While esophageal cancer is rare, cases are rising. Those with symptoms, or those at risk of developing esophageal cancer, should talk to their doctors about screening options. Esophageal cancer is often diagnosed after it has progressed, so early detection through screening is key to ensure the best possible treatment outcomes. If your doctors decide that you should undergo further evaluation, oncologists at the OSUCCC – James will make recommendations for your specific needs.
Diagnosing esophageal cancer
An accurate, complete diagnosis is essential for effectively treating esophageal cancer. If esophageal cancer is suspected, your OSUCCC – James specialists will examine you and ask you about your medical history, including information about symptoms and any risk factors you may have.
First, your OSUCCC – James specialists will perform a physical exam, feeling the neck, thyroid, voice box (larynx) and neck lymph nodes for unusual growths (nodules) or swelling.
After the physical exam, different tests may be ordered so specialists can form a diagnosis.
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 condition. 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
For a barium swallow X-ray test, you’ll ingest barium sulfate, a thick liquid that provides imaging contrast. The X-ray will then be performed. The barium sulfate coating will outline the inner walls of the esophagus and upper gastrointestinal (GI) tract so that experts can easily analyze the inner lining of the stomach, esophagus and part of the small intestine for any signs of cancer.
After this test, you may need to drink a lot of water and take a fiber supplement or a gentle laxative if you experience constipation and to remove the excess barium from your system.
Computed tomography scan (CT scan)
A CT scan can show evidence of an esophageal tumor. This type of X-ray produces detailed, cross-sectional images of your body. This procedure is also called computed tomography, computerized tomography or computerized axial tomography.
Magnetic resonance imaging (MRI)
MRI scans use a high-powered magnet and radio waves to produce detailed images of the body. It sometimes uses a contrast dye injected into a vein. You will lie still for an MRI in a darkened space.
Positron emission tomography scan (PET scan)
A special imaging camera can display cancerous cells more brightly on PET images. For a PET scan, you’ll have a vein injected with a tracer (an irradiated agent mixed with glucose [sugar]). This tracer will pinpoint areas of cancerous activity in the body, as it will migrate to areas that are very active. The reason this method works is because cancer cells absorb sugar faster than normal cells.
Esophagoscopy
An esophagoscopy is a procedure that uses a thin, flexible, tube-shaped esophagoscope with a light and lens attached to see inside the esophagus. It’s mildly uncomfortable because the esophagoscope will go down your throat or up your nose. Tissue for a biopsy may be removed with a special tool on the scope, 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.
Once any of these tests have been performed, your oncologists will analyze the results. They’ll communicate any findings with you once they’ve been determined.
Staging esophageal cancer
If it's concluded that you have esophageal cancer, your team will classify and stage the condition. This helps our cancer experts determine the type, amount and location of your cancer, and it can help them choose the most effective, personalized treatment options for you. Staging is dependent on whether the cancer is squamous cell carcinoma or adenocarcinoma of the esophagus. The staging classification remains the same through treatment.
Staging squamous cell carcinoma of the esophagus
Stage I
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 like normal cells under a microscope.
Stage IB
- Cancer has formed in the inner (mucosal) layer of the esophageal wall, and the tumor cells look abnormal; 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
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 normal 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 outer layer of the esophagus or is growing into the lamina propria, tissue under the epithelium (muscularis mucosa) or into the submucosa.
- Cancer is found in one or two neck lymph nodes near the tumor.
Stage III
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 three to six neck lymph nodes near the tumor; or
- Cancer has spread into the outer (connective tissue) layer of the esophageal wall. Cancer is found in one or two neck lymph nodes near the tumor; or
- Cancer has spread into the diaphragm, the aortic sac around the heart or to tissue that covers the lungs and lines the inner chest cavity wall. Surgery is recommended.
Stage IIIB
- Cancer has spread into the outer (connective tissue) layer of the esophageal wall.
- Cancer is found in three to six neck lymph nodes near the tumor.
Stage IIIC
- Cancer has spread into the diaphragm, the heart’s aortic sac, or to the tissue covering the lungs and lining the inner wall of the chest cavity. Surgery is needed. Cancer is found in one to six neck lymph nodes near the tumor; or
- Cancer has spread into other nearby organs such as the aorta, trachea or spine and cannot be surgically removed; or
- Cancer has spread to seven or more lymph nodes near the tumor.
Stage IV
- Cancer has spread to other parts of the body.
Staging of adenocarcinoma of the esophagus
The following stages are used for adenocarcinoma of the esophagus:
Stage I
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 like normal cells under a microscope.
Stage IB
- Cancer has formed in the inner (mucosal) layer of the esophageal wall. The tumor cells look abnormal 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 normal under a microscope.
Stage II
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 look abnormal and 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 one or two neck lymph nodes near the tumor.
Stage III
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 three to six neck lymph nodes near the tumor; or
- Cancer has spread into the outer (connective tissue) layer of the esophageal wall; it is found in one or two neck lymph nodes near the tumor; or
- Cancer has spread into the diaphragm, the aortic sac, or to the tissue covering the lungs and lining 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 three to six neck lymph nodes near the tumor.
Stage IIIC
- Cancer has spread into the diaphragm, the aortic sac, or to the tissue covering the lungs and lining the inner wall of the chest cavity. Surgery is needed.
- Cancer is found in one to six neck 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 seven or more lymph nodes near the tumor.
Stage IV
Cancer has spread to other parts of the body.
If you’ve been diagnosed with esophageal cancer or would like a second opinion, we can help. Call The James Line at 614-293-5066 or toll free at 800-293-5066 to make an appointment.
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