Oesophageal cancer - Diagnosing oesophageal cancer

If your GP suspects you have cancer of the oesophagus they will first take a detailed look at your medical history and carry out a physical examination.

They will then arrange for you to go to hospital to see a specialist for further tests.

The specialist will look for any signs of abnormalities, such as a lump in your abdomen, which may indicate a tumour. Before testing for oesophageal cancer they will carry out a physical examination, and may check your general health with blood tests and a chest X-ray.

Tests

The two most common tests used to diagnose oesophageal cancer are:

• an oesophagoscopy – a type of endoscopy
• a barium swallow – a type of X-ray

These are described in more detail below.

Endoscopy 

This is one of the first tests you will have to help confirm a diagnosis of cancer of the oesophagus.

Endoscopy is a medical procedure that allows doctors to see inside the body. During this procedure a thin, flexible instrument called an endoscope is passed through your mouth and down towards your stomach.

The endoscope has a light attached to the end and feeds back the images of your oesophagus to a monitor. This will allow your doctor to look for any signs of abnormal cells or tumours.

Before having an endoscopy you should avoid eating for several hours, as food can obstruct the view of the endoscope.

An endoscopy should not cause you any pain, although it may feel uncomfortable. Before the endoscopy takes place you will normally be given a local anaesthetic or sedative to help you relax and to help make the procedure less uncomfortable. The endoscopy itself will usually take about 15 minutes, although you should allow approximately two hours for your visit.

After an endoscopy you may notice that you have a sore throat, which will usually last for a few days. If your symptoms persist, see your GP. 

Barium swallow 

A barium swallow is a test that involves drinking a thick white liquid called barium. Once you have swallowed the barium you will undergo a series of X-rays.

The barium coats the lining of your oesophagus so that it shows up on the X-ray. These X-rays are able to show your doctor whether there is an obstruction in your oesophagus, which may be an indication of a tumour.

You may have to undergo this test if your cancer has already been diagnosed, as it will help your doctor to assess the size of your tumour.

A barium swallow usually takes about 15 minutes to perform. After the procedure you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system.

Further tests

If the initial tests confirm a diagnosis of oesophageal cancer, further tests may be needed to see where the cancer is and if it has spread. These tests may include:

• a computerised tomography (CT) scan
• an endoscopic ultrasound
• a laparoscopy to take a sample of cells (biopsy)
• a positron emission tomography (PET) scan

These are described in more detail below.

Computerised tomography (CT) scan 

A CT scan takes a series of X-ray images of your body and uses a computer to put them together. This then creates a very detailed picture of the inside of your body.

This will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours in any other places within the body. A CT scan will also allow your doctors to work out which type of treatment will be most effective and appropriate for you.

Endoscopic ultrasound 

Once cancer of the oesophagus has been diagnosed your doctor will need to assess how far the cancer has spread and how large the tumour has grown.

An endoscopic ultrasound will help your doctors assess how far your oesophageal cancer has progressed. It involves having a very small ultrasound probe passed into your oesophagus using an endoscope. This test produces sound waves that can penetrate the surrounding tissues.

These waves are then used to produce an image of your oesophagus so your doctor can see if the cancer has spread to the surrounding tissue.

Laparoscopy

A laparoscopy may be used to examine the area, depending on the location of the tumour. A sample of cells can be taken (biopsy) by using a special extracting instrument connected to the laparoscope.

A laparoscopy is carried out under general anaesthetic, so it will require a short stay in hospital.

The biopsy will be examined underneath a microscope in a laboratory and the results will show whether the cells are malignant (cancerous) or benign (non-cancerous). The results will normally take seven to 10 days to come back.

PET scan

A positive emission tomography (PET) scan can produce a detailed, three-dimensional picture of the inside of the body. During a PET scan a substance known as a radiotracer is passed into your body. A radiotracer is a radioactive chemical that releases tiny particles called positrons.

A PET scan may be used to find out whether the cancer has spread. It may also be used for follow-up examinations after treatment to check for scar tissue or any remaining cancer cells.

Staging and grading oesophageal cancer

The above tests will help to determine what stage and grade your cancer is at. This can help doctors to decide what treatment you need, and the possibility of achieving a complete cure.

Read more detailed information about what cancer stages and grades mean.

Some doctors may prefer to describe the stages of cancer using the more complex TNM staging system. The three categories are used to create a more detailed classification:

• T (tumour) – the location and size of the tumour
• N (nodes) – whether the cancer has spread to the lymph nodes
• M (metastatic) – whether the cancer has spread to other parts of the body such as the lungs, liver or bone

Read more information about how oesophageal cancer is treated.

Want to know more?

• Cancer Research UK: tests for oesophageal cancer
• Macmillan: how oesophageal cancer is diagnosed