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Diagnostics of esophageal cancer

Diagnostics are important to assess whether cancer exists and to assess the extent of the disease. It is recommended that the work-up and treatment are discussed by an interdisciplinary team consisting of a radiologist, surgeon, oncologist, and pathologist.   

Most of the esophagus is not available for external inspection. In very rare cases, the tumor can be palpated in the lower part of the throat. More often, there are palpable lymph node metastases in the neck, but this is also rare. 

There is no good serological marker. Blood tests can indicate anemia and reduced nutrition status or disturbances in liver function. There is still a relatively large portion of patients in the catabolic phase at the time of diagnosis, which is evident by a low albumin level.

Hospitals with larger treatment volumes are better at identifying metastases thereby avoiding unnecessary surgery. 

Endoscopy

The diagnosis is made using esophago-gastroscopy with  biopsy. If esophagitis exists with fibrosis, repeated biopsies may be necessary.  In most cases, esophagoscopy provides better and more reliable information than X-ray exams, as well as tissue samples for pathology examinations.

Ultrasound of esophagus

An ultrasound of the esophagus using an endoscope is the most suitable method for assessing the extent of the disease in the esophageal wall. This can be combined with a transesophageal needle biopsy of suspect lymph nodes in the mediastinum. If stenosis is prominent a thin ultrasound probe can be used by inserted  it through the biopsy channel of the scope and through the stenosis. However, the quality of the image is somewhat inferior.

Radiological work-up

  • CT of the thorax is best for assessing extent in the mediastinum, throat, lungs, and liver. There is a higher frequency of inoperability criteria when this is carried out by specialists.
  • X-ray of the esophagus with a contrast agent may be indicated to assess the length of the stenosis, but not for making a diagnosis.
  • Studies indicate that PET can determine lymph node spreading better than other techniques and the method should be a part of the preoperative work-up for esophageal cancer.

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