Diagnosis of Esophageal Cancer
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The diagnosis and prognosis of esophageal cancer includes the following:
- ]]>Review of medical history]]>
- ]]>Physical exam]]>
- ]]>Diagnostic testing]]>
Review of Medical History
Your doctor will ask about your symptoms and medical history. Significant elements in your medical history include your country of origin, race, symptoms of chronic reflux esophagitis (“ heartburn]]> ” or gastroesophageal reflux disease), and exposure to substances that irritate and damage the throat. Your doctor may also ask about rare congenital conditions.
No part of your physical exam points directly to this disease, but your doctor will do a thorough exam to evaluate your overall health and look for associated conditions, like malnutrition, pneumonia]]> , and head, neck, and ]]>lung cancer]]> .
Your doctor may do the following tests:
X-rays]]> —This series of x-rays will be taken while you are swallowing contrast medium (barium). The barium makes it easier for the doctor to see abnormalities on the x-ray.
Endoscopy —This test involves the insertion of a fiberoptic tube with a lighted tip (an endoscope) through the mouth and down through the gastrointestinal (GI) tract to examine the entire passageway from mouth to stomach. This allows your doctor to look for abnormalities and perhaps to obtain a biopsy specimen of the cancer. A similar examination of the lungs (bronchoscopy) may also be done.
Endoscopic ultrasonography (EUS) —During this procedure, a thin, lighted tube (endoscope) is passed into the esophagus. The endoscope has a miniscule ultrasound transducer within it.
CT scan —This is a type of x-ray, done to determine the extent of your cancer, that uses a computer to produce cross-sectional images of the inside of the body.
]]>MRI scan]]> —This test uses magnetic waves to produce images of the inside of the body. Using a large magnet, radio waves, and a computer, an MRI produces two-dimensional and three-dimensional pictures. This is done to determine the extent of your cancer.
]]>Positron emission tomography (PET)]]> —This test assesses metabolic activity in the tissue, since cancer cells typically generate more activity than noncancerous cells. A PET scan can be performed on a variety of body tissues. A nurse or technologist administers a radioactive substance by an intravenous injection. It takes between 60 to 90 minutes for the substance to be absorbed by the tissue under study. You lie on a table and are moved into a machine that looks like a large, square-shaped doughnut. This machine detects and records the energy levels emitted from the substance that was injected earlier. The images are viewed on a nearby computer monitor.
]]>Bone scan]]> —An injection of a radioactive compound called technetium- methylen diphosphonate is given. Three hours later, you lie on a table while special cameras move slowly above and below the table taking pictures. These cameras detect small amounts of radioactivity in the injected technetium. This test is performed to detect if you have cancer cells in the bone. Usually a bone scan is performed if you complain from bone pain.
]]>Laparoscopy]]> —Tiny incisions are made in the abdomen, and a small fiberoptic tube with a lighted tip (a laparoscope) is inserted. This allows for a visual examination of the abdomen. Miniature surgical tools can also be inserted into the abdomen to remove tissue samples ( ]]>biopsies]]> ), which are checked for cancer cells.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
It may be difficult to remove a sample of tissue (biopsy), because it is often covered with a thick layer of normal tissue. Cells may be obtained by brushing the tissue during endoscopy. At the present time, due to the grim prognosis for this disease, biopsy and tissue identification is not particularly helpful other than to confirm the diagnosis.
Staging is the process by which physicians determine the anatomical extent of the cancer disease. Accurate staging is considered one of the main prognostic factors that determine the fate of the disease. Staging is also essential for making treatment decisions (eg, surgery vs. chemotherapy]]> ). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor (T), lymph nodes involvement (N), and spread to distant sites (M), called metastasis. Low staging classifications (1-2) imply a favorable prognosis, whereas high staging classifications (3-4) imply an unfavorable prognosis.
The TNM system of classification is used to stage esophageal cancer. The “stage” may be predicted by the use of radiologic data, such as that from CT scans, MRI, endoscopy, endoscopic ultrasound, and biopsies. The stage is comprised of a T (size of the tumor), N (presence of cancer in lymph nodes), and M (presence of cancer in distant sites like bone, liver, and lung).
Staging Classifications I through IV
Stage I : Cancer is found only in the innermost layers of the esophagus.
Stage II : Cancer penetrates deeper into the esophagus, or it has spread to nearby lymph nodes.
Stage III : Cancer is found still deeper in the wall of the esophagus or has spread to tissues or nearby lymph nodes.
Stage IV : Cancer has spread to other parts of the body.
Staging Based on T, N, and M
Tumor (T) Stages
Tx : The cancer cannot be evaluated.
T0 : No cancer is present.
Tis : Cancer does not invade beyond the superficial mucosa (in situ).
T1 : Cancer is present in the lamina propria or submucosa.
T2 : Cancer is present in muscularis propria.
T3 : Cancer is present in adventitia.
T4 : Cancer is growing directly into an adjacent structure.
Lymph Nodes (N) Stages
Nx : Lymph node involvement by tumor cannot be assessed.
N0 : Cancer cells are not present in local (regional) lymph nodes.*
N1 : Cancer cells are present in local lymph nodes.*
*In esophagus cancer, a regional lymph node is based on the location of the tumor in the esophagus.
Metastasis (M) Stages
Mx : Metastasis cannot or has not been assessed.
M0 : Metastases are not present.
M1a : Metastases are present in nonregional lymph nodes.
M1b : Metastases are present in other organs.
Overall Stage, Based on T, N, and M
|Overall Stage||T, N, and M Stages|
|Stage 0||Tis, N0, M0|
|Stage I||T1, N0, M0|
|Stage IIA||T2, N0, M0|
|T3, N0, M0|
|Stage IIB||T1, N1, M0|
|T2, N1, M0|
|Stage III||T3, N1, M0|
|T4, any N, M0|
|Stage IVA||Any T, any N, M1a|
|Stage IVB||Any T, Any N, M1b|
AJCC Cancer Staging Handbook. 6th ed. New York, NY: Springer; 2002: 101-109.
Esophageal cancer. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancerinfo/wyntk/esophagus . Accessed December 2, 2002.
Harrison's Principles of Internal Medicine. 14th ed. McGraw-Hill; 1998.
Neoplasms of the esophagus. American Cancer Society website. Available at http://www.cancer.org/docroot/home/index.asp . Accessed November 30, 2002.
Last reviewed November 2008 by ]]>Mohei Abouzied, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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