Esophageal Cancer Diagnosis

Early cancers of the esophagus have no symptoms and there are no tests that can be used to screen for esophageal cancer. The presence of symptoms usually indicates that the cancer is at an advanced stage when a cure will be unlikely. Difficulty swallowing is the most common symptom, which is noticed when the diameter of the esophagus has been narrowed substantially.

Both adenocarcinomas and squamous carcinomas occur, but the relative frequency of adenocarcinomas has been rapidly increasing, possibly related to gastric reflux disease. Squamous cell carcinoma tends to occur more frequently in the upper esophagus, whereas adenocarcinoma generally occurs at the gastroesophageal junction secondary to Barrett’s esophagus.

For diagnosis of esophageal cancer, endoscopy with biopsy is usually indicated and endoscopic ultrasound is then used to assess depth of tumor invasion. PET/CT is useful in evaluating for local invasion by the primary tumor, and staging of metastatic disease.

PET/CT is a very useful tool for staging the presence or absence of systemic metastases of esophageal carcinoma.