How oesophageal cancer is diagnosed

Your doctor will ask about your symptoms and examine your neck. Then, they may arrange for you to have some tests. If your GP thinks your symptoms may be due to cancer, you will be referred to a hospital for a test called an endoscopy within two weeks.

The main test you will have is an endoscopy. This is when a thin, flexible tube with a light and camera on the end, is put into your oesophagus. You will usually have an endoscopy in the hospital outpatient department, but sometimes you will need to stay in hospital overnight. You may also need other tests such as a CT scan, PET CT, endoscopic ultrasound, or laparoscopy. It may take from a few days to a couple of weeks for the results of your tests to be ready.

Being diagnosed with oesophageal cancer

You usually start by seeing your GP, who will examine you. You may have blood tests to check your general health. If your GP is unsure what the problem is or thinks you may have cancer, they will refer you to a hospital for a test called an endoscopy (see below) and specialist advice and treatment. If a cancer is suspected, you should be seen at the hospital within two weeks.


At the hospital

Your first appointment at the hospital may be for an endoscopy. If the endoscopy shows that you might have cancer, you will then see a specialist. They will ask you about your general health and any previous medical problems. They will also examine you. You may have blood tests and a chest x-ray to check your general health. In some hospitals, you will be seen by a specialist nurse before seeing a doctor.


Endoscopy

The doctor or a specialist nurse will put a thin, flexible tube (endoscope) into your oesophagus. There is a tiny light and camera on the end of the tube. This helps the doctor or nurse to see any abnormal areas. If necessary, they can take a small sample of tissue (biopsy) to examine under a microscope. This can usually confirm whether there is a cancer. The biopsy is not painful.

You will usually have an endoscopy in the hospital outpatient department, but sometimes you will need to stay in hospital overnight. You will be asked not to eat or drink anything for at least four hours before the procedure. Your doctor or nurse will also give you instructions about any medicines you are taking.

When you have the endoscopy, you will be asked to lie on your side on a couch. A local anaesthetic may be sprayed on to the back of your throat. Or your doctor or nurse may give you a sedative to make you feel sleepy and reduce any discomfort. The sedative is usually injected into a vein in your arm. They may give you both the injection and the spray. The doctor or nurse then passes the endoscope down the oesophagus to examine it.

An endoscopy can be uncomfortable, but it should not be painful. Tell your doctor if you have any chest pain during or after the procedure.

The local anaesthetic spray to the back of your throat can take an hour to wear off. You should not try to swallow anything during this time. You may need to stay in hospital until you are able to swallow and drink fluids safely again. The effect of the sedative will wear off after a few hours and you will be able to go home. You should not drive for several hours after the test and should arrange for someone to travel home with you.

Some people have a sore throat afterwards. This is normal and should get better after a few days. If it does not, let your doctor at the hospital know.

After suffering swallowing difficulties, I went to my GP. The results of the biopsies confirmed that it was oesophageal cancer. The recommended treatment was chemotherapy, followed by surgery.

David


Further tests

If the first tests suggest that you have oesophageal cancer, your specialist may want to do some further tests mentioned below. This is to confirm the diagnosis and see whether the cancer has spread to any other part of the body. This process is called staging. It may take a few weeks. The results of these tests will help you and your doctor decide on the best treatment.

You may have more tests even if no cancer was found, or if the results were unclear. Sometimes, these tests may be repeated during and after treatment to check on your progress.


CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. 

The scan takes 10 to 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.

CT scan
CT scan

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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 is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.


PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, 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 cannot 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. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.


Endoscopic ultrasound (EUS)

This is like an endoscopy, but the tip of the endoscope has an ultrasound probe on it.

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 a microscope.

You may have a slightly stronger sedative than for a gastro-intestinal endoscopy. This is because an EUS may take longer and you need to lie very still during this test. If you are given a stronger sedative, it will take a little longer to recover.


Laparoscopy

This is a small operation, which is done under a general anaesthetic. If your doctor has enough information from other tests, you may not need a laparoscopy. Your doctor will discuss the test with you if they think it will be helpful.

The surgeon makes a cut about 2cm long near the tummy button (navel). They then carefully insert a thin tube with a tiny video camera on the end (laparoscope) into your tummy (abdomen). The surgeon uses the laparoscope to look at the lining of your tummy and the organs nearby. The surgeon may take a biopsy. To do this, they will make another small cut and insert an instrument to take the sample.

When the effects of the anaesthetic have worn off, you will be able to get up. You sometimes need to stay in hospital overnight. You will have 1 or 2 stitches in your tummy where the cuts were made.

A laparoscopy
A laparoscopy

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Waiting for test results

Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. 

You may find it helpful to talk with your partner, family or a close friend. 

Your specialist nurse can also provide support. 

You can also talk things over with one of our cancer support specialists on 0808 808 00 00.

Back to Diagnosing

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