Before you start any treatment, we’ll help you understand your disease clearly. Our doctors will discuss your medical history and give you an overall health exam. We will probably take a sample of the tumor so we can look at the tissue under a microscope.
We may also look at the tumor with endoscopic ultrasound, MRI, or CT and PET scans. Getting an accurate diagnosis is the first step toward getting the best cancer care.
A biopsy is when your doctor looks at your actual tissue. Biopsies for esophageal cancer are usually done with an endoscope (a thin, lighted tube) that lets your doctor see the inside of the esophagus. After you take an anesthetic to relax you, your doctor puts the endoscope through your mouth and into your esophagus, giving a clear picture of the esophagus and what’s inside it.
Your doctor will take a small sample of tissue from the tumor so it can be looked at. After the biopsy, a doctor who specializes in esophageal cancer looks at the cells under a microscope and does other tests to learn more about the tumor.
In addition to doing standard tests, we do research to make the diagnosis of esophageal cancer even better. Our researchers are working to find mutations and markers in tumors that could be used to figure out how aggressive certain cancers are and help decide when chemotherapy is needed.
Stages of Esophageal Cancer
If a tissue sample from the tumor shows that you have esophageal cancer, the next step is to find out if the cancer has spread, and if so, how far. This process, called staging, is important in deciding which treatment will be best for you. When our doctors know the stage of the cancer, they can prepare a treatment plan that’s customized specifically to each person’s needs.
The stages of esophageal cancer are based on the location and size of the tumor and how far it may have spread.
Staging the tumor requires one or more tests, including:
Computed Tomography (CT) scans obtain cross-sectional pictures of the body. Our doctors may do CT scans of the chest and abdomen to look at the different organs and lymph nodes around the esophagus.
Positron Emission Tomography (PET) scans take images that help doctors tell apart active and dormant tissue. Higher metabolism is often a sign of cancer, so a PET scan can help identify areas of the body that may have a tumor and should be investigated further. Our doctors may do a combined PET and CT scan using images from PET and CT scans that have been performed at the same time using the same machine. This can create a more complete picture of what is going on in the body.
An endoscopic ultrasound uses an endoscope (a thin, lighted tube with a tiny video camera) with a small ultrasound probe at its tip. A doctor inserts the endoscope through the mouth and down your throat into the esophagus and stomach. The ultrasound probe allows doctors to measure how thick the tumor is and see how deep the cancer has spread into the wall of the esophagus (and its several layers) or if it has affected the lymph nodes.
This procedure uses an endoscope to remove the tumor. For early stage esophageal cancer, endoscopic resection can be a cure. However, the procedure is also used as part of diagnosis because it can more precisely identify how deep the tumor has penetrated the esophageal wall layers compared with imaging or endoscopic ultrasound. Endoscopic resection also provides a specimen that pathologists can evaluate to identify tumor characteristics associated with lymph nodal involvement.
This procedure uses an endoscope placed through the nose or mouth to see whether the cancer has entered the windpipe or airways.
This procedure involves inserting a small endoscope with an ultrasound tip into your windpipe or airways to look at abnormalities surrounding these structures. The doctor can pass a thin, hollow needle into the abnormal structure (usually lymph nodes) to get a sample.
Interventional Radiology or Surgical Biopsies
If suspicious areas are identified outside the esophagus, our doctors may take additional tissue samples to determine whether the cancer has spread.
For early-stage esophageal cancer, MSK patients often can avoid having their esophagus removed. Instead, our doctors can treat the cancer using an endoscope, either to remove the tumor using small surgical tools or destroying the tumor by other methods such as freezing it or using high-energy radio waves.
These are the stages of esophageal cancer:
Stage 0 Esophageal Cancer
Abnormal cells (also called high-grade dysplasia, or HDG) are found only in the superficial (surface) layer lining the esophagus (This is also called the epithelium.) Stage 0 esophageal cancer is sometimes diagnosed when someone with Barrett’s esophagus has an endoscopy with biopsy. HGD can effectively be treated with an endoscopic approach called radiofrequency ablation.
Stage 1 Esophageal Cancer
Stage 1 esophageal cancer is in the first or second layer of the esophagus (mucosa and or submucosa), but it has not spread to the esophageal muscle nor the lymph nodes or other organs. For treatment purposes, Stage 1 cancer is often divided into Stage 1A and 1B.
- Stage 1A cancer is only in the mucosa, the first layer of the esophageal wall, or the thin muscle layer underneath it. These cancers are usually treated with endoscopic resection.
- Stage 1B cancer has penetrated the submucosa, the next layer down. These cancers are usually treated with esophagectomy (removal of some or all of the esophagus). Some low-risk tumors can be treated with endoscopic resection.
Stage 2 Esophageal Cancer
Stage 2 esophageal cancer has spread to the muscular layers of the esophagus but is still contained within the organ. It may also have spread to lymph nodes. These tumors are usually treated with esophagectomy alone or combined with chemotherapy or chemotherapy plus radiation.
Stage 3 Esophageal Cancer
Stage 3 esophageal cancer has spread beyond the esophagus to nearby tissue and has also spread to lymph nodes. These cancers area usually treated with a combination of chemotherapy plus radiation and surgery.
Stage 4 Esophageal Cancer
Stage 4 esophageal cancer has spread (metastasized) to another part of the body through the bloodstream. These cancers are usually treated with chemotherapy and possibly targeted drug therapy.