your throat and into the oesophagus and stomach. The endoscope’s camera is connected to a monitor, which lets the doctor see any abnormal areas in the wall of the oesophagus clearly.
The doctor can take tissue samples from any abnormal areas. These samples are sent to the lab to check if they contain cancer.
If an oesophageal cancer is found and is blocking the oesophagus, certain instruments can be used to help enlarge the opening (dilate) to help food and liquid pass.
Upper endoscopy can give the doctor important information about the size and spread of the tumour, which can be used to help determine if the tumour can be removed with surgery.
Another type of ultrasound – called an endoscopic ultrasound (EUS) – is a procedure that uses an endoscope probe that gives off soundwaves to take pictures of any tumours within the oesophageus. This test is very useful in determining the size of an oesophageal cancer and how far it has grown into nearby areas.
An EUS can help a doctor see a pancreatic tumour’s location and size, check whether the cancer has spread to other nearby areas of the body, or take a biopsy/tumour sample for examination. The images provided by this internal ultrasound have been shown to be helpful in determining whether a tumour can be removed with surgery.
If the scopes find a tumour, your doctor may wish to take a biopsy. This involves taking samples of tissue from the oesophagus for testing under a microscope.
A CT scan uses x-rays to build up a three-dimensional picture of the oesophagus and the other organs around it. It is also usual to scan your chest and pelvic area to check for any signs of cancer outside the oesophagus.
MRI uses magnetic fields and radio waves to produce detailed images of the inside of the body. Like a CT scan, an MRI photographs the organs several times, while a patient lies on a table. A computer creates a 3D image that doctors can use to help diagnose and monitor oesophageal cancer.
Positron Emission Tomography (PET) is a test where a small amount of radioactive substance is injected into a vein. On the scans the injected substance shows up areas where the cells are more active in the body. Cells need glucose (sugar) for energy. Growing cells, such as cancer cells, use glucose faster than other cells. PET imaging shows this change. PET scans may indicate whether the mass is cancerous, help the healthcare team figure out the right treatment, including whether surgery is possible or show if and where liver cancer has spread.
This scan combines a CT scan with a PET (Positron Emission Tomography) scan. A PET scan uses a small amount of radioactive material, which is injected into your body and is absorbed into your organs and tissues. CT is a type of X-ray. The combination of the two scans has been proven to be extremely sensitive in detecting small tumours that are undetectable by other imaging procedures or CT alone. PET-CT information can be used to determine what kind of surgery, radiation therapy and chemotherapy is most likely to be successful in managing a patient’s cancer.
Waiting to have tests carried out
Even if you have been given an urgent referral for a particular scan or investigation you may have to wait several days or possibly weeks for your appointment. This can be frustrating and worrying, especially if you are already feeling unwell.
If your symptoms get worse or you start to feel more unwell while you are waiting, it is a good idea to get in touch with your GP or specialist if you already have one. If you cannot get in contact with them you may need to present to the closest emergency department of your symptoms cannot be controlled at home.
How long will I have to wait for my test results?
Depending on which tests you have had it may take from a few days to a few weeks for the results to come through. Waiting for test results can be an anxious time.
It is a good idea to ask how long you may have to wait when you go for tests. If you think you have been waiting too long, then contact your GP or a specialist to follow up on the progress of your results. Usually the doctor who does the test will write a report and send it to your specialist. If your GP sent you for the test the results will be sent to the GP clinic.
You will need an appointment with your specialist or GP to discuss the test results and how they might affect your treatment. Usually your specialist will discuss your results and plan your subsequent care.
Your test results will enable your doctors to make a detailed diagnosis and indicate to them at what stage your cancer is.
Staging is how doctors refer to the size of a cancer and whether it has spread around the tumour site or to other areas of the body. It is an important part of their assessment and contributes to treatment planning.
One system uses numbers to describe the stage of the cancer, the other uses the tumour-nodes-metasteses staging system. Your cancer staging may be explained to you by one or both ways.
The cancer is only in the epithelium (the top layer of cells lining the inside of the oesophagus). It has not started growing. This stage is also known as high-grade dysplasia.
When cancer is growing into the oesophagus lining.
The cancer is usually larger and has spread deeper into the muscle and outer layers of the oesophagus.
The cancer is usually larger and has spread deeper into the muscle and outer layers of the oesophagus and to nearby lymph nodes, known as locally advanced disease.
The cancer is growing into the pleura (the thin layer of tissue covering the lungs), the pericardium (the thin sac surrounding the heart), the diaphragm (the muscle below the lungs that separates the chest from the abdomen), the trachea (windpipe), the aorta (the large blood vessel coming from the heart), or the spine, and spread to no more than 6 nearby lymph nodes. It has not spread to distant organs.
The cancer has spread to other parts of the body (metastatic cancer) such as the liver, lungs, distant lymph nodes or stomach.
TNM (Tumour-Nodes-Metastases) staging
The TNM gives a number according to tumour size (T), how many lymph nodes are affected (N), and how far the cancer has spread, or metastasised, to distant parts of the body (M). This information is used to help decide the best treatment.
|single tumour less than 2 cm; Child–Pugh A|
|single tumour greater than 2 cm or up to 3 tumours less than 3 cm; Child–Pugh A or B|
|multiple tumours in the liver; Child–Pugh A–B|
|the tumour has grown into one of the main blood vessels of the liver, or spread to the lymph nodes or other body organs; Child–Pugh A–B|
Receiving an oesophageal cancer diagnosis
Receiving the diagnosis of oesophageal cancer can be unnerving, confusing, and disorienting. You have mixed emotions of surprise, disbelief, and anger; and you may feel sad and disappointed, with fear and uncertainty for the future. But you are not alone.
The PanSupport Team is here for you – to connect you with a community of people who have a shared experience and to support you through all stages of your experience.
A Common Path: Oesophagogastric cancer
The ‘A Common Path’ suite of cancer support and advice videos have been developed by the North Eastern Melbourne Integrated Cancer Service, with support from Pancare, for people who have been newly diagnosed with cancer. They provide people with an opportunity to learn from others who have already experienced a cancer diagnosis and treatment, highlighting how they made decisions, the things they learned along the way, the things that helped, and the things they wish they had known or done better.
> Oesophageal cancer treatment options