Diagnosing Esophageal Cancer

About Esophageal Cancer

At Penn Medicine's Abramson Cancer Center, patients with esophageal cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Esophageal cancer is cancer that develops within the lining of the esophagus, the muscular tube through which food passes from the mouth to the stomach.

There are two types of esophageal cancer:

  • Squamous cell carcinoma: Cancer that begins in the flat skin-like cells lining the esophagus.
  • Adenocarcinoma: Cancer that begins in the intestinal-type cells that make and release mucus and other fluids.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more About Esophageal Cancer

Diagnosing Esophageal Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in developing personalized treatment options for esophageal cancer.

Patients who choose Penn’s Abramson Cancer Center benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan custom designed for each patient with esophageal cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing esophageal cancer and are actively researching better and more precise ways to detect esophageal cancer.

An accurate diagnosis is a critical step in planning cancer treatment, so it’s important patients know that when they come to the Abramson Cancer Center, they are taking an important step in getting the best cancer treatment available.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).


Screening for Esophageal Cancer

Currently, there are no standard screening recommendations for the general public like mammograms for breast cancer and colonoscopy for colon cancer.

However, surveillance is very important for people diagnosed with Barrett’s esophagus to ensure their disease does not progress to cancer. Patients with Barrett’s esophagus may undergo esophageal biopsies through an endoscopic procedure. A biopsy can detect if cancerous cells are present.

Diagnostic Tools for Esophageal Cancer

Penn Medicine’s multidisciplinary cancer team includes nationally recognized gastroenterologists, pathologists and radiologists who are experts at finding and diagnosing cancer.

If cancer is suspected, one or more of these diagnostic tests may be ordered:

  • Imaging tests. Pictures of the inside of the body can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working.
    • Barium swallow. Patients swallow a liquid containing barium and a series of X-rays are taken. The barium coats the lining of the esophagus, stomach and intestines, so abnormalities are easier to see on the X-ray. If there is an abnormality detected, an endoscopic biopsy can help make the diagnosis of cancer.
    • Endoscopy. An endoscope, a thin instrument with a camera and biopsy channel, is used to examine the esophagus. Tissue samples may be taken to check for cancerous cells.
    • Endoscopic ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This procedure is often done at the same time as the upper endoscopy. The endoscopic ultrasound can show enlarged lymph nodes, which may indicate a tumor or advanced disease. Needle biopsies may be obtained to help in staging and diagnosis.
    • Computed tomography (CT) scan. A CT scan creates a 3-D X-ray of the inside of the body. A computer combines the images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan is used to see if the cancer has spread to the liver and to detect a carcinoid tumor in lymph nodes behind the abdomen. Sometimes, a contrast medium (dye) is used to provide better detail.
    • Positron emission tomography (PET) scan. A PET scan creates pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into the patient and cancer cells absorb the radioactive substance. A scanner detects this substance to produce images.
    • Bronchoscopy. A bronchoscopy uses an endoscope to look into the windpipe (trachea) and lung structures to examine if cancer is present in some patients.
    • Thoracoscopy and laparoscopy. These procedures allow a physician to see lymph nodes and other organs to see if cancer has spread. Biopsies may be taken of the organ tissue if there is a question concerning suitability for surgery.
  • Biopsy. A sample of the suspicious area is removed and viewed under a microscope.  A biopsy, such as fine-needle aspiration, is the only way to tell if cancer is truly present.

Staging Esophageal Cancer

After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started. Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment.

  • Stage 0. Abnormal cells are found only in the inner layer of tissue lining the esophagus; also called carcinoma in situ.
  • Stage I. The cancer has grown through the inner layer of tissue to the next layer in the wall of the esophagus.
  • Stage II. One of the following, divided into IIA and IIB.
    • IIA: Cancer has spread to the layer of esophageal muscle or outer wall of the esophagus.
    • IIB: Cancer may have spread to any of the first three layers of the esophagus and to the nearby lymph nodes.
  • Stage III. Cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.
  • Stage IV. One of the following, divided into IVA and IVB.
    • IVA: Cancer has spread to nearby or distant lymph nodes.
    • IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

A Penn Medicine cancer physician can answer any questions about the stage of cancer and what it might mean regarding prognosis and treatment.

Esophageal Cancer Treatment

Following the diagnosis and staging of esophageal cancer, cancer specialists at Penn's Abramson Cancer Center develop a personalized treatment plan. Penn's treatment options for esophageal cancer include:

  • Surgery
    • Esophagectomy
  • Radiation therapy
    • 3-D conformal radiation therapy
    • Intensity-modulated radiation treatment (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
  • Chemotherapy
  • Endoscopy
    • Endoscopic mucosal resection
    • Radiofrequency ablation
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Esophageal Cancer Treatment

Esophageal Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of esophageal cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle. There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Esophageal Cancer Survivorship


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Clinical Trials