To find the cause of any of these symptoms, the doctor asks about the patient’s personal and family medical history and does a complete physical exam. In addition to checking general signs of health, the doctor usually orders x-rays and other tests.
An esophagram (also called a barium swallow) is a series of x- rays of the esophagus. To prepare for this test, the patient drinks a barium solution. The barium, which shows up on x-rays, coats the inside of the esophagus. The esophagram shows changes in the shape of the esophagus. The doctor can also use a special x-ray machine called a fluoroscope to watch the barium move down the esophagus to the stomach as the patient swallows.
Most patients also have a test called esophagoscopy. For this procedure, the patient’s throat is sprayed with a local anesthetic to reduce discomfort and gagging. The doctor then passes a thin, flexible, lighted instrument called an endoscope through the mouth and down the throat into the esophagus. The scope lets the doctor see the lining of the esophagus and the place where the esophagus joins the stomach. If an abnormal area is found, the doctor does a biopsy (removal of a small amount of tissue through the endoscopy). Also, cells can be brushed or washed from the walls of the esophagus through the scope. A pathologist examines the samples under a microscope to see whether cancer is present.
If cancer is found, the pathologist can tell what type of cancer it is. Cancer that occurs in the middle or upper part of the esophagus is usually squamous cell carcinoma. When cancer develops at the lower end of the esophagus, near the stomach, it is usually adenocarcinoma. (Carcinoma is another name for cancer in the lining of tissues.)
If the pathologist finds esophageal cancer, the patient’s doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out what parts of the body are affected by the cancer.
Treatment decisions depend on these findings. Staging usually involves a physical exam, with special attention to the neck and chest, blood tests, additional x-rays, and other tests. The results show whether the cancer is just in the esophagus or has spread.
The doctor usually order CT (or CAT) scans of the chest and upper abdomen. During a CT scan, many x-rays are taken and a computer combines them to create detailed pictures. Some patients also have an MRI scan, which produces pictures using a huge magnet linked to a computer.
The doctor uses special instruments to check the organs near the esophagus. For example, the doctor can look through a laryngoscope to see whether the cancer has spread to the larynx (voice box). A bronchoscope lets the doctor see into the trachea and bronchi (airways that lead into the lungs).
If lymph nodes near the esophagus are enlarged, the surgeon may perform a biopsy to find out whether they contain cancer cells. Sometimes, the surgeon also removes samples of other tissues in the area to see whether the cancer has spread.