Persistent symptoms that indicate esophageal cancer should not be ignored and should be brought to a physician’s attention immediately. Multiple tests are recommended to diagnose and stage the disease accurately. Once the disease is staged, the expert team employs a multidisciplinary approach to thoroughly study the case, understand the individual patient parameters, and devise a personalized care plan.
Esophageal Cancer Diagnosis Tests
The doctor will initially perform a physical examination and medical history assessment to understand the cause of the symptoms and see if the patient has a family history of esophageal cancer or has underlying medical conditions. Doctors will recommend additional tests if the observations from the physical examination hint at the possibility of esophageal cancer. The following are the different tests recommended for esophageal cancer diagnosis:
Barium Swallow
A barium swallow is a form of X-ray test wherein the patient swallows a white-chalky liquid containing barium sulfate. Barium sulfate coats the structures of the esophagus and appears white on X-rays. This test helps specialists look for various esophagus-related abnormalities, such as strictures, tumors, and other anomalies.
CT Scan
A computed tomography (CT) scan is an imaging method that uses X-rays to create more detailed, cross-sectional images. It is recommended during an esophageal cancer diagnosis to determine the size, location, and extent of the disease’s spread. This information helps the specialists stage the disease accurately and devise the most effective treatment plan.
Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy (EGD), or upper endoscopy, is a diagnostic procedure that involves inserting an elongated, flexible tube that carries a light source and a camera through the mouth to examine the regions of the esophagus for any abnormalities. At times, biopsy samples may also be collected during this procedure with the help of specialized tools.
Esophageal Endoscopic Ultrasound
As the name says, esophageal endoscopic ultrasound combines an
endoscopy with an ultrasound scan to obtain detailed images of the esophagus, along
with the nearby tissues and lymph nodes.
An endoscope along with an
ultrasound probe is inserted through the mouth to examine the esophageal region.
This dual endoscope allows specialists to directly visualize the organ and create
real-time, detailed images through the sound waves emitted by the probe. This test
helps with esophageal carcinoma diagnosis by helping specialists determine the
extent of tumor invasion and the possibility of lymph node involvement and by
facilitating guided biopsies.
Biopsy
A biopsy is recommended for the confirmatory esophageal cancer diagnosis. During this procedure, a small sample of the esophageal tissue is removed. This tissue sample is later examined for the presence of cancer cells. The biopsy sample, in most cases, is collected during an endoscopy.
Endoscopy
An endoscopy involves inserting a thin, flexible, and elongated tube through the mouth to examine the interior of the esophagus. As a test for esophageal cancer, endoscopy facilitates direct visualization and biopsy sample collection.
Esophageal Cancer Treatments
Once the esophageal cancer diagnosis is confirmed and staging is done, an individualized treatment plan is devised based on several parameters, such as the type of esophageal cancer, its stage, its grade, the exact location of the tumor, the patient’s age, the patient’s overall health status, and lastly, their preferences. Surgery, radiation therapy, chemotherapy, and targeted therapy are the different treatment options available for esophageal cancer
Surgery
Surgery is often the first line of esophageal cancer treatment.
Depending on the stage of the disease, specialists recommend different
esophageal cancer surgery types. Esophagectomy refers to the partial or complete
removal of the esophagus, depending on the disease’s stage. This esophageal
cancer surgery may be open or minimally invasive.
Lymphadenectomy may
also be recommended, wherein the lymph nodes close to the tumor are removed to
prevent the disease from metastasizing.
In the case of a partial
esophagectomy, the remaining esophagus is connected back to the stomach. If the
esophagus is removed completely, the surgeon may reconstruct the esophagus from
the small intestine and then insert it between the mouth and the stomach.
Radiation Therapy
Radiation treatment for esophageal cancer involves targeting
and destroying cancer cells using high-energy radiation beams, such as X-rays.
Radiotherapy for esophageal cancer is often administered along with other
treatments for more effective management of the disease.
Radiation
therapy for esophageal cancer helps shrink the tumor, destroy residual cancer
cells, and ease symptoms in the advanced stages.
Over the years,
radiation therapy has become more precise, and today, due to modern
technologies, we can target tumors more accurately and reduce side effects for
patients.
Chemotherapy
Chemotherapy is one of the most important treatments recommended for esophageal cancer. Esophageal chemotherapy involves the use of powerful drugs that disrupt the growth of fast-growing cells in the body. Chemotherapy for esophageal cancer may be recommended before the surgery (neoadjuvant chemotherapy) to shrink the tumor size or after the surgery (adjuvant chemotherapy) to destroy the residual cancer cells.
Endoscopic Mucosal Resection (EMR)
Endoscopic mucosal resection (EMR) is recommended for early-stage esophageal cancers. This is a minimally invasive procedure wherein an endoscope with specialized surgical tools is sent to the esophagus through the mouth. These tools carefully remove the cancerous or precancerous tissue from the inner lining of the esophagus.
Endoscopic Submucosal Dissection (ESD)
Endoscopic submucosal dissection (ESD) is a minimally invasive procedure recommended for early-stage esophageal cancers. Just like endoscopic mucosal resection, this is also an endoscopic procedure; however, it is recommended for larger lesions that have a higher likelihood of developing into aggressive cancer. ESD is recommended when the lesions cannot be removed through EMR or have recurred after EMR.
Photodynamic Therapy (PDT)
Also referred to as light-activated cancer cell destruction,
photodynamic therapy (PDT) is also recommended as one of the esophageal cancer
treatments. This procedure involves administering a photosensitizing agent into
the body, which tends to accumulate in cancer cells. This photosensitizing agent
is activated by exposure to light. Once activated, this agent releases oxygen
radicals, which destroy the cancer cells.
This treatment is often
recommended for Barrett’s esophagus, early-stage esophageal cancer, and
advanced-stage esophageal cancers. In patients with stage 4 esophageal cancer,
PDT helps alleviate symptoms, such as swallowing difficulties, and improve the
quality of life.
Endoscopic Laser Therapy
This esophageal cancer therapy uses powerful beams of light to destroy cancer cells through heat. It is often administered as a part of palliative care and helps address complications such as obstruction or superficial lesions. This treatment procedure may not destroy all cancer cells, but it is effective in alleviating advanced-stage symptoms.
Targeted Therapy
Targeted therapy is a personalized esophageal cancer treatment approach. Drugs administered as a part of this treatment approach target specific biomolecules and cellular pathways that are associated with cancer cells. Targeted therapy treats esophageal cancer by blocking the molecules and pathways responsible for cancer growth. These targets associated with cancer cells are identified through molecular profiling, and based on these, a treatment plan, including specific targeted therapy drugs, is devised.
Immunotherapy
Immunotherapy involves stimulating the body’s immune system to identify and attack cancer cells throughout the body. Many studies have identified that certain checkpoint inhibitors can help block those proteins that block the immune response and help the body attack and destroy cancer cells. This new treatment for esophageal cancer is highly precise, safer, and more effective.
Why Choose HCG for Esophageal Cancer Diagnosis and Treatment?
As one of the best cancer hospitals in India, HCG is equipped with all major diagnostic and treatment facilities for the effective management of esophageal cancer. Our experts are globally trained and have vast experience in managing simple to complex esophageal cancer cases successfully through a patient-centric and personalized approach. This approach will not only help us improve the survival rates of our patients but also their quality of life.
Conclusion
Esophageal cancer is best treated when it is diagnosed early. Early diagnosis also has a significant impact on success rates. Different tests recommended for esophageal cancer diagnosis include endoscopy, ultrasound, biopsy, and imaging tests. Upon arriving at a confirmed diagnosis and staging the disease, doctors may recommend surgery, radiation therapy, chemotherapy, laser therapy, targeted therapy, etc., as a part of esophageal cancer treatment.
Frequently Asked Questions
After esophageal cancer treatment, it is normal for the patient’s eating abilities to be affected, depending on the stage of the disease.
Regaining eating abilities after treatment is a gradual process. Doctors will initially recommend soft or pureed foods and slowly progress to a regular diet upon observing the patient’s tolerance.
Nutrition plays a pivotal role in recovery after esophageal cancer treatment. Therefore, patients must talk to their nutritionist for a personalized diet plan.
Early diagnosis is crucial for the effective management of esophageal cancer. Some of the measures that may help in the early detection of esophageal cancer include:
Being mindful of symptoms: It is important to be aware of different signs and symptoms of esophagus cancer and promptly see a doctor whenever necessary.
Being mindful of the different risk factors associated with esophageal cancer: Conditions like chronic acid reflux, Barrett's esophagus, etc., increase the risk of esophageal cancer. Therefore, those with these conditions should talk to their doctor for appropriate screening guidance.
Opting for regular screening: Those having a higher chance of developing esophageal cancer should talk to their doctor about regular esophageal cancer screening.
The success rate of immunotherapy for esophageal cancer may depend on numerous factors. In recent times, pembrolizumab, a checkpoint inhibitor administered as a part of immunotherapy, has shown promising results in certain esophageal cancer patients. However, the success rates may vary depending on the stage of esophageal cancer, the specific molecular characteristics of cancer, the stage of the disease, and the patient’s overall health.
The number of radiotherapy sessions required for esophageal cancer management may vary from one patient to another. It depends on various factors, such as the type of esophageal cancer, its stage, the patient’s age, their overall health status, and their body's response to other treatments administered.
Blood tests are not usually recommended for esophageal cancer diagnosis. Commonly recommended blood tests for esophageal cancer include a complete blood count (CBC) and liver panel to measure the different types of blood cells and liver functions, respectively, in esophageal cancer patients.
Certain biomarkers, such as carcinoembryonic antigen (CEA) and CA 19-9, are elevated in esophageal cancer patients. However, the levels of these biomarkers are high in other health conditions, too, which makes blood tests less reliable. Therefore, other tests like endoscopy, biopsy, and imaging tests are recommended for a definitive diagnosis.
The health outcomes or success rates of chemotherapy for esophageal adenocarcinoma depend on various individual factors, such as the stage of the disease, the patient’s age, their overall health condition, etc. In most cases, esophageal cancer patients show a good response to chemotherapy.
