How is esophagus cancer diagnosed?

February 19, 2006 (Press Release) -- If you have difficulty swallowing, it does NOT mean that you have cancer of the esophagus. In fact, most patients with this complaint have a hiatal hernia or non-cancerous stricture which blocks the passage of food. It is your doctor's job to determine the underlying cause of your symptoms. If you complain about difficulty swallowing, tests will be necessary to evaluate your condition. Testing will usually begin with a medical history and physical exam. The doctor will want to know how often and under what circumstances the problem occurs.
Most cases will require a "scope" test of the upper digestive system. Also known as a gastroscopy or EGD exam, this simple test is quickly and painlessly performed using a mild sedative. A thin flexible sterilized tube is passed through the mouth and down into the esophagus and stomach. A tiny color video camera within this instrument allows the doctor to directly examine the esophagus, stomach, and upper small intestine on a TV monitor. When necessary, photographs and biopsies can be obtained to determine if cancer is present, and if so, its type (squamous cell cancer or adenocarcinoma).
One of the best ways to determine the nature of an esophageal tumor and its depth of invasion, is a special "scope" test known as an Endoscopic Ultrasound or EUS exam. This new procedure uses a modified endoscope which has a miniaturized ultrasound probe hidden in the tip. During an EUS exam, the doctor places the ultrasound probe directly into the esophagus, very close to the area of interest. It sends out very sensitive sound waves that penetrate deep into the tissues. Like sonar in a submarine, these sound waves bounce back forming a picture that shows how deeply the cancer has invaded into the esophagus. EUS has been shown to be superior to routine x-rays such as abdominal ultrasound, barium studies, CAT scans, and even MRI scans for looking at the local spread of cancer of the esophagus. This procedure is very highly specialized and is performed by a gastroenterologist who has extra training in this area.
X-ray studies are often used. Barium x-rays may be requested to view the esophagus during the act of swallowing. A CT scan or MRI can help determine if the cancer has broken through the wall and spread beyond the esophagus.
Less commonly, the doctor may request an esophageal manometry study which measures the strength and coordination of the esophageal contractions as well as the pressure of the special "trapdoor valve" between the stomach and esophagus.