How oesophageal cancer (cancer of the gullet) is diagnosed
If you have some of the symptoms of oesophageal cancer (cancer of the gullet) you would usually, begin by seeing your family doctor (GP), who will examine you. If your GP thinks that cancer may be present, or is not sure what the problem is, they will refer you to a hospital for specialist advice and treatment.
At the hospital
Whether it’s my GP or a consultant, before I go and see them I write down a list of questions and points I want to raise, and make sure that they answer those questions.
At the hospital the specialist will ask you about your general health and any previous medical problems, before examining you. You may have blood tests and a chest x-ray taken to check your general health.
The following tests may be used to diagnose cancer of the oesophagus.
Upper gastro-intestinal endoscopy
An endoscopy may be carried out by either a doctor or a specialist nurse. An endoscope is a thin flexible tube with a tiny camera and light on the end. During an endoscopy, the endoscope is gently passed down your oesophagus so the doctor or nurse can see if there are any abnormal areas.
The doctor can also, if necessary, take a small sample of the cells (a biopsy) to be examined under a microscope. This can usually confirm whether or not there’s a cancer present.
You can usually have an endoscopy as an outpatient, but occasionally you’ll need to stay in hospital overnight. You’ll be asked not to eat or drink for at least four hours before the procedure, and you’ll be given instructions about any medicines you’re taking.
To have the endoscopy, you lie on your side on a couch. You may be given a sedative, usually injected into a vein in your arm, to make you feel sleepy and reduce any discomfort. Or a local anaesthetic may be sprayed on to the back of your throat. Sometimes both an injection and the spray are used. The doctor then passes the endoscope down and examines the inside of the oesophagus.
An endoscopy can be uncomfortable but shouldn’t be painful. Let your doctor know if you have any chest pain during or after the procedure. After a few hours, the effect of the sedative will wear off and you’ll be able to go home. You shouldn’t drive for several hours after the test and, if possible, you should arrange for someone to travel home with you. If you’ve had the local anaesthetic spray to the back of your throat you may need to stay in hospital until it has worn off. This usually takes about four hours, and you shouldn’t try to swallow anything during this time.
Some people have a sore throat afterwards. This is normal and should get better after a couple of days. If it doesn’t, let your doctor at the hospital know.
This test is used less often. It’s done in the hospital x-ray department and involves drinking a white, chalky liquid (barium) that helps the oesophagus show up on an x-ray.
Before a barium swallow your stomach needs to be empty, so it’s important not to eat or drink anything for at least four hours before the test. You’ll be given some barium to drink and asked to lie on a couch. The doctor will watch on the x-ray screen as the barium passes down your oesophagus. The test usually takes less than an hour. It may be slightly uncomfortable.
The doctor, and often a nurse, will be in the room with you and can answer any of your questions. Most people are able to go home straight after the test, but it may be a good idea for a relative or friend to travel with you.
Your bowel motions (stools) are likely to be very pale for a few days until all the barium has passed out of your system. Sometimes the barium causes constipation, so you may need to take a laxative. Drinking plenty of fluids will also help.