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Esophageal Cancer Early Detection, Screening, Diagnosis, and Testing

Screening is the process of testing for cancer despite the absence of symptoms. There is currently no established screening protocol for people who are at low to medium risk of esophageal cancer. But for people who are at high risk, doctors recommend several tests for detection.

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Barrett's esophagus is one of the biggest risk factors for esophageal cancer, and doctors recommend that anyone with this condition have regular upper endoscopy done. Doctors will place an endoscope, which is a thin, flexible tube with a camera at the end inside the esophagus, to check for any signs of precancer (dysplasia) or cancer cells. If dysplasia, especially high-grade dysplasia, is found, doctors may do a biopsy, which involves taking tissue samples to be examined in the laboratory. People with Barrett's syndrome should consider testing for esophageal cancer starting at 41 years old, even without any symptoms.

For rare inherited diseases like blood syndrome or tylosis, doctors recommend screening with an upper endoscopy as early as 20 years old.

Tests for Esophageal Cancer

Your doctor should refer you to a gastroenterologist, a specialist in the digestive system if he suspects your condition might need more serious attention. The following tests for esophageal cancer may be administered:

Medical History and Physical Examination

Your doctor will want to know the details of your health, through records, and your lifestyle, because certain risk factors like diet and smoking or alcohol consumption could increase the chances of getting esophageal cancer. Your family history is also important, because heritable diseases like tylosis may increase the risks as well. It is important to be completely honest with your doctor, especially if you engage in activities that may harm your throat like frequent consumption of extremely spicy foods.

Imaging Tests for Esophageal Cancer

Imaging tests can create pictures of areas inside your body to help the doctor spot tumors or other irregularities.

Barium Swallow Test

If you are having trouble swallowing, a barium swallow test may be done first. A doctor will ask you to swallow a thick, chalky barium liquid to coat the esophagus so X-rays can outline it. This can be done alone or as part of an upper GI series including the stomach and intestines. The test can reveal abnormal areas in the normally smooth esophageal lining, but not cancer spread outside it.

It can show even small, early cancers as bumps or flat plaques, while advanced cancers appear as large, irregular areas that narrow the esophagus. The barium swallow test can also diagnose tracheo-esophageal fistulas, where the tumor destroys tissue between the esophagus and windpipe, creating a hole connecting them so anything swallowed can enter the lungs, causing coughing or pneumonia. This serious complication can be treated with surgery or endoscopy.

Computed Tomography (CT) Scan

A CT scan uses multiple X-rays and a computer to create detailed cross-sectional images of the body to assess if esophageal cancer has spread to nearby organs, lymph nodes, or distant sites. Before the scan, you will be asked to drink 1-2 pints of oral contrast to outline the esophagus and intestines, so inform your doctor if you have trouble swallowing. The test can also use a guided biopsy needle to obtain tissue samples from suspected cancer areas deep in the body. Unlike a regular X-ray that takes 1-2 pictures, a CT scanner takes many pictures that are combined by a computer to show sections of the body part being studied.


Magnetic Resonance Imaging (MRI) uses radio waves and magnets instead of strong X-rays to show detailed images of soft tissues in the body. MRIs are useful in spotting cancers that have spread to further areas like the brain and the spine.

PET Scan

For a PET scan, a radioactive sugar is injected into the bloodstream and collects mainly in cancer cells, then a special camera detects the radioactivity to identify cancer locations. A PET/CT scan combines a PET and CT scan using one machine to allow a comparison of the PET radioactivity to the CT's detailed picture. PET/CT scans can help diagnose esophageal cancer and identify potential cancer spread to organs like the liver or bones, but not to the brain or spinal cord. The fused images provide more information on the extent of the cancer than either test alone.


An endoscopy uses a flexible, narrow tube called an endoscope, which has a camera attached at the end. This allows the doctor to look inside the esophagus and spot potential cancer or precancer cells.

Upper Endoscopy

In an upper endoscopy, you are first sedated before the doctor passes an endoscope down your throat into the esophagus and stomach. The camera displays on a monitor, letting the doctor see any abnormal areas in the esophageal wall. Instruments through the scope can take tissue samples from suspicious areas for biopsy to check for cancer. If cancer is blocking the esophageal lumen, instruments can enlarge the opening to improve food/liquid passage. Endoscopy provides key information on tumor size and spread to determine if it's surgically removable. The doctor can also use endoscopy instruments to help relieve blockage and take biopsies to diagnose esophageal cancer.

A similar procedure can be done to the bronchus called a ‘bronchoscopy’ if the doctor suspects that the cancer has spread to the trachea and bronchi.

Endoscopic Ultrasound

An endoscopic ultrasound is usually done at the same time as an endoscopy. A probe that emits sound waves is inserted at the end of an endoscope, which allows the probe to get closer to tumors and map the area with sound waves. This can help determine the size and spread of the cancer, as well as any lymph nodes that might be already affected.

Thoracoscopy and Laparoscopy

Thoracoscopy and laparoscopy allow doctors to view lymph nodes and organs near the esophagus inside the chest and abdomen through a lighted tube and take biopsy samples, with the procedures done under general anesthesia. Small incisions are made in the chest wall or abdomen to insert a thin, lighted scope with a camera to view the area around the esophagus use tools to remove lymph nodes and take biopsy samples. These minimally invasive exams determine if cancer has spread, key information when deciding if a patient can benefit from surgery to remove the esophageal tumor.

Laboratory Testing for Biopsy Samples

A biopsy involves removing small pieces of tissue to be analyzed in the laboratory. Using chemicals and sophisticated instruments, the doctors will be able to determine the presence, and even the extent of cancer. Other samples like blood, stool, and urine will also undergo laboratory analysis.

HER2 Testing

If esophageal cancer is too advanced for surgery, biopsy samples may be tested for excess HER2 protein, which helps some cancer cells grow. Targeted drugs against HER2 could help treat these cancers, so doctors may test tumor samples to see if these drugs could be beneficial.

PD-L1 Testing

Some esophageal cancer cells may be tested for levels of PD-L1 protein. Tumors with more PD-L1 might respond better to immunotherapy drugs that target this protein.

MMR and MSI Testing

Esophageal cancers may also be tested for microsatellite instability (MSI) or changes in mismatch repair (MMR) genes like MLH1 and MSH2. Advanced, recurring, or spread cancers that test positive for MSI or MMR changes might benefit from immunotherapy treatment.

Blood Tests

Doctors will also administer a complete blood count (CBC) test and liver enzyme tests. This can check for anemia caused by bleeding due to the tumor and for any chances that the cancer has spread to the liver.

If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your esophageal cancer, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.

Last Updated on March 1, 2024 by Michael S. Porter
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