Tests That Help Evaluate Esophageal Cancer
Your doctor took a biopsy from your esophagus to know that you have cancer. Your doctor may request more tests to learn more about your specific type of cancer and its location. This information helps you and your doctor decide on the treatment that is likely to be most effective. These tests can also help your doctor learn if cancer has spread beyond the esophagus. CT scan and endoscopic ultrasound are the two most common tests.
Your doctor may request other tests as well. This depends on your symptoms and your treatment plan. In addition to the tests described here, other tests may include bone or brain scans and heart and lung tests.
Computed tomography scan (CT scan)
You may have a CT scan. This test helps show if the cancer has spread to other parts of the body, such as the lymph nodes, liver, lungs, or adrenal glands.
During a CT scan, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner directs beams of X-rays at your neck, chest, and abdomen. You may be asked to hold your breath one or more times during the scan. In some cases, you may be asked to drink a contrast dye before the scan. And you may be asked not to eat anything in the time between drinking the contrast dye and the scan. The contrast dye will gradually pass through your system and exit through your bowel movements. A computer puts these X-rays together to create detailed pictures.
Endoscopic ultrasound (EUS)
Your doctor uses this test to measure the size of a tumor and how far it has grown into nearby structures. It can also show the lymph nodes near the esophagus to see if cancer has spread to them. This helps your doctor decide on the best treatment for you. The ultrasound is usually done during an esophagoscopy.
For this test, the doctor sprays your throat with a local anesthetic to numb the area. This helps reduce discomfort and gagging. Your doctor may also give you medication to reduce pain and a sedative to help you relax. Then the doctor inserts a thin, lighted tube called an endoscope through your nose or mouth and down into your esophagus. The endoscope bounces sound waves against the esophagus and nearby areas. The echo from the sound waves creates an image of the esophagus. This image is called a sonogram. After the test, you may need to remain at the testing area for a few hours until the sedative wears off.
Magnetic resonance imaging (MRI)
You may have an MRI to create even more detailed pictures of your esophagus and nearby blood vessels. An MRI can help show whether the cancer has spread. MRI makes pictures using a huge magnet linked to a computer. For an MRI, you lie still on a table as it passes through a tube-like scanner. The scanner directs a continuous beam of magnetic waves to your neck, chest, and abdomen. A computer uses the data from the magnet waves to create a detailed picture of that area of your body. Each set of images may take up to 15 minutes. The entire scan may take an hour or more. MRI is painless. Ask for earplugs if they aren't offered, since there is a loud thumping noise during the scan. If you're claustrophobic, you may be given a sedative before having this test.
A bronchoscopy exam can help show whether the cancer has spread to your airways. First, you may receive medication to help you relax. Then the doctor places a thin, lighted scope, called a bronchoscope, through your nose or mouth down through your airway (trachea) and into your lungs. Your doctor views images from the scope on a video monitor. If your doctor notices abnormal tissue, he or she can take a biopsy by inserting a tiny tool to remove a bit of the tissue. The doctor sends the sample to a pathologist, who can check the sample for cancer.
This is a surgical procedure that allows your doctor to see if cancer has spread to areas in your chest. You will be given general anesthesia so that you feel no pain and will not be awake. Your doctor makes a small incision between two of your ribs. The doctor inserts a thin, lighted tube called a thoracoscope into your chest. The thoracoscope sends images of your chest that your doctor can view on a video monitor. The doctor may also place a small tool through the cut to take a biopsy, small samples of tissues from the esophagus, lungs, or lymph nodes. Your doctor sends the tissue samples to a pathologist, who can view them to determine whether they contain cancer cells. Your doctor will explain what to expect after the surgery and how long you will remain in the hospital.
This is a surgical procedure that allows your doctor to see if cancer has spread to areas in your abdomen. A biopsy may also be done during laparoscopy. You will be given general anesthesia so that you feel no pain and will not be awake. During the procedure, the doctor makes one or more small cuts in the skin over your abdomen. Then, the doctor inserts small instruments into your abdomen. The doctor inserts a scope and lighted tube called a laparoscope to view the abdominal area. Your doctor may use another instrument to remove any abnormal tissue for testing. Your doctor will explain what to expect after the surgery and how long you will remain in the hospital.
Positron emission tomography scan (PET scan)
A PET scan uses a radioactive glucose (sugar) dye to highlight cancer cells and create pictures. The test is done much like a CT scan. First, the doctor or nurse injects a small amount of radioactive dye into your vein. Then a scanner is moved around your body and takes many pictures of your neck, chest, and abdomen. A computer puts these pictures together to show exactly where the cancer cells are located. Cancer cells show up brighter in the picture because these cells take up more of the dye than normal cells. Researchers are still testing PET scanning in clinical trials to see how well it helps evaluate esophageal cancer.