Diagnosing Esophageal Cancer

An accurate, complete diagnosis is essential for effectively treating esophageal cancer. Because there is no routine cancer, the OSUCCC – James’s world-renowned esophageal cancer specialists and sub-specialists reach across multiple disciplines and modes of treatment to offer patients the latest technologies and the most advanced procedures to understand esophageal cancer at the molecular and genetic levels – the levels that drive each patient’s specific cancer.

The OSUCCC — James is home to world-renowned diagnostic experts in esophageal cancers. In fact, our team includes experts who specialize in gastrointestinal cancers – and only gastrointestinal cancers, 24/7 – studying, discovering and treating each kind, and developing and delivering leading-edge therapies.

These sub-specialists and super sub-specialists use the most accurate, advanced diagnostic testing and technology to analyze your cancer, enabling an entire team across multiple medical disciplines to determine the most effective, targeted treatment specifically for you.

If esophageal cancer is suspected, your OSUCCC – James specialist will examine you and ask you about your medical history, including information about symptoms and any risk factors you may have.

The experts may also conduct the following tests to form a diagnosis:

Physical Exam

Your OSUCCC – James specialist examines the neck, thyroid, larynx(voice box) and lymph nodes in the neck for unusual growths (called nodules) or swelling.

Imaging Tests

Imaging tests produce pictures of the inside of the body, and they can help the experts check for esophageal cancer and determine the extent of the disease. Tests may include:

Chest X-ray

A painless test that uses electromagnetic waves to create a picture of the inside of your body. Enlarged lymph nodes or other enlarged organs can usually be seen on a chest x-ray.

Barium Swallow or Upper Gastrointestinal (GI) Series

A barium swallow is an X-ray test in which the patient swallows a thick liquid substance called barium sulfate. The barium sulfate coats and outlines the inner walls of the esophagus and upper gastrointestinal (GI) tract so that specially trained OSUCCC – James experts can analyze the inner lining of the stomach, esophagus and part of the small intestine for any signs of cancer.  

CT Scan (Computed Tomography Scan)

A type of x-ray test that produces detailed, cross-sectional images of your body. This procedure is also called computed tomography, computerized tomography or computerized axial tomography. A CT scan can show evidence of an esophageal tumor.

MRI (Magnetic Resonance Imaging)

MRI scans use a high-powered magnet and radio waves to produce detailed images of the body.

PET Scan (Positron-Emission Tomography Scan)

Your OSUCCC – James specialists use a small amount of a radioactive agent mixed with glucose (sugar) to identify areas of cancerous activity the body. (Cancer cells absorb sugar faster than normal cells.)

A special imaging camera is able to display cancerous cells brighter on PET images.

Esophagoscopy 

An esophagoscopy is a procedure that uses a thin, tube-shaped instrument (called an esophagoscope) to look inside the esophagus. Your OSUCCC – James specialist inserts the esophagoscope, which is a light and small lens for viewing, through the mouth or nose and down the throat. It may also have a special tool to remove tissue (biopsy) if needed.

Biopsy

During a biopsy, your esophageal cancer specialist removes a small piece of tissue so that a specially trained OSUCCC – James pathologist can examine the cells under a microscope for any signs of cancer. A biopsy can confirm a diagnosis and help the experts determine what type of cancer it is.

(Source: National Cancer Institute)

Staging Esophageal Cancer

If you are diagnosed with a gastrointestinal cancer such as esophageal cancer, staging the tumor is just one of many ways your OSUCCC – James esophageal cancer experts can determine the amount and location of your cancer, and it can help them choose the most effective, personalized treatment options for your particular disease.

The staging classification remains the same through treatment.

The four stages of esophageal cancer are:

Stage 0 — High-Grade Dysplasia

  • Abnormal cells are found in the inner (mucosal) layer of the esophageal wall. These abnormal cells may become cancer and spread into nearby normal tissue.
  • Stage 0 is also called high-grade dysplasia.

Stage I — Squamous Cell Carcinoma of the Esophagus

Stage I is divided into Stage IA and Stage IB, depending on where the cancer is found.

Stage IA

  • Cancer has formed in the inner (mucosal) layer of the esophageal wall.
  • The tumor cells look similar to normal cells under a microscope.

Stage IB

  • Cancer has formed in the inner (mucosal) layer of the esophageal wall, and the tumor cells do not look like normal cells under a microscope; or
  • Cancer has formed in the inner (mucosal) layer and spread into the middle (muscle) layer or the outer (connective tissue) layer of the esophageal wall.

Stage II — Squamous Cell Carcinoma of the Esophagus

Stage II is divided into Stage IIA and Stage IIB, depending on where the cancer has spread.

Stage IIA

  • Cancer has spread into the middle (muscle) layer of the outer (connective tissue) layer of the esophageal wall. The tumor cells look similar to normal cells under a microscope. The tumor is in either the upper or middle esophagus; or
  • Cancer has spread into the middle (muscle) layer or the outer (connective tissue) layer of the esophageal wall.

Stage IIB

  • Cancer has spread into the middle (muscle) layer of the outer (connective tissue) layer of the esophageal wall. The tumor cells do not look like normal cells under a microscope. The tumor is in either the upper or middle esophagus; or
  • Cancer has been found in the inner (mucosal) layer and may have spread into the middle (muscle) layer of the esophageal wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Stage III — Squamous Cell Carcinoma of the Esophagus

Stage III is divided into Stage IIIA, Stage IIIB and Stage IIIC, depending on where the cancer has spread.

Stage IIIA

  • Cancer is in the inner (mucosal) layer and may have spread into the middle (muscle) layer of the esophageal wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
  • Cancer has spread into the outer (connective tissue) layer of the esophageal wall. Cancer is found in 1 or 2 lymph nodes near the tumor; or
  • Cancer has spread into the diaphragm, sac around the heart, or tissue that covers the lungs and lines the inner chest cavity wall. The cancer can be removed by surgery.

Stage IIIB

  • Cancer has spread into the outer (connective tissue) layer of the esophageal wall.
  • Cancer is found in 3 to 6 lymph nodes near the tumor.

Stage IIIC

  • Cancer has spread into the diaphragm, sac around the heart, or the tissue covering the lungs and that lines the inner wall of the chest cavity. The cancer can be removed by surgery. Cancer is found in 1 to 6 lymph nodes near the tumor; or
  • Cancer has spread into other nearby organs such as the aorta, trachea or spine, and the cancer cannot be removed by surgery; or
  • Cancer has spread to 7 or more lymph nodes near the tumor. 

Stage IV — Squamous Cell Carcinoma of the Esophagus

  • Cancer has spread to other parts of the body.

The following stages are used for adenocarcinoma of the esophagus:

Stage 0 — High-Grade Dysplasia

  • Abnormal cells are found in the inner (mucosal) layer of the esophageal wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called high-grade dysplasia. 

Stage I — Adenocarcinoma of the Esophagus

Stage I is divided into Stage IA and Stage IB, depending on where the cancer is found. 

Stage IA

  • Cancer has formed in the inner (mucosal) layer of the esophageal wall.
  • The tumor cells look similar to normal cells under a microscope. 

Stage IB

  • Cancer has formed in the inner (mucosal) layer of the esophageal wall. The tumor cells do not look like normal cells under a microscope and they grow quickly; or
  • Cancer has formed in the inner (mucosal) layer and spread into the middle (muscle) layer of the esophageal wall. The tumor cells look similar to normal cells under a microscope.

Stage II — Adenocarcinoma of the Esophagus

Stage II is divided into Stage IIA and Stage IIB, depending on where the cancer has spread. 

Stage IIA

  • Cancer has spread into the middle (muscle) layer of the esophageal wall.
  • The tumor cells do not look like normal cells under a microscope, and they grow quickly. 

Stage IIB

  • Cancer has spread into the outer (connective tissue) layer of the esophageal wall; or
  • Cancer is in the inner (mucosal) layer and may have spread into the middle (muscle) layer of the esophageal wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Stage III — Adenocarcinoma of the Esophagus

Stage III is divided into Stage IIIA, Stage IIIB, and Stage IIIC, depending on where the cancer has spread.

Stage IIIA

  • Cancer is in the inner (mucosal) layer and may have spread into the middle (muscle) layer of the esophageal wall; it is found in 3 to 6 lymph nodes near the tumor; or
  • Cancer has spread into the outer (connective tissue) layer of the esophageal wall; it is found in 1 or 2 lymph nodes near the tumor; or
  • Cancer has spread into the diaphragm, sac around the heart, or the tissue covering the lungs and lines the inner wall of the chest cavity. The cancer can be removed by surgery.

Stage IIIB

  • Cancer has spread into the outer (connective tissue) layer of the esophageal wall.
  • Cancer is found in 3 to 6 lymph nodes near the tumor.

Stage IIIC

  • Cancer has spread into the diaphragm, sac around the heart, or the tissue covering the lungs and lines the inner wall of the chest cavity; the cancer can be removed by surgery. Cancer is found in 1 to 6 lymph nodes near the tumor; or
  • Cancer has spread into other nearby organs such as the aorta, trachea or spine, and the cancer cannot be removed by surgery; or
  • Cancer has spread to 7 or more lymph nodes near the tumor.

Stage IV - Adenocarcinoma of the Esophagus

  • Cancer has spread to other parts of the body.

(Source: National Cancer Institute)

If you’ve been diagnosed with esophageal cancer, would like a second opinion or would like to speak with an esophageal cancer specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

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The James Cancer Hospital and Solove Research Institute

460 West 10th Avenue

Columbus, Ohio 43210

800-293-5066 or 614-293-5066

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