If no warning signs have surfaced

then you should assess if you are generally at risk.  Ask your Gastroenterologist about screening.

If you are experiencing difficulty swallowing

A battery of tests can be performed to assess and then validate your diagnosis. Diagnosing esophageal cancer will generally consist of external scans (such as such as a CT scan) and internal examination of the esophagus (such as an endoscopy).  The following outlines commons tests to diagnose EC:

Barium Swallow


A patient presenting with swallowing difficulties will undergo a barium swallow test.

Barium Swallow Test: In this test, the patient swallows a liquid barium mixture while at an x-ray machine. The barium is opaque to the x-rays and is therefore able to indicate any area of narrowing in the esophagus.

If narrowing is found, a more direct test is usually performed known as an endoscopy which is performed using an endoscope.
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Endoscopy

An endoscope: is a medical instrument. It consists of a narrow flexible tube with a light and camera at the end which is used to look into the esophagus. This instrument is capable of extending into the esophagus and can be threaded down to the stomach. It is often equipped with fiber optics that can transmit images of the inside of the esophagus to a television monitor. It may also have a small attachment to take a sample or biopsy of the esophageal tissue. If the endoscope is also outfitted with another imaging system, an ultrasound probe, it may be possible to determine if lymph nodes outside of the esophagus have tumor cells present there, called a metastasis.

Endoscopy is done with the patient sedated and generally causes no major discomfort afterwards. Microscopic analysis of the biopsy determines whether or not cancerous cells are present and how far they have invaded into the wall of the esophagus. The microscopic evaluation and the endoscopic procedures together will confirm how advanced the cancer is, if tumor cells are present.
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Transnasal Esophagoscopy - TNE

Transnasal esophagoscopy (TNE) is a safe and inexpensive way to examine the esophagus in patients at risk for esophageal cancer and other disorders.

TNE is an office based procedure in which the patient is anesthetized locally in the nose and throat. A flexible endoscope (camera) is then passed through one of the nasal passages into the throat and down into the esophagus. Air is puffed into the esophagus and stomach, which can cause some burping. The scope is advanced through the esophageal inlet to the stomach, where the esophagus can be examined, with special attention paid to the gastroesophageal (GE) junction. An advantage of TNE over other more invasive cancer screening methods that require conscious sedation is that it can be performed using topical anesthesia alone with the patient sitting upright in an exam chair unencumbered by cardiac monitoring equipment.

TNE, as it is used today, was developed by Dr. Jonathan E. Aviv who published his findings on the first series of TNE that he performed. View this important video of Dr. Jonathan Aviv’s presentation at Mt Sinai Hospital on “The Changing Face of Esophageal Cancer…The Fastest Growing Cancer in America: New Presenting Symptoms, New Ways to Diagnose”.
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Biopsy

A biopsy is the removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include:

(1) incisional biopsy, in which only a sample of tissue is removed;
(2) excisional biopsy, in which an entire lump or suspicious area is removed; and
(3) needle biopsy, in which a sample of tissue or fluid is removed with a needle.

When a wide needle is used, the procedure is called a core biopsy.

When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

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CT & PET Scans

Another valuable diagnostic test that is widely used is a Positron Emission Tomography (PET) scan. Patients are given a dose of glucose that is altered so it is radioactive. Tumor cells require much more sugar in the form of glucose for energy than normal cells in the body. After receiving the glucose, the patient waits for about an hour, giving the cancer cells in the body time to absorb large amounts of glucose before the scan. The PET scanner is able to locate where there is an excess of radioactive glucose and where there are likely to be tumor cells. The radioactivity rapidly decays, so that it does not cause lasting effects.

For even greater accuracy in locating and measuring the size of the tumors, the PET scan is usually done in combination with a CT scan. This is a very valuable combination not only for a very accurate diagnosis, but also to determine how successful cancer treatments have been in getting rid of the malignant cells.

A CT scan is an x-ray machine linked to a computer that takes a series of detailed pictures of your chest and abdomen. Doctors use CT scans to look for esophageal cancer that has spread to lymph nodes and other areas. You may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.

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Other Tests


Other diagnostic tests include:

MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside your body. An MRI can show whether cancer has spread to lymph nodes or other areas. Sometimes contrast material is given by injection into your blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.

Bone scan: You get an injection of a small amount of a radioactive substance. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.

Laparoscopy: After you are given general anesthesia, the surgeon makes small incisions (cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen. Lymph nodes or other tissue samples may be removed to check for cancer cells.

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Source: The Web site of the National Cancer Institute

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