Esophageal Cancer: Tests After Diagnosis
After you’re diagnosed with esophageal cancer, you’ll likely have other tests. These tests help your healthcare providers learn more about your cancer. They can help show if the cancer has grown into nearby areas or spread to other parts of the body. The test results help your healthcare providers decide the best ways to treat the cancer. If you have any questions about these or other tests, talk with your healthcare team.
The tests you may have can include:
Computed tomography (CT) scan
During a CT or CAT scan, X-rays are used to scan a part of your body to make detailed pictures. You may have this done on your stomach or chest. When you have esophageal cancer, these pictures can show if the cancer has spread to nearby lymph nodes or to other organs. These can include your lungs, liver, or adrenal glands. These are small glands that rest on top of each kidney.
To have the test, you lie still on a table as it slowly slides through the center of the CT scanner. Then the scanner directs beams of X-rays at your body. A computer uses the data from the X-rays to make many detailed pictures of your chest.
A CT scan is painless. You may be asked to hold your breath one or more times during the scan. In some cases, you get an intravenous (IV) drip with a contrast medium before the scan. This helps any tumors show up better. The contrast will slowly pass through your system. It will exit through your bowel movements.
Magnetic resonance imaging (MRI)
You may have an MRI to create even more detailed pictures of your esophagus and nearby blood vessels. An MRI uses magnets, radio waves, and a computer to make detailed pictures of the inside of your body.
MRIs aren’t painful. They can take a long time to do, up to one hour. During that time, you’ll need to lie still on a table that’s moved into a long, narrow tube. Some people say the test makes them feel claustrophobic. If you’ve had problems with small spaces in the past, talk to your healthcare provider before the test. Your healthcare provider may give you a sedative to help you stay calm during the test. Newer, more open MRI machines are sometimes used instead. But the images may not be as sharp in some cases. The machine also makes loud banging noises during the test. You can ask for earplugs if you think the noise will bother you.
Because the test uses powerful magnets, you won’t be allowed to have anything metal in the room. Even eyeglasses and pens can become dangerous projectiles when the magnets are turned on. If you have any kind of metal implant, such as a heart valve or a joint pin, you may not be able to have an MRI. This depends on the type of metal it’s made from. The machine may also affect other implants, such as a pacemaker.
Positron emission tomography (PET) scan
A PET scan can show whether an abnormal area seen on a CT scan or other imaging test is a tumor. If you’ve already been diagnosed with cancer, your healthcare provider may use this test to look for spread of the cancer to lymph nodes or other parts of the body. A PET scan can also be helpful if your healthcare provider thinks the cancer may have spread, but doesn't know where. The picture isn’t as detailed as a CT scan, but it can be used along with a CT scan to look for tumors.
For this test, you’re injected with a sugar that has a mildly radioactive substance. Cancer cells absorb more of this sugar than normal cells. The radioactive substance shows up on the image from the scan. To have the scan, you’ll need to lie still on a table. It’ll be pushed into the PET scanner. This is a machine takes pictures that show where the sugar is in your body. The test may take several hours. Other than the injection, a PET scan is painless. But if you’re sensitive to the sugar, you may have side effects. These include nausea, headache, or vomiting.
This test can be used to learn the size of the cancer. It can also see how far the cancer has grown into the wall of the esophagus or nearby structures. It can also be used look if the cancer has spread to lymph nodes or other problems in the area between your lungs (mediastinum).
This is often done during an upper endoscopy. For this test, a long, flexible tube with a tiny video camera on the end (endoscope) is passed down your throat and esophagus. It contains a transducer. You may be sedated or asleep (under general anesthesia) for this test. The transducer gives off sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into a black and white image on a computer screen. The transducer can be pointed in different directions to look at lymph nodes and other structures in between your lungs. If your healthcare provider sees suspicious areas, he or she will pass a hollow needle through the endoscope to get biopsy samples of them. The samples are then sent to a lab to be looked at under a microscope.
Lab tests of biopsy samples
Esophageal cancer is often diagnosed by removing samples of the tumor in a biopsy. This is done during an upper endoscopy. Your healthcare provider will do special lab tests on the biopsy samples to check the type of cancer. He or she may also check if the cancer cells have certain gene changes. These tests can help show if certain types of cancer medicines are likely to work.
You may need this test to check if the cancer has spread to your airways. First, you may receive medicine to help you relax. Then your healthcare provider places a thin, lighted scope (bronchoscope) through your nose or mouth down through your windpipe (trachea) and into your lungs. Your healthcare provider views images from the scope on a video screen. If he or she sees abnormal tissue, he or she may take a biopsy. Your healthcare provider sends the sample to a lab to be checked for cancer.
This surgery may be done if your healthcare provider thinks your cancer might have spread to areas in your abdomen. You’ll receive general anesthesia so that you won’t be awake and won’t feel any pain. During the surgery, your healthcare provider makes one or more small cuts in your skin over your abdomen. Then, he or she places long, thin instruments into your abdomen. One of these is a thin, lighted tube (laparoscope). This lets your healthcare provider see your abdomen. Your healthcare provider may use another tool to biopsy any abnormal tissue for testing. He or she will tell you what to expect after the surgery. Your healthcare provider will also let you know how long you’ll stay in the hospital.
Working with your healthcare provider
Your healthcare provider will talk with you about which tests you'll have. Make sure to follow directions on how to get ready for these tests. Ask questions and talk about any concerns you have.
March 21, 2017
Diagnosis and Staging of Esophageal Cancer. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD