Oesophageal cancer - Diagnosis

Diagnosis-Oesophageal cancer




See a GP if you experience symptoms of oesophageal cancer. They'll carry out an initial assessment and decide whether you need to have any further tests.

Seeing a GP

A GP may:
  • ask about your symptoms
  • carry out a physical examination
  • take a look at your medical history
If they think you need to have some tests, they can refer you to a hospital specialist.
This will usually be a gastroenterologist, a specialist in the digestive system.

Tests to diagnose oesophageal cancer

The 2 main tests used to diagnose oesophageal cancer are:
  • an endoscopy – this is the most common test
  • a barium swallow or barium meal

Endoscopy

An endoscopy is a procedure that allows your doctor to see inside your oesophagus so they can check for cancer.
A thin, flexible tube with a light and camera at the end is passed into your mouth and down towards your stomach.
Small samples of tissue are also removed from your oesophagus so they can be checked for cancer under a microscope. This is called a biopsy.
You'll be awake while an endoscopy is carried out. It should not be painful, but may be a bit uncomfortable.
You'll normally be given local anaesthetic to numb your throat and possibly a sedative to help you relax.

Barium swallow or barium meal

A barium swallow or barium meal involves drinking a harmless white liquid called barium before several X-rays are taken.
The barium coats the lining of your oesophagus so it shows up on the X-ray.
This can show whether there's anything blocking your oesophagus, which may be a sign of cancer.
This test is not used to diagnose oesophageal cancer very often nowadays because the best way to confirm a diagnosis is to use tissue samples taken during an endoscopy.

Further tests

If you have oesophageal cancer, further tests can show how far the cancer has spread, called the "stage".
These tests may include:
  • a CT scan – where a series of X-rays are taken and put together by a computer to create a detailed picture of the inside of your body
  • an endoscopic ultrasound scan – where a small probe that produces sound waves is passed down your throat to create an image of your oesophagus and the surrounding area
  • a PET scan – a scan that can help show how far the cancer has spread
  • a laparoscopy – a type of keyhole surgery performed under general anaesthetic (where you're asleep), in which a thin tube with a camera at the end is inserted through a cut in your skin to examine the area around your oesophagus

Stages of oesophageal cancer

The most widely used system for staging oesophageal cancer is the TNM system.
This involves scoring the cancer in 3 categories:
  • T (tumour) – the location and size of the tumour
  • N (node) – whether the cancer has spread to the lymph nodes (a network of glands throughout the body)
  • M (metastasis) – whether the cancer has spread to other parts of the body, such as the lungs, liver or bones
Scores for each category are then often used in a simpler number system, ranging from stage 1 (early cancer) to stage 4 (advanced cancer).
Knowing the stage of your cancer will help your care team work out the best treatment for you.
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