If your GP suspects you may have cancer of the oesophagus, they will first take a detailed look at your medical history, before carrying out a physical examination. During this examination your GP will look for any signs of abnormalities, such as a lump in your abdomen, which may indicate a tumour.
If your GP still suspects oesophageal cancer, you will be referred for further tests at a hospital. Some of the tests you may receive are outlined below.
Endoscopy
This is one of the first tests you will have to help confirm a diagnosis of cancer of the oesophagus.
Endoscopy is a medical procedure that allows doctors to see inside the body. During this procedure, a thin flexible telescope, called an endoscope, is passed through your mouth and down towards your stomach.
The endoscope has a light attached to the end, and feeds back the images of your oesophagus to a monitor. This will allow your doctor to look for any signs of abnormal cells or tumours.
Before having an endoscopy, you should avoid eating for several hours, as food can obstruct the view of the endoscope.
An endoscopy should not cause you any pain, although it may feel uncomfortable. Before the endoscopy takes place, you will normally be given a local anaesthetic or sedative, to help you relax, and to help make the procedure less uncomfortable. The endoscopy itself will usually take about 15 minutes, although you should allow approximately two hours for your visit.
You may notice that you have a sore throat following an endoscopy, which will usually last for a few days. If your symptoms persist, see your GP.
Biopsy
If the specialist carrying out your endoscopy finds any indication of an abnormality, then a sample of cells can be taken (biopsy). This is done by using a special extracting instrument that is connected to the endoscope.
This biopsy will then be examined underneath a microscope in a laboratory. The results of the biopsy will show whether the cells are malignant (cancerous) or benign (non-cancerous). The results will normally take seven to ten days to come back.
Barium swallow
A barium swallow is a test that involves you drinking thick, white-coloured liquid called barium. Once you have swallowed the barium, you will undergo a series of X-rays.
The barium coats the lining of your oesophagus, so that it shows up on the X-ray. These X-rays are able to show your doctor whether there is any obstruction in your oesophagus, which may be an indication of a tumour.
You may have to undergo this test if your cancer has already been diagnosed, as it will help your doctor to assess the size of your tumour.
A barium swallow usually takes about 15 minutes to perform. After the procedure, you will be able to eat and drink as normal, although you may need to drink more water, to help flush the barium out of your system.
Endoscopic ultrasound
Once cancer of the oesophagus has been diagnosed, your doctor will need to assess how far the cancer has spread, and how large the tumour has grown.
An endoscopic ultrasound will help your doctors to assess how far your oesophageal cancer has progressed. It involves having a very small ultrasound probe passed into your oesophagus using an endoscope. This test produces sound waves, which can penetrate the surrounding tissues.
These waves are then used to produce an image of your oesophagus, so your doctor can see if the cancer has spread to the surrounding tissue.
Computerised tomography (CT) scan
A CT scan takes a series of X-ray images of your body and uses a computer to put them together. This then creates a very detailed picture of the inside of your body.
A CT scan will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours in any other places within the body. A CT scan will allow your doctors to work out which type of treatment will be most effective and appropriate for you.
Staging
The above tests will usually determine what stage your cancer is at, what you need in terms of your treatment and the possibility of achieving a complete cure.
The stages of oesophageal cancer are described below.
- Stage 1: the cancer is limited to the top layers of the lining of the oesophagus, or is only in a small part of the oesophagus. It has not spread to nearby tissue or lymph nodes.
- Stage 2A: the cancer has spread into the layer of muscle that surrounds the oesophagus, but has not spread to nearby lymph nodes.
- Stage 2B: the cancer has spread to both the muscle layer and into nearby lymph nodes.
- Stage 3: the cancer has spread through the wall of the oesophagus and into nearby lymph nodes and the surrounding tissue. However, it has not spread into other parts of the body.
- Stage 4: the cancer has spread into other parts of the body, such as your liver, lungs or stomach.
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