Diagnosis & Staging
The esophagus is the swallowing tube. When you swallow, the muscles in the wall of your esophagus contract (squeeze), moving food and liquids into your stomach.
- Difficulty swallowing, at first with solid foods. As the cancer grows, liquids and soft foods are difficult to swallow.
- Unexplained weight loss.
- Unexplained choking.
- Pressure or burning in your chest.
- Frequent indigestion or heartburn.
- Loss of appetite.
- Hoarseness (raspy voice) or cough.
- Painful spasms after eating.
- Vocal cord paralysis (your vocal cords do not work properly and you cannot speak).
- Coughing up blood.
- Persistent anemia (low iron in your blood).
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests that may help diagnose esophageal cancer include:
- Barium x-ray (barium swallow): You swallow a special liquid (barium) that will help the esophagus show up on x-rays. The barium is not radioactive.
- Endoscopy: a doctor uses an endoscope (a tube with a small camera on the end) to see inside your esophagus.
- Biopsy: a surgeon takes a sample of tissue. The sample is examined by a specialist (pathologist) to see if it is cancer.
If any of the tests show that you have esophageal cancer, your health care team will check to see if the cancer has spread. You may need some of these test:
- CT (computed tomography) scan
- Endoscopic ultrasound: a doctor puts an endoscope with a small ultrasound device through your mouth and into your esophagus.
- Bronchoscopy: a doctor puts a bronchoscope (a thin tube with a light and small camera) through your nose or mouth and into your esophagus.
- Mediastinoscopy: a mediastinoscope (a type of endoscope) is put through a small cut made at the bottom of your neck, just above your breastbone. You will be given general anesthetic (put under) for this procedure. This procedure allows your doctor to look at the space in your chest between your lungs (the mediastinum).
- Laparoscopy: a laparascope (thin tube with a light and camera) is put through a cut made in your abdomen. This procedure is done under general anesthetic.
- PET (positron emission tomography) scan
more information on tests used to diagnose cancer, see BC Cancer Library screening and diagnosis pathfinder.
- Squamous cell carcinomas: develop in the squamous cells that line the esophagus. These cancers usually grow in the middle or upper part of the esophagus.
- Adenocarcinomas: grow in the glandular cells in the lower part of the esophagus.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
- Stage 0: Very early cancer. Has not spread below the lining of the first layer of tissue of the esophagus.
- Stage 1: Tumour (cancer growth) is only in the inner lining of the esophagus.
- Stage 2: Tumour may be in the entire wall of the esophagus or cancer may have spread to the lymph nodes and in the inner lining only.
- Stage 3: Tumour is in the entire wall of the esophagus and cancer has spread to the lymph nodes.
- Stage 4: Cancer has spread outside of the esophagus (metastasis).
For more information on staging see, About Cancer
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Esophageal cancer can be grade 1, 2, or 3. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
The grade of the cancer helps your health care team plan your treatment.