Diagnosis

Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer.

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  
  
  
  
• Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called a Barium swallow

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Barium follow through showing the lesion of the esophageal cancer



• Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.
  “It is myth that cancer spreads after biopsy”

After esophageal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the esophagus or to other parts of the body.
The process used to find out if cancer cells have spread within the esophagus or to other parts of the body is called staging. It is important to know the stage in order to plan treatment.  The following tests and procedures may be used in the staging process:

• Bronchoscopy
• Chest x-ray
• Laryngoscopy
• CT scan
• PET scan (positron emission tomography scan), if necessary in selected patients.
• Endoscopic ultrasound (EUS), if necessary in selected patients 
• Thoracoscopy
• Laparoscopy

There are three ways that cancer spreads in the body.

• Through tissue. Cancer invades the surrounding normal tissue
• Through the lymphatic system (the system that produces, stores, and carries the cells that fight infections). Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

When the cancer cells can break away from a primary tumor and enter the bloodstream or lymphatic system. That is how cancer cells spread to other parts of the body. The spread of the cancer is termed as Metastasis.

 

Staging

Stage 0 (Carcinoma in Situ)	Abnormal cells are found in the innermost layer of tissue lining the esophagus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I	Cancer has formed and spread beyond the innermost layer of tissue to the next layer of tissue in the wall of the esophagus
Stage II	Stage II esophageal cancer is divided into stage IIA and stage IIB, depending on where the cancer has spread. Stage IIA: Cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus. Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes.
Stage III	Cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.
Stage IV	Stage IV esophageal cancer is divided into stage IVA and stage IVB, depending on where the cancer has spread. Stage IVA: Cancer has spread to nearby or distant lymph nodes. Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.