Diagnosis

It is always recommended to never put off tests if cancer is suspected, or if the doctor is unsure of what is happening with you. Always do the tests as soon as possible for peace of mind, and for your better health. Remember, early diagnosis is crucial as it increases your chance of recovery as treatment is more effective. If your doctor does not refer you to further tests but you think that there is something wrong, don't be afraid to ask for further tests!

Diagnosis may involve one or all of the following procedures:

• Endoscopy

• Endoscopic ultrasound

• Barium swallow and barium meal

Endoscopy/Gastroscopy/Upper GI Endoscopy/Oesophagoscopy: Involves inserting a thin and flexible tube with a tiny camera through the throat to examine the upper GI tract. You can ask for a sedative or anaesthetic to feel comfortable during the procedure. If necessary, the doctor will remove some tissue (a biopsy) for further analysis. This is the most common type of test.

Endoscopic Ultrasound: Altough an edoscopic ultrasound is common for stomach issues, but can also be used for the oesophagus. A tube is feed down the throat with a tiny probe at the end of it. This emits high-frequency soundwaves, that echo when they bounce of the organs. Tissue samples may also be taken for further analysis. You will be sedated throughout this procedure, and you will need to fast for a certain amount of time.

Barium Swallow: This involves drinking a thick, chalky liquid (the barium), probably through a straw. Barium is detectable by x-rays, and coats your oesophagus and stomach, therefore outlining any tumours or irregularities. X-rays will then scan your oesophagus.

What Happens Next

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• Consultation with your doctor/specialist to discuss the results.

• Pre-cancerous cells may be detected, in which case your doctor will advice the best path of preventing the cancer through constant monitoring and possibly removing the pre-cancerous cells.

• Nothing may be detected. It is always a good idea to monitor the situation and have regular tests and make healthier lifestyle choices. 

• If a cancer has been detected, further tests are required to reveal the extent of the cancer, in order to choose the best form of treatment.

PET Scan: A higher-grade medical imaging test. You will need to drink a radioactive glucose solution, which works in a similar way to the barium swallow, in that the cancer cells will uptake the solution in about 30-90 minutes, so that the cancer's size, shape and location can be more exactly determined by the PET scan. The PET scan can take several hours overall to complete.

CT Scan: A stronger type of x-ray. You will need to drink or be injected with a special dye, which again works in a similar way to the PET scan glucose solution. It usually only takes about 10-30 minutes for this solution to spread, then the CT scan only takes a few minutes.

Ultrasound: An ultrasound may be taken of your oesophagus. Can take between 15-20 minutes.

Bone Scan: This is to determine if the cancer has spread to the bones. A small amount fo radioactive substance is injected, and after 2-3 hours a scan will be taken to see if there is any radioactivity in the bones.

Bronchoscopy: Similar to an endoscopy, except that the tube investigates the trachea to see if the cancer has spread there.

Keyhole Surgery: This may be done before surgery for treatment. This is done so that the doctors can diagnose the grade of cancer, see if the cancer has spread to the liver and to collect a small tissue sample for a biopsy.

Grading:The cancer will then be assigned a grade, depending on where it is located, and the type of cells.

T - Refers to a tumour.

N - Refers to spread to lymph nodes.

M - Refers to metastasis (how far cancer has spread).

Low grade cells: grow slowly.

High grade cells: look abnormal and grows quickly.

Treatment will then be discussed between you and your doctor.

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