If an individual is suspected to have esophageal cancer, detailed investigations are required to establish the diagnosis and stage the disease, which in turn helps in selecting an appropriate treatment option. Following are some commonly used methods for esophageal cancer diagnosis:
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- Barium swallow: In this test, a thick, viscous liquid containing barium (a heavy element that reflects x-rays) is first swallowed. Then, x-rays are obtained for the upper gastrointestinal system where any abnormal area is detected by the irregular barium coating.
- Endoscopy: Endoscopy is a diagnostic technique which uses an endoscope – a long, flexible, slender tube usually equipped with a camera, a light source, and some special instruments for biopsy or surgery. This enables the doctors to look inside the body parts such as the esophagus, stomach, and duodenum to determine the abnormalities.
Upper Endoscopy: This is generally the first diagnostic test performed on a patient presented with the symptoms of stomach cancer. In this technique, the doctor examines for any abnormal areas in the wall of the stomach using an endoscope. Biopsy samples are generally collected from abnormal areas using a special biopsy instrument in conjunction with the endoscope.
Endoscopic Ultrasound: In this technique, an ultrasound device is used along with an endoscope, to determine the location and extent of tumor invasion in the stomach wall and nearby lymph nodes. It can also signal the spread of disease to nearby organs; however, it cannot accurately determine the extent of disease spread to distant organs such as lungs or bones.
- Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected.
Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.
Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, a strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g. fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose spread of disease to distant body parts. It is usually combined with CT scan (PET/CT).
- Laboratory Tests for Biopsy Samples: Biopsy samples contain a small number of cells or a tiny piece of tissue collected from the affected area or lymph node with the help of a biopsy needle or other biopsy instrument. Biopsy samples are generally collected from abnormal areas using a special biopsy instrument in conjunction with the endoscope.
These samples provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved, and the presence of specific defective genes or proteins.
Watch the video below to understand the INVESTIGATIONS required for diagnosis and staging of esophageal cancer.
CancerBro, what are the investigations required to confirm the esophageal cancer diagnosis?
First investigation to be done in a person with a suspicion of esophageal cancer is upper GI endoscopy.
The next step is to do imaging to look for the involvement of other structures.
First, we will discuss the upper GI endoscopy.
As you can see in the figure, endoscopy helps us to take a biopsy from the mass, and also to do an endoscopic ultrasound, to look for the depth of mass infiltration and involvement of surrounding lymph nodes.
CT scan of thorax, and preferable abdomen should be done to look for local extention and distant spread.
Rarely, PET CT test may also be done.
In this way endoscopy, biopsy and imaging help us to diagnose as well as stage the disease.