If you have symptoms that could be a sign of oesophageal (gullet) cancer, see your GP as soon as possible.
Your GP will ask about your symptoms, including what they are, when you get them, and whether anything you do makes them feel better or worse. They will then carry out a physical examination. This may include a blood test, which will assess your overall health.
If your GP suspects you may have oesophageal cancer, they will refer you to a specialist for investigations.
Due to the potentially serious nature of oesophageal cancer you should be referred to the specialist within two weeks.
The main tests used to diagnose oesophageal cancer are outlined below.
The two most common tests used to diagnose oesophageal cancer are:
- an oesophagoscopy – a type of endoscopy
- a barium swallow – a type of X-ray
These are described in more detail below.
This is one of the first tests you will have to help confirm a diagnosis of cancer of the oesophagus.
Endoscopy is a medical procedure that allows doctors to see inside the body. During this procedure a thin, flexible instrument called an endoscope is passed through your mouth and down towards your stomach.
The endoscope has a light attached to the end and feeds back the images of your oesophagus to a monitor. This will allow your doctor to look for any signs of abnormal cells or tumours.
A barium meal X-ray or barium swallow uses a liquid containing a substance called barium, which makes your oesophagus and stomach show up on an X-ray. Nowadays, however, it's less commonly used to diagnose oesophageal cancer.
If the initial tests confirm a diagnosis of oesophageal cancer, further tests may be needed to see where the cancer is and if it has spread. These tests may include:
- a computerised tomography (CT) scan
- a positron emission tomography (PET) scan
- an endoscopic ultrasound
- a laparoscopy to take a sample of cells (biopsy)
These are described in more detail below.
A CT scan takes a series of X-ray images of your body and uses a computer to put them together. This then creates a very detailed picture of the inside of your body.
This will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours in any other places within the body. A CT scan will also allow your doctors to work out which type of treatment will be most effective and appropriate for you.
A positive emission tomography (PET) scan can produce a detailed, three-dimensional picture of the inside of the body. During a PET scan a substance known as a radiotracer is passed into your body. A radiotracer is a radioactive chemical that releases tiny particles called positrons.
A PET scan may be used to find out whether the cancer has spread. It may also be used for follow-up examinations after treatment to check for any remaining cancer cells or response to treatment.
nce cancer of the oesophagus has been diagnosed your doctor will need to assess how far the cancer has spread and how large the tumour has grown.
An endoscopic ultrasound will help your doctors assess how far your oesophageal cancer has progressed. It involves having a very small ultrasound probe passed into your oesophagus using an endoscope. This test produces sound waves that can penetrate the surrounding tissues.
These waves are then used to produce an image of your oesophagus so your doctor can see if the cancer has spread to the surrounding tissue or lymph nodes.
Your specialist may need to examine your stomach in more detail to see if the cancer has spread, especially to the lining of the abdominal cavity (peritoneum).
This procedure is carried out under a general anaesthetic, so you will be asleep.
Your specialist will insert a thin viewing tube with a camera on the end (a laparoscope) into your stomach through a small cut (incision) in the lower part of your tummy. In some cases, your specialist may need to examine more than one area of your stomach and may need to make more than one incision.
Sometimes biopsies are taken to examine specific areas such as the peritoneum, liver or diaphragm.
After all of the tests have been completed and your test results are known, it should be possible to tell what stage and grade of oesophageal cancer you have.
Staging is a measurement of how far cancer has spread. There are a number of different ways oesophageal cancer can be staged. One method uses a numbering system from one to four. The higher the number, the further the cancer has advanced.
Some doctors may prefer to describe the stages of cancer using the more complex TNM staging system. The three categories are used to create a more detailed classification:
- T (tumour) – the location and size of the tumour
- N (nodes) – whether the cancer has spread to the lymph nodes
- M (metastatic) – whether the cancer has spread to other parts of the body such as the lungs, liver or bone
Cancer Research UK has more information about the staging and grading of oesophageal cancer.