How esophageal cancer is diagnosed
Usually, the first thing you do it see your GP, who will examine you. You may have to have blood tests done to check the overall state of your health. If your GP is unsure of what the problem is or if they believe it may be cancer, they will send you to a hospital for specialist treatment and advice.
Your first appointment in the hospital may be for an endoscopy. If the endoscopy suggests you may have cancer, you will see a specialist next. They will ask you about your overall health and prior medical problems and will examine you. You may have to have blood work and x-rays to check on your overall health.
You will have a thin, flexible tube (endoscope) inserted into your esophagus. The endoscope will have a small light and a camera on the end. This helps your doctor see any area of abnormality. If necessary, they may take a small sample of cells (biopsy) and examine it under a microscope. This can confirm the presence of cancer, and the procedure isn't painful.
Endoscopies are usually done in the hospital on an outpatient basis, though occasionally it is necessary to stay in the hospital overnight. You will be asked to refrain from eating and drinking for at least four hours before the procedure, and you will be given instructions about the medication you may be taking.
A local anesthetic administered as an aerosol spray may be used on the back part of the throat, or you may be given a sedative to limit your discomfort; sedatives are normally injected into a vein in the arm. In some cases, both methods are used.
An endoscopy can be uncomfortable, though it shouldn't be painful. Tell your doctor if you have chest pain during or after the procedure.
If you have been given a local anesthetic, you will have to stay in the hospital until the effect has worn off; this normally takes about an hour. You will not be able to swallow anything during this time.
Some people have a sore throat afterwards. This is normal and gets better in a couple of days. Tell your doctor if this isn't the case.
CT (computed tomography)
A CT takes a series of x-rays, creating a 3-D image of the inside of the body. It takes from 10 to 30 minutes and is painless. A small amount of radiation is used, though it is very unlikely to cause you any harm. You will be asked to refrain from eating and drinking for at least an hour before the procedure.
You may be given a drink or an injection with a dye, which makes it possible to see certain areas more clearly. This may make you feel hot for a few minutes. It is important that you inform your health professionals if you are allergic to iodine or have asthma, as you may have a reaction to the injection.
This is like an endoscopy, but it has an ultrasound probe on the end. Ultrasound uses sound waves to create an image of the area. It allows doctors to obtain a deeper image of the wall of the esophagus and surrounding area, which may give them a better idea of the depth of the tumor.
They may take a sample of tissue (biopsy) and examine it under a microscope.
You may be given a slightly stronger sedative than when having GI endoscopy, as you must remain still during the procedure.
This is a combination of computed tomography and positron emission tomography (PET). PET uses low doses of radiation to measure cell activity in different parts of the body. This test offers more detailed information on the part of the body being scanned.
You will not be able to eat for six hours before the test. A slightly radioactive substance is injected into a vein (normally the arm). This is followed by a wait of at least an hour before the examination, which takes between 30 and 90 minutes.
This test entails a small operation carried out under general anesthesia. It is not always necessary, as the necessary information can be obtained using the other tests.
The surgeon will make a small incision of about 2 cm in length in the skin and muscle near your belly button, and will carefully insert a fine tube with a small video camera on its end (laparoscope) into your abdomen. The surgeon will use the laparoscope to observe your organs. They may take a biopsy by making a small cut through which they can insert an instrument that will obtain the sample.
You should be able to get up as soon as the effects of the anesthesia wear off. You will have one or two stitches where the incisions were made. You may have to remain in the hospital overnight.