How is cancer of the esophagus diagnosed?
Esophagus cancers are usually found because of signs or symptoms a person is having. If esophagus cancer is suspected, tests will be needed to confirm the diagnosis.
Signs and symptoms of esophageal cancer
In most cases, cancers of the esophagus are found because of the symptoms they cause. Diagnosis in people without symptoms is rare and usually accidental (because of tests done to check other medical problems). Unfortunately, most esophageal cancers do not cause symptoms until they have reached an advanced stage, when they are harder to treat.
The most common symptom of esophageal cancer is a problem swallowing, with the feeling like the food is stuck in the throat or chest. The medical term for this is dysphagia. This is often mild when it starts, and then gets worse over time as the opening inside the esophagus gets narrower. Dysphagia is commonly a late symptom caused by a large cancer.
When swallowing becomes difficult, people often change their diet and eating habits without realizing it. They take smaller bites and chew their food more carefully and slowly. As the cancer grows larger, the problem gets worse. People then may start eating softer foods that can pass through the esophagus more easily. They may avoid bread and meat, since these foods typically get stuck. The swallowing problem may even get bad enough that some people stop eating solid food completely and switch to a liquid diet. If the cancer keeps growing, at some point even liquids will not be able to pass.
To help pass food through the esophagus, the body makes more saliva. This causes some people to complain of bringing up lots of thick mucus or saliva.
Sometimes, people complain of pain or discomfort in the middle part of their chest. Some people describe a feeling of pressure or burning in the chest. These symptoms are more often caused by problems other than cancer, such as heartburn, and so they are rarely seen as a signal that a person may have cancer.
Swallowing may become painful when the cancer is large enough to limit the passage of food through the esophagus. Pain may be felt a few seconds after swallowing, as food or liquid reaches the tumor and has trouble getting past it.
About half of patients with esophageal cancer lose weight (without trying to). This happens because their swallowing problems keep them from eating enough to maintain their weight. Other factors include a decreased appetite and an increase in metabolism from the cancer.
Other possible symptoms with cancer of the esophagus can include:
Bleeding into the esophagus. This blood then passes through the digestive tract, which may turn stools black. Over time, this blood loss can lead to anemia (low red blood cell levels), which may make a person feel tired.
Having one or more of the symptoms above does not mean you have esophageal cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if you have any of these symptoms, especially trouble swallowing, it is very important to have them checked by a doctor so that the cause can be found and treated, if needed.
Medical history and physical exam
If you have symptoms that may be caused by esophageal cancer, the doctor will ask about your medical history to check for possible risk factors and to learn more about your symptoms. Your doctor will also examine you to look for possible signs of esophageal cancer and other health problems. He or she will probably pay special attention to your neck and chest areas.
If the results of the exam are abnormal, your doctor will likely order tests to help find the problem. You may also be referred to a gastroenterologist (a doctor specializing in diseases of digestive tract).
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests may be done for a number of reasons both before and after a diagnosis of esophageal cancer, including:
To help find a suspicious area that might be cancerous
To learn how far cancer may have spread
To help determine if treatment has been effective
To look for possible signs of cancer recurrence after treatment
An endoscope is a flexible, narrow tube with a video camera and light on the end that is used to look inside the body. Several tests that use endoscopes can help diagnose esophageal cancer or determine the extent of its spread.
This is an important test for diagnosing esophageal cancer. During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes the endoscope down the throat and into the esophagus and stomach. The camera is connected to a monitor, which lets the doctor see any abnormal areas in the wall of the esophagus clearly.
The doctor can use special instruments through the scope to remove (biopsy) samples from any abnormal areas. These samples are sent to the lab so that a doctor can look at them under a microscope to see if cancer is present.
If the esophageal cancer is blocking the opening (called the lumen) of the esophagus, certain instruments can be used to help enlarge the opening to help food and liquid pass.
Upper endoscopy can give the doctor important information about the size and spread of the tumor, which can be used to help determine if the tumor can be completely removed with surgery.
Endoscopy of Cancer of the Esophagus
Esophagus Cancer of the middle third
Release Esophageal Stent in Esophagus Cancer
Escamo Celular carcinoma that infiltrates the lower third of the esophagus and the gastric foundus
Carcinoma epidermoide del tercio superior.
Paciente masculino de 83 años, con el antecedente de masticar tabaco y alcoholismo.
Carcinoma de células pequeñas del pulmón que infiltra el tercio superior y medio del esófago.
El tabaquismo es el mayor factor de riesgo para la evolución del cáncer de pulmón de células pequeñas.
Hay dos tipos de cáncer de pulmón: cáncer de pulmón de células pequeñas y cáncer de pulmón de células no pequeñas.
El Carcinoma de células pequeñas, este tumor por lo general proviene cerca del hilium.
Es el tumor más maligno del pulmón y es compuesto de células en forma de avena, las cuales son
más pequeñas que las células tumorales encontradas en el carcinoma escamoso o el adenocarcinoma.
Carcinoma del tercio medio de esófago mujer de cuarenta y cinco años.
Femenino sesenta y siete años carcinoma del tercio medio del esófago al momento del examen endoscopico tenía masa en el flanco derecho, presentaba disfagia progresiva primero a sólidos y luego a líquidos .
Carcinoma escamo celular del tercio inferior, paciente de 69 años quien había presentado disfagia progresiva.
Carcinoma del tercio superior del esófago.
Masculino de 82 años, francés, con bloqueo cardiaco completo quien había tenido historia de disfagia.
En la imagen se observa estenosis severa del esófago, presento perforación esofágica con cuadro de mediastinitis.