Esophageal Cancer

Diagnosis

Squamous cell carcinoma often is discovered on a chest X-ray, where it appears as a dark, shaded area. Other imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI) and positron emission tomography (PET scans), may be used to further determine the size, shape and location of the tumor.

These tests help to find the best place to obtain a sample of the tumor to determine whether it is a type of lung cancer or whether the cancer spread to the lung from another place outside the chest. The type of cancer affects what treatment you should get.

Other tests that can be used to diagnose this type of cancer include:

• Thoracentesis - A needle is used to remove pleural fluid, the fluid between the lung and the chest wall. This fluid is examined for cancer cells. This procedure may be performed when the chest x ray shows an abnormal accumulation of fluid.

• Mediastinoscopy - This is a surgical procedure that lets the doctor remove lymph nodes from the lungs through very small incisions. The incision is generally made at the bottom of the neck, right above the chest bone to allow a specialized tube to be inserted into the central portion of the chest. The surgeon then is able to collect certain cells of the lymph nodes in the central portion of the chest. The cells and pieces of tissue from the biopsy are then sent to a pathologist who tests them for cancer.

• Needle biopsy or fine-needle aspiration - In this procedure, a needle is used to remove (aspirate) fluid or tissue for testing from lymph nodes, a lung mass or from an area in the bone marrow or other organ where the tumor may have spread.

• Bronchoscopy - A flexible, fiber-optic viewing instrument is passed through the airway into the lung. The instrument allows the doctor to examine the tumor directly and to remove cells for examination.

Occasionally, surgery is done to remove the tumor first and then the diagnosis is made.

PET scanning is used to help make the initial diagnosis and to help determine whether the lung cancer has spread and the extent of spread. This test is able to detect, using very sophisticated chemicals, the metabolic activity of abnormal cancer cells by measuring their uptake of a sugar substance (glucose). Recent studies have shown improved accuracy in detecting cancer spread to other areas of the body when PET scanning has been compared to CT scanning. This type of information will greatly influence the type of treatment that is offered to the patient.

Expected Duration

Without treatment, cancer will continue to grow. As with any cancer, even if large cell carcinoma seems to have disappeared (gone into remission) after treatment, there is a chance the cancer can return.