Further tests for oesophageal cancer (cancer of the gullet)
If the first tests suggest that you have cancer of the oesophagus, your specialist may want to do some further tests to confirm the diagnosis and see whether the cancer has spread to any other part of the body. This process is called staging and may take some time.
The results of these tests will help you and your doctor decide on the best treatment.
These tests may also be done if no cancer was found following the initial tests, or if the results weren’t clear.
Sometimes these tests may be done again, during and after treatment, to check on your progress.
CT (computerised tomography) scan
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A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body (see the photo opposite). The scan takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You’ll be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you’re allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
Endoscopic ultrasound (EUS)
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This involves the same procedure as the upper gastrointestinal endoscopy. A tiny ultrasound probe is connected to the end of the endoscope tube and passed along the oesophagus. You may be given slightly stronger sedation, as you need to lie very still during this test.
Ultrasound uses sound waves to build up a picture of the area. It allows the doctors to get a deeper view of the wall of the oesophagus and surrounding areas. This may give them a better idea of the size and depth of the tumour. They may also be able to see whether nearby lymph nodes are enlarged.
A sample of tissue (a biopsy) can be taken to be examined under the microscope. This can tell whether the enlargement is due to cancer or due to inflammation caused by infection.
This procedure allows the doctor to look at the upper part of the abdomen (tummy) and take further biopsies if required.
It’s done under a general anaesthetic and will require a short stay in hospital. Whether or a not a laparoscopy is needed varies and sometimes depends on the position of the tumour within the oesophagus.
While you’re under the anaesthetic, the doctor makes a small cut that’s approximately 2cm in length in the skin and muscle near the belly button (navel). They then carefully insert a thin, rigid tube with a light and a camera at the end (a laparoscope). By looking through the laparoscope, the doctor can look at the abnormal area. If a small sample of tissue (a biopsy) is needed, the doctor will make another small cut in the skin and muscle and insert an instrument to take the sample. The biopsy will be examined in the laboratory later.
During the operation, carbon dioxide (CO2) gas is passed into the abdomen to make it easier to see. The gas won’t harm you, and gradually goes away after the laparoscopy. But it can cause uncomfortable wind and/or shoulder pains for several days afterwards. The pain is often eased by walking about or by taking sips of peppermint water.
After a laparoscopy, you’ll have stitches in one or two small wounds in your lower abdomen. You should be able to get up as soon as the effects of the anaesthetic have worn off.
This is a combination of a CT scan and a positron emission tomography (PET) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.
PET/CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You can’t eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done after at least an hour’s wait. It usually takes 30-90 minutes. You should be able to go home after the scan.
Waiting for test results
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Waiting for test results can be a difficult time. It may take anywhere from a few days to a couple of weeks for the results of your tests to be ready. During this time you may find it helpful to talk to your family or a close friend. It may help to talk things over with your specialist nurse (if you have one), a close friend or relative, our cancer support specialists or a knowledgeable support organisation such as the Oesophageal Patients Association or Ochre.