Oesophageal Cancer:
Diagnosis and Staging

This page covers tests that are often used to help diagnose and stage oesophageal cancer.
Depending on the symptoms you have, you may also be asked to undergo other tests and investigations.
Diagnostic Tests to Determine Cancer Type

Once the doctor is sure of an abnormality, the following tests are done to determine further details about the type of cancer present. 

These tests are used to supplement blood tests such as the complete blood count (CBC) and certain tumour marker tests.

Endoscopic Ultrasound

What to expect

An endoscopic ultrasound (EUS) is used to examine the lining of the oesophagus from the inside. During the procedure, your doctor will insert a thin, flexible tube into your mouth or rectum, in order to examine your oesophagus and surrounding structures for any tissues that could be cancerous. You can expect some minor pain or discomfort while undergoing the procedure. It is important that you choose a doctor and clinical team that you are comfortable with to perform your procedure.

Prior to the procedure, you will need to ensure that your stomach is empty. Any residue may obscure the view of the oesophagus during the exam. In order to ensure that the stomach is empty, your doctor may ask you to:

  • Refrain from taking solid foods the day before the procedure
  • Have clear liquids (such as plain water, black tea or black coffee or juices)
  • Stop taking food and liquids the night before the procedure
  • Take a laxative
  • Have an enema

It is important that you follow the instructions given by your doctor in order to ensure a successful procedure. Be sure to inform your doctor prior to the procedure if

  • You are pregnant or breastfeeding
  • You have previously had an allergic reaction to sedatives
  • You are taking any vitamins, supplements, ayurvedic medicines or homeopathic medicines

During an EUS

  • You may be asked remove your clothing (including undergarments) and change into a hospital gown. 
  • You may also be asked to empty your bladder.
  • You may be given a mild sedative or pain medication, either in a pill form or through an IV, to minimize discomfort during the procedure.
  • If the endoscope will be inserted through your mouth, you will be asked to lie on your back on the examination table.
  • If the endoscope will be inserted through your rectum, you will be asked to lie on your side on the examination table, usually with your knees drawn towards your chest.
  • Try to relax, as this will make the procedure more comfortable for you.
  • Next, the doctor will insert the endoscope into your mouth or rectum. The endoscope is a long, flexible tube. It has a small ultrasound device (called a transducer), which produces sound waves to create a precise image of your stomach and the surrounding tissue, including the lymph nodes in the chest.
  • The doctor will then move the endoscope through your throat into the stomach, or through your colon into the stomach. When the scope is moved, you may feel mild abdominal cramping. If the scope has been inserted through the rectum, you may have the urge to have a bowel movement.
  • If any abnormal areas are seen, your doctor may recommend that a biopsy be done.
  • The procedure will usually take 30 minutes to an hour to complete.
  • After the procedure, you may receive special instructions regarding the sedative. For example, your doctor may keep you under observation while you recover, to ensure that you do not have an allergic reaction. You may also be told to temporarily follow a special diet.
  • You may feel a cramping pain and experience light bleeding after the procedure. If you experience excessive bleeding or persistent abdominal pain, inform your doctor immediately.

Biopsy

What to expect

Biopsy involves the removal of a sample of oesophageal cells or tissues for laboratory testing and is the only definitive method to diagnose oesophageal cancer. It is a way to evaluate a suspicious area in your oesophagus to determine whether it is cancerous. 

Typically, biopsies will be done along with the endoscopic ultrasound (EUS). It is important that you choose a doctor and clinical team that you are comfortable with to perform your procedure.

The fine-needle aspiration (FNA) biopsy is generally used for oesophageal cancer. This is a quick, simple test in which a thin needle is used to remove tissue or fluid for examination under a microscope. 

For a few days after the biopsy, your throat and oesophageal area may feel sore and bruised. Don’t hesitate to talk to your clinical team about pain medication if you feel you might need it. The pain and bruising will generally subside in a couple of weeks. If it persists, please contact your doctor immediately.

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