Esophageal Cancer: Diagnosis & Staging

Pictured: Hans Gerdes Hans Gerdes (center), Director of our Gastrointestinal Endoscopy unit, uses endoscopic methods to screen for, diagnose, treat, and relieve symptoms of gastrointestinal cancers.

Getting an accurate diagnosis is the first step toward getting the best cancer care. Because Memorial Sloan Kettering has a team that specializes in treating esophageal cancer exclusively, we bring a high level of expertise to the process of assessing your tumor.

Most patients who come to Memorial Sloan Kettering for the treatment of esophageal cancer first meet with a surgeon. He or she will work together with gastroenterologists, pathologists, radiologists, and other esophageal cancer experts to determine the specific type of cancer you have and how advanced it is. These findings help your esophageal cancer disease management team to develop the treatment plan that will be most successful for you.

Biopsy & Endoscopy

If your doctor suspects that you have esophageal cancer, arrangements will be made to perform a biopsy. A biopsy is the only way for your doctors to determine whether the suspicious growth is esophageal cancer and if so what type of cancer it is.

Biopsies for esophageal cancer are usually performed using an endoscope – a thin, lighted tube that enables doctors to examine the interior lining of the organ. After you receive an anesthetic to relax you, a gastroenterologist will insert the endoscope through the mouth and into the esophagus, giving a clear picture of the esophagus and any obstructions. If the tumor is blocking the esophagus, the doctor can use the endoscope to make the opening bigger by stretching or dilating the passage, and possibly placing a stent.

After the biopsy is complete, a pathologist who specializes in esophageal cancer examines the cells under a microscope and performs other tests to learn more about the tumor.

Staging

If a biopsy indicates that you have esophageal cancer, the next step is to determine whether and how far the cancer has invaded the wall of the esophagus and whether it has spread to nearby lymph nodes or other organs. This process, called staging, is an important factor in deciding which treatment will be most effective for you.

Staging the tumor requires performing one or more possible studies, including:

  • CT scans of the chest and upper gastrointestinal tract
  • A combined PET/CT scan, which allows doctors to measure and analyze the location of tumors more accurately. This technology can also help track how the tumor responds to treatment as your care progresses.
  • Endoscopic ultrasound, a procedure that uses an endoscope with a small ultrasound probe at its tip. The device can measure how thick the tumor is and see whether it has invaded the wall of the esophagus. The test can also help your doctors to determine whether cancer cells are in the lymph nodes.
  • Bronchoscopy, an endoscopy procedure, to evaluate cancer involvement of the trachea (windpipe) or main bronchi (airways)
  • Interventional radiology or surgical biopsies if suspicious areas are identified outside the esophagus

Using results from your staging studies, your doctors will classify the cancer into one of four stages. The stage indicates how large the tumor has grown and how widely it has spread in the body.

Molecular Diagnostics

In addition to performing standard pathology tests, Memorial Sloan Kettering is conducting research to make the diagnosis of esophageal cancer more precise. Clinical researchers are working to identify genetic mutations or protein markers in tumors that could be used to determine how aggressive individual cancers are and to guide decision making when chemotherapy is needed.