Esophageal Cancer Diagnosis
For many esophageal cancer patients, the first symptom is trouble swallowing (dysphagia).
If you have symptoms that may signal esophageal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.
Since esophageal cancer often does not have symptoms in early stages, it may be found during procedures or tests for other conditions.
Esophageal Cancer Diagnostic Tests
MD Anderson's experts use the most advanced technology and techniques to pinpoint esophageal cancer. Precise diagnosis often improves your chances for successful treatment.
One or more of the following tests may be used to find out if you have esophageal cancer and if it has spread. These tests also may be used to find out if treatment is working.
Blood tests
Imaging tests, which may include:
- X-rays
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
Barium swallow test: In this test, you will swallow a chalky liquid that contains barium before undergoing an x-ray. The barium will coat the inside lining of your esophagus and appear clearly on the x-ray. This allows your doctor to see any tissue changes.
Biopsy: A biopsy is the removal of suspected cancer cells for examination under a microscope. Esophageal cancer biopsy procedures include:
Upper gastrointestinal endoscopy: An endoscope, a tube with a high-definition camera and light, is inserted through the mouth into the esophagus. The doctor looks at the esophagus and removes small pieces of tissue for review by our Pathology department.
Endoscopic ultrasound (EUS) or endosonography: An endoscope with an ultrasound device attached to the tip is inserted through an opening in the body, usually the mouth. At the end of the tube, there is a light, a tiny camera and a device that sends out ultrasound waves to generate images of internal organs. This method helps the physician determine how deeply a tumor invades into the esophageal wall. It can also be used to examine nearby lymph nodes for cancer spread.
Bronchoscopy: Using a tool called a bronchoscope, the doctor looks at the trachea (windpipe) and the tubes that go into the lungs. This may be performed if there is suspicion of esophageal cancer invading the respiratory tract.
Laryngoscopy: The doctor examines the larynx (voice box) using a tool called a laryngoscope, which is similar to an endoscope.
CT-guided biopsy: During this procedure, a doctor examines other organs such as the lungs or liver to see if cancer has spread (metastasized). This may be used to determine staging.
Esophageal Cancer Staging
(source: National Cancer Institute)
The stage of esophageal cancer indicates how advanced the tumor is and if it has spread. It also informs your care team about potential treatment options. The most common system used to stage esophageal cancer is the TNM system.
The TNM system describes three key pieces of information:
- T-category refers to how deep in the esophagus the primary tumor is and how far it has spread within the esophagus and to nearby organs
- N-category refers to cancer spread to nearby lymph nodes
- M-category indicates whether the esophageal cancer has metastasized (spread to distant lymph nodes or organs)
Staging also takes into account the cell type of the cancer, grade of the cancer and, in some cases, location of the tumor.
The overall “stage” of a cancer is a combination of the key elements described above. Cancer stages range from stage 0 (pre-cancer) to stage IV (advanced cancer.)
Esophageal Cancer Stages
T Categories
- Tis: The cancer is only in the top layer of cells lining the esophagus (epithelium). This stage is also known as high-grade dysplasia.
- T1: The cancer is growing into the tissue under the epithelium, such as the lamina propria, muscularis mucosae or submucosa
- T1a: The cancer is growing into the lamina propria or muscularis mucosae
- T1b: The cancer is growing into the submucosa
- T2: The cancer is growing into the muscle layer (muscularis propria)
- T3: The cancer is growing into the outer layer of tissue covering the esophagus (adventitia)
- T4: The cancer is growing into nearby structures
- T4a: The cancer is growing into the tissue covering the lungs (pleura), the tissue covering the heart (pericardium), azygos vein, diaphragm or peritoneum
- T4b: The cancer is growing into other structures such as the aorta, vertebral body or airway
N Categories
- N0: The cancer has not spread (metastasized) to nearby lymph nodes
- N1: The cancer has spread to one or two nearby lymph nodes
- N2: The cancer has spread to three to six nearby lymph nodes
- N3: The cancer has spread to seven or more nearby lymph nodes
M Categories
- M0: The cancer has not spread (metastasized) to distant organs or lymph nodes
- M1: The cancer has spread to distant lymph nodes and/or other organs
Grade
The grade of a cancer is based on how normal (or differentiated) the cells appear when they are looked at under the microscope. The higher the number, the more abnormal the cells look. Higher-grade tumors tend to be more aggressive, spreading faster than lower-grade tumors.
- GX: The grade cannot be assessed
- G1: The cells are well differentiated
- G2: The cells are moderately differentiated
- G3: The cells are poorly differentiated or undifferentiated
Location
Some esophageal cancer staging also takes into account where the tumor is in the esophagus. The location is upper, middle or lower based on the center of the tumor in the esophagus.