Esophageal Cancer: Tests After Diagnosis

After you’re diagnosed with esophageal cancer, you’ll need other tests. These tests help your healthcare providers learn more about your cancer. They can help show if the cancer has grown into nearby areas or spread to other parts of your body. The test results help your healthcare providers decide the best ways to treat the cancer. If you have any questions about these or other tests, talk with your healthcare team.

The tests you may have can include:

  • Imaging tests

  • Procedures

  • Surgery

Imaging tests

CT scan

During a CT scan, X-rays are used to scan part of your body to make detailed pictures of your insides. You may have a stomach or chest CT done. When you have esophageal cancer, these pictures can show if the cancer has spread to nearby lymph nodes or to other organs, like your lungs, liver, or adrenal glands.

To get this test, you lie still on a table as it slowly slides through the center of the ring-shaped CT scanner. The scanner directs X-ray beams at your body. A computer uses the data from the X-rays to make many detailed pictures of your insides.

A CT scan doesn't hurt. You may be asked to hold your breath one or more times during the scan. In some cases, you get an intravenous (IV) contrast dye or may be asked to drink a contrast medium before the scan. This helps outline the esophagus and make any tumors show up better. The contrast will slowly pass through your system. You'll get rid of it through your bowel movements.

MRI

You may have an MRI to create even more detailed pictures of your esophagus and nearby blood vessels. An MRI uses magnets, radio waves, and a computer to make detailed pictures of the inside of your body.

MRIs don’t hurt. But they can take a long time to do, often up to an hour. During that time, you’ll need to lie still on a table that slides into a long, narrow tube. Some people say this test makes them feel claustrophobic. If you’ve had problems with small spaces in the past, talk to your healthcare provider before the test. You may be given a sedative to help you stay calm during the test. The machine also makes loud banging noises during the test. You can ask for earplugs or headphones if you think the noise will bother you.

Because the test uses powerful magnets, you won’t be allowed to have anything metal in the room. If you have any kind of metal implant, such as a heart valve or a joint pin, you may not be able to have an MRI. It depends on the type of metal it’s made from. The machine may also affect other implants, like a pacemaker. Talk to your healthcare provider about any implants you have before planning to get an MRI.

Positron emission tomography (PET) scan

A PET scan can show whether change seen on another imaging test is a tumor. Your healthcare provider may use this test to look for spread of the cancer to lymph nodes or other parts of your body. A PET scan looks at your whole body, so it can be helpful if your healthcare provider thinks the cancer may have spread, but doesn't know where. The picture isn’t as detailed as a CT scan, but it can be used along with a CT scan to look for tumors. 

For this test, you’re injected with a mildly radioactive sugar. Over the next few hours, the cancer cells absorb more of this sugar than normal cells. The radioactive substance then shows up on the image from the scan. To get the scan, you’ll need to lie still on a table. It’ll be pushed into the PET scanner, which takes pictures that show where the sugar is in your body. The test may take several hours. Other than the injection, a PET scan is painless.

Procedures

Endoscopic ultrasound

This test can be used to find out how big the tumor is. It can also show how far the cancer has grown into the wall of the esophagus or nearby structures. It can be used to see if the cancer has spread to nearby lymph nodes or other tissues in the area between your lungs (mediastinum). 

This is often done during an upper endoscopy. You may be sedated or asleep (under general anesthesia) for this test. To do it, the healthcare provider puts a long, flexible tube with a tiny camera on the end (an endoscope) down your throat and into your esophagus. It contains an ultrasound transducer. The transducer gives off sound waves and picks up the echoes as they bounce off nearby tissues. A computer converts the echoes into images on a screen. The transducer can be pointed in different directions to look at lymph nodes and other structures between your lungs. If your healthcare provider sees suspicious areas, a hollow needle can be passed through the endoscope to take out biopsy samples. The samples are then sent to a lab to be tested for cancer.

Biopsy

Esophageal cancer is diagnosed by removing samples or tiny pieces of the tumor in a biopsy. This is done during an upper endoscopy. A biopsy is also used to find cancer that has spread. Special lab tests are done on the biopsy samples to find out if it's cancer and the type of cancer. Tests can also be done to see if the cancer cells have certain gene changes. This helps your healthcare provider know which treatments are likely to work best.

Bronchoscopy

This test may be done to see if the cancer has spread to your airways (bronchi). First, you're given medicine to help you relax. Then a thin, lighted scope (bronchoscope) is put into your nose or mouth and passed down through your windpipe (trachea) into your lungs. Your healthcare provider looks at images from the scope on a video screen. If abnormal tissue is seen, a biopsy can be taken out through the scope. It's sent to a lab to be checked for cancer.

Surgery

Laparoscopy

This surgery may be done if your healthcare provider thinks the cancer might have spread to parts of your abdomen (belly). You’ll be given general anesthesia so that you won’t be awake and won’t feel any pain. During the surgery, your healthcare provider makes one or more small cuts in your skin over your abdomen. Then long, thin instruments are put into your abdomen through the cuts. One of these is a thin, lighted tube (laparoscope). The laparoscope lets your provider see the inside of your abdomen. Another tool may be used to biopsy any abnormal tissue for testing. Your provider will tell you what to expect after the surgery and how long you’ll stay in the hospital.

Working with your healthcare provider

Your healthcare provider will talk with you about which tests you'll have. Make sure to follow directions on how to get ready for these tests. Ask questions and talk about any concerns you have.

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