Tests
A number of different tests can be performed to assess people
who might have oesophageal cancer, to make the diagnosis and to
make further assessments to plan treatment. Our cancer care is
provided as part of a regional network. Patients may therefore have
different tests in different hospitals. For example, a patient may
have an upper GI endosocpy in Weston, a PET-CT scan at Southmead
Hospital in Bristol, and an EUS in the Bristol Royal Infirmary. As
far as possible, we will minimise the number of trips and travel
distances required. However, we also need to make sure we gather
the correct information from the different tests available to make
the right treatment decision for each patient.
Upper GI endoscopy
The first test for people with difficulty swallowing or problems
with heartburn is usually an upper GI endoscopy (often referred to
as an OGD). This is a common procedure involving the insertion of a
thin tube with a camera on the end through the mouth into the
oesophagus, stomach and first part of the small bowel called the
duodenum. This test is important to look for oesophageal cancer as
well as a range of other problems such as acid damage or
non-cancerous narrowing of the oesophagus. It is a routine
procedure, but as with any test there are benefits and risks, even
though the risks are very low. More information on this procedure,
its benefits and risks are available
here.
Computed Tomography (CT)
A CT scan is usually the first of a series of specific tests
that are done to assess the cancer itself and look for any spread
to glands or lymph nodes, and other organs around the body. Having
a CT scan involves lying down on a narrow bed which moves through
an open ring, like a big doughnut. The scan itself usually takes a
few minutes. It involves exposure to x-rays, a form of ionising
radiation. Doctors always minimise the amount of radiation to which
patients are exposed. For people with oesophageal cancer, the
benefits of this test and the information it provides to plan
treatment outweigh its risks.
Positron Emission Tomography (PET)-CT
This is a special type of CT. It is another way of looking for
spread of cancer to glands or lymph nodes and to other organs. It
involves a special injection of a radioactive, sugar-based dye
which is combined with a CT scan. The dose of this radioactive dye
is very low. The test is very similar to having a normal CT, as
described above.
Endoscopic Ultrasound (EUS)
This test is similar to having a standard upper GI endoscopy, as
described above, but involves using a slightly different endoscope
that has a small ultrasound device at the end of the tube. This
procedure is done with a combination of injections (a painkiller
and a sedative medication) to help the person relax and allow a
careful examination to be performed. The procedure is designed to
gain more information about the cancer itself, and it also allows a
close look at the glands or lymph nodes near the cancer. If needed,
small samples of these nodes can be taken to try and determine if
they are affected by spread of cancer.
Staging laparoscopy
This procedure may be performed in selected cases of oesophageal
cancer, although it is not necessary for everybody. It is a small
operation that is done under a general anaesthetic, using key-hole
surgery to have a look inside the tummy or abdomen. It usually
requires 3 small incisions. It is performed to look for any
evidence of spread of the cancer within the space around the
different organs in the abdomen. During the operation, a sample of
fluid is often taken to help look for cells that have spread that
can only be seen with a microscope, and any abnormal areas that are
seen may also be sampled or biopsied. These samples have to be sent
off to a laboratory to be examined, which takes 1-2 weeks, so the
result is not available straight after the operation. Most people
go home the same day. As with any operation, there are some risks
which your doctor will explain to you.
Other tests
Occasionally, other tests are required. These may be required to
look at specific areas identified by the above tests. For example,
the scans may detect an abnormal area on the lower bowel. This may
then mean that a telescope examination of the lower bowel is
required to know exactly what is going on at the abnormal area. In
addition, tests may be required to help assess fitness for
treatments. These include tests to examine how well the heart or
lungs are working, to know if a person is fit enough to have major
surgery. Your doctor will explain any additional tests and why they
may be needed.
