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How Does My Doctor Know I Have Esophageal Cancer?

If you’re having symptoms that could be linked to esophageal cancer, your doctor will want to know why. Your doctor is likely to ask you questions such as these:

  • What is your medical history?

  • Have you ever had problems with your esophagus or your digestive system?

  • Has anyone in your family had cancer or digestive system problems?

  • Do you smoke? Have you ever smoked?

  • How much alcohol do you drink?

  • Do you often have heartburn or chest pain? 

Your doctor may do a physical exam of your head, neck, chest, and abdomen. Your doctor may also request one or more of these tests to check your esophagus. These tests usually give enough information for your doctor to decide whether you have esophageal cancer.

Barium swallow (also called upper GI series or video esophagram)

This test has several names, all describing the same test. For this test, you have a series of X-rays made of your esophagus while you swallow. The X-rays can show whether the opening in your esophagus is too narrow.

Here’s a general overview of what happens for this test. You won’t be able to eat or drink anything the night before your test. On the day of the test, you drink a liquid that contains barium, which is a chemical that coats the esophagus and makes it easier to see in an X-ray. While you swallow, a technician takes a series of X-rays. A doctor who specializes in X-rays (called a radiologist) views a video image that shows your whole esophagus as you swallow. This video X-ray machine is called a fluoroscope. It shows how the barium moves through your digestive system. This helps the doctor see narrowed places or clumps of cells or parts that aren’t moving properly. These are clues that you might have cancer. Used alone, this test cannot usually diagnose cancer. The test takes a couple of hours.

Upper endoscopy (also called upper gastrointestinal endoscopy or esophagoscopy)

This test can let the doctor see the lining of your esophagus all the way down to the gastroesophageal junction (where it meets the stomach). Upper endoscopy can confirm whether you have cancer in the esophagus, as well as its size.

Illustration of an esophagogastroduodenoscopy procedure
Click Image to Enlarge

For this test, the doctor sprays your throat with a local anesthetic to numb the area. This helps reduce discomfort and gagging. Your doctor may also give you medication to reduce pain and a sedative to help you relax. Then, the doctor inserts a lighted tube with a tiny camera on the end, called an endoscope, through your mouth and down your throat into your esophagus. The doctor sees the picture from the scope on a monitor. These pictures of the inside of your esophagus let the doctor note any tissue that is not normal.

If needed, your doctor can also insert tools through the endoscope to remove a small bit of tissue for testing. This is called a biopsy. The doctor sends the removed tissue to a lab. There, it is looked at under a microscope by a special doctor called a pathologist. The pathologist can see whether cancer is present.

An upper GI endoscopy takes about 30 minutes. You will stay in the testing area for about one to two hours until the sedative wears off.

If cancer is found, other types of imaging or endoscopy tests may be needed to help determine how far the cancer has spread. 


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