Virginia Commonwealth University

VCU Massey Cancer Center

Diagnosis and staging

How is esophageal cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:

  • Chest X-ray – a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
  • Upper GI (gastrointestinal) series (also called barium swallows) – a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy) – a procedure that allows the physician to examine the inside of the esophagus, stomach and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary). 

Computed tomography scan (CT or CAT scan) – diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

  • Endoscopic ultrasound – this imaging technique uses sound waves to create a computer image of the inside of the esophagus and stomach. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the physician to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).
  • Thoracoscopy and laparoscopy – these methods allow the physician to examine the lymph nodes inside the chest or abdomen with a hollow, lighted tube, and remove these nodes for further testing.

 

What are the stages of esophageal cancer?

When esophageal cancer is diagnosed, tests will be performed to determine how much cancer is present, and if the cancer has spread to other parts of the body. This step is is called staging, and is an important step toward planning a treatment program. The National Cancer Institute defines the following stages for esophageal cancer:

 

Stage I 

The cancer is detected only in the top layers of cells lining the esophagus. 

Stage II 

The cancer involves deeper layers of the lining of the esophagus, invaded the muscle layer, grown through the outer layer of the esophagus or it has spread to nearby lymph nodes. However, the cancer has not spread to other parts of the body. 

Stage III 

The cancer has grown through the outer layer and cancer cells have spread to lymph nodes, or the cancer has invaded nearby structures, such as airways.

Stage IV 

The cancer has spread to distant organs, such as the liver.