Esophageal Cancer - Diagnosis and Treatment

Diagnosis

X-ray Test With Barium Liquid

Doctors often start with a special X-ray test called a barium swallow. For this test, the patient drinks a thick, white liquid called barium. This liquid coats the inside of the esophagus, making it show up clearly on X-rays.

The healthcare team looks for unusual areas, such as narrow spots, lumps, or changes in shape. If the barium test finds something that looks suspicious, the doctor will likely suggest more tests, such as looking directly inside the esophagus.

Key Facts:

Helps find abnormal shapes or narrowing in the esophagus
Quick and non-invasive
May be used to spot early signs in people with symptoms

Looking at the Esophagus With a Camera

A gastroenterologist often performs an upper endoscopy to see inside the esophagus. During this test, the doctor uses a thin, flexible tube with a tiny camera and light at the end (called an endoscope).

The tube goes through the patient’s mouth and down into the esophagus. This allows the doctor to view the lining and look for problems, such as red, thick areas, or growths.

If a problem appears, the doctor can use special tools passed through the tube to take samples.

Upper endoscopy is helpful for:

Detecting visible changes in the esophageal tissue.
Locating tumors or signs of cancer.
Helping decide where to take tissue samples.

Taking Small Tissue Samples

To tell whether a spot on the esophagus is cancer, doctors take a biopsy. During an endoscopy, tiny cutting tools go through the tube and remove small pieces of tissue from areas that look abnormal.

Lab technicians examine these samples under a microscope to look for cancer cells, such as squamous cell carcinoma or adenocarcinoma.

Why a biopsy is important:

Confirms the diagnosis of cancer.
Shows the type of cancer cells.
Guides the next steps in care.

Diagnostic Step	Purpose	Is it Invasive?
Barium swallow	X-ray exam for shape changes	No
Upper endoscopy	Direct view with a camera	Slightly
Biopsy	Tissue sample for lab testing	Yes

Finding Out How Far the Cancer Has Spread

After diagnosing cancer, doctors order more tests to see if it has moved to other areas, such as lymph nodes or distant organs.

This process is called staging. Imaging tests may include a CT scan, MRI, PET scan, and sometimes an endoscopic ultrasound.

In some cases, doctors use bronchoscopy to look at the airways or perform procedures such as laparoscopy or thoracoscopy to view other parts of the chest and abdomen.

Staging is important because:

Shows if the cancer is only in the esophagus or has spread (metastasized).
Helps doctors plan the most effective treatment.
Stages go from 0 (small, only on the surface) to 4 (cancer has spread to other organs).

Some people also have blood tests to check overall health and see how organs are working. The results from all of these tests help the healthcare team make the right treatment choices for each person with esophageal cancer.

Treatment

Surgical Procedures

Surgeons can often remove the cancer from the esophagus. Some people may need only the tumor removed from the inside lining using a long, flexible tube (endoscopic removal).

This method works well when the cancer is tiny and hasn’t grown deeply.

For larger tumors or those that have spread within the esophagus, surgeons sometimes remove a section of the esophagus itself (partial esophagectomy). In certain cases, the surgical team may also remove a part of the stomach or nearby lymph nodes.

When both the esophagus and part of the stomach are removed, the procedure is called esophagogastrectomy. The remaining parts are then reconnected so that swallowing food is still possible.

Surgeons can perform esophageal cancer operations as open surgery with large cuts, or use smaller incisions and special tools (minimally invasive surgery).

The approach depends on the patient’s specific situation and the preferences of the surgical team, which often includes thoracic surgeons and surgical oncologists.

Risks of surgery include bleeding, infection, and leaking at the area where two parts are rejoined. The cancer stage, general health, and team input at a cancer center guide decisions about surgery.

Table: Types of Surgery for Esophageal Cancer

Type of Surgery	When Used	What Is Removed
Endoscopic mucosal resection	Very early-stage cancer	Tumor and some healthy tissue
Esophagectomy	Cancer confined to part of esophagus	Part of esophagus ± lymph nodes
Esophagogastrectomy	Cancer near stomach or more advanced cases	Part of esophagus + stomach

Medicine Used to Kill Cancer Cells

Doctors use chemotherapy to kill cancer cells or slow their growth. For esophageal cancer, they may give chemotherapy before surgery to shrink the tumor (called neoadjuvant therapy), after surgery to reduce return risk (adjuvant therapy), or together with radiation.

If the cancer has spread and surgery isn’t possible, doctors might use chemotherapy alone to help control symptoms and limit growth of the tumor.

Some common side effects of chemotherapy are:

Tiredness
Losing appetite
Feeling sick to the stomach
Diarrhea
Hair loss

The exact side effects depend on the drugs used and the patient’s condition.

Energy Radiation Treatments

Radiation therapy targets cancer cells with high-powered beams. Most often, doctors deliver these beams using a machine that moves around the patient (external beam radiation).

Sometimes, they place thin wires or tubes very close to the tumor to deliver internal radiation (brachytherapy), but this is less common.

A radiation oncologist can give radiation treatments before or after surgery, or at the same time as chemotherapy to boost effectiveness. In some cases, doctors use radiation to ease certain symptoms, like trouble swallowing.

Possible side effects include:

Sore throat or painful swallowing
Red or blistered skin over the treatment area
Problems with nearby organs (lungs or heart)

Doctors carefully plan radiation to minimize risk to healthy tissues.

Using Both Chemotherapy and Radiation

Doctors sometimes combine chemotherapy and radiation therapy to make each method more effective. This approach may help people who can’t have surgery or shrink tumors ahead of surgery.

Combining treatments may work better at controlling the cancer, but can also lead to stronger side effects, such as more severe fatigue, mouth sores, or trouble swallowing.

The care team, which may include a medical oncologist and other specialists, monitors patients closely during this time.

Medicines That Target Cancer Markers

Doctors use targeted treatments to attack specific changes found in cancer cells. These medicines can block the chemicals or proteins that help the cancer grow.

As a result, targeted drugs may slow or stop cancer growth without harming as many normal cells.

For some people with advanced or recurring esophageal cancer, these drugs may be used alone or with chemotherapy. Not all patients are eligible; doctors run tests on the cancer cells to see if these medicines will help.

Examples of targeted treatments include drugs that block specific protein signals that fuel cancer growth. Doctors decide if targeted drugs are useful by checking for certain genetic or molecular features in each person’s cancer.

Immunity-Boosting Cancer Therapy

Doctors use immunotherapy to help the body’s own defense system (immune system) find and attack cancer cells. Cancer cells can “hide” from the immune system, but immunotherapy allows immune cells to see and destroy them.

Doctors may give immunotherapy before or after surgery, or use it when surgery isn’t possible due to advanced disease. They may also recommend it for cancers that have come back after finishing other treatments.

Not every person responds to immunotherapy in the same way. Some benefit greatly, while others do not. Side effects can include skin rashes, fatigue, and sometimes swelling or inflammation of organs.

Approaches to Manage Problems from Cancer

Esophageal cancer can sometimes block the passage where food travels, making it hard to swallow or eat. Doctors use several ways to manage these problems.

Methods to relieve a blocked esophagus:

Placing a stent (small metal tube) to keep the esophagus open
Using laser therapy or special light treatments (photodynamic therapy)
Small surgeries to remove or reduce the blockage
Radiation and chemotherapy to shrink the tumor and improve swallowing

When swallowing is very difficult, doctors may place a feeding tube into the stomach or small intestine. This tube provides liquid nutrition so the body gets what it needs to heal and be strong during treatment.

Comfort Care and Supportive Treatments

Palliative care teams focus on making patients as comfortable as possible, no matter the stage of cancer. This type of care is about improving quality of life, not just treating the disease.

A palliative care team might include doctors, nurses, counselors, and others. They help manage pain, trouble swallowing, fatigue, anxiety, or any other symptoms. These experts also support families and help people make decisions about care and treatment options.

Palliative care can be given at any time, even while curative treatments like surgery or chemotherapy are underway.

What Palliative Care Can Help With:

Easing pain.
Reducing nausea or other side effects.
Offering emotional or practical support.
Helping coordinate care among different specialists.

Complementary Approaches

Some people use complementary treatments to help with symptoms linked to esophageal cancer. These do not cure the disease but can offer relief alongside standard medical care.

Examples include:

Acupuncture
Massage
Relaxation exercises
Guided visualization
Hypnosis

Discuss any new therapies with a healthcare provider to make sure they are appropriate and safe.

Coping and Getting Support

Understanding Esophageal Cancer to Make Informed Choices

Learning about esophageal cancer can help people feel more in control. Understanding symptoms like trouble swallowing, weight loss, heartburn, cough, and dysphagia supports better decision-making.

People can talk to their healthcare team about treatments and test results. This helps them feel more confident about managing side effects like anemia, chest pain, or hoarseness.

Helpful questions for your medical team:

What treatments are available for my situation?
What side effects should I watch for?
How will my quality of life be affected?

Staying Connected With Loved Ones

Close friends and family can be a huge help during treatment for esophageal cancer.

Support can be practical, such as help with meals or rides to appointments, especially if a person is dealing with fatigue, pneumonia, or needs extra care at home.

Emotional support is important, too, when facing worries or stress. Regular contact with loved ones may help people feel less alone and more hopeful.

Seeking Someone Who Listens

Talking to someone who understands can make a difference. This could be a friend, a family member, or a professional like a counselor or a medical social worker.

Joining a support group, either in person or online, can offer comfort. Support groups allow sharing of experiences and learning from others who are coping with similar symptoms and challenges.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Being organized before seeing the doctor can help the appointment go smoothly. Consider the following tips:

Check for any instructions from your doctor. Some appointments may require you to avoid food or certain medicines in advance. Always ask if you need to follow special directions.
Write down all your symptoms, no matter how minor they seem. Some symptoms that appear unrelated could be important.
Keep a record of your medical background. Bring notes about your health history, especially past illnesses, current medical issues, medications, and supplements (include the name and dosage). Share information about risk factors like tobacco use, alcohol use, or problems with obesity. If you have a history of smoking, mention it because it can raise the risk for some types of cancer.
Note personal and family medical history. The doctor may ask about cancer, digestive diseases, or other conditions among your relatives. List major life changes or sources of stress as well.
Bring a support person. If possible, invite a family member or friend to go with you. They can listen, help remember what the doctor says, and offer emotional support.
Prepare a list of questions. Prioritize them so you cover the most important concerns first. Here are some examples:
- Where is the cancer located?
- Do you know how advanced it is?
- What do the test results mean?
- What treatment options are available?
- What side effects might occur?
- Would you suggest getting a second opinion?
- What steps should I take before my next visit?
Don’t hesitate to ask extra questions. If something is unclear, ask for more information.

Questions the Doctor Might Ask

During your appointment, the healthcare provider will likely ask for details about your symptoms and lifestyle. Being ready to respond can save time and help you get the care you need. Typical questions may include:

When did your symptoms start?
Do they come and go, or are they always present?
How severe is the discomfort or pain?
What makes the symptoms better or worse?
Have you ever used tobacco, or do you drink alcohol?
Is there any history of cancer or digestive issues in your family?
Have you noticed any recent weight changes?
Have you been exposed to other risk factors, such as obesity?

If you give complete and accurate answers, doctors can better understand your situation and recommend appropriate diagnosis, treatment, and follow-up.

Esophageal Cancer – Diagnosis and Treatment