There are no early detection tests used in the United States to screen the general population for esophageal cancer. However, people who are at high risk for esophageal cancer, such as those with Barrett esophagus, are followed closely to ensure that any further abnormal changes are found early. There is no evidence to recommend looking for Barrett esophagus in people with GERD (heartburn), although some doctors do this.
Testing for People at High Risk
People with strong risk factors for esophageal cancer (such as tylosis) should have endoscopic examinations (looking inside the esophagus through a flexible lighted tube called an endoscope) and biopsies (removal of a small sample of tissue to examine under the microscope) regularly.
Doctors recommend that people with Barrett esophagus have an upper endoscopy and biopsy done on a frequent basis. If dysplasia (abnormal cells, but not yet cancerous) is found, then an endoscopy and biopsy are usually repeated more frequently, at least every year.
If the dysplasia is high grade (meaning that the cells appear very abnormal), this is particularly worrisome. Many, but not all, doctors recommend surgery to remove the area of Barrett esophagus unless the patient is in poor health and unable to withstand the operation. Surgery is recommended because of the high risk that an adenocarcinoma-type cancer is already present (but not found) or will develop within a few years. The prognosis for these patients is relatively good. This monitoring strategy can help detect cancers early when they are more likely to respond to treatment.
Other treatment options for certain patients with high-grade dysplasia include endomucosal resection (EMR), photodynamic therapy (PDT), and cryoablation.