Staging and Detection Tests
Once a cancer has been diagnosed, it is very important for doctors to find out where the cancer may have spread (the “stage” of the cancer) to determine the best possible treatment plan for you. To find out, doctors use staging tests, which include:
- Different types of scans
- Different ways to take tissue samples to look for tumor cells microscopically (biopsy tests)
Scans and other tests may also be used:
- In a “surveillance program” looking for any signs of relapse after treatment
- In a “screening program” to detect cancer early in individuals at high-risk
- To monitor responses to treatment
Tests that may be used include:
Chest X-ray – An X-ray of the organs and bones inside the chest.
Barium swallow – The patient swallows barium liquid and it flows through the esophagus and into the stomach. X-rays are taken to look for abnormal areas.
Esophagoscopy – A thin, lighted tube is inserted through the mouth and into the esophagus to look for and biopsy abnormal areas.
Biopsy – The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
Types of scans and procedures include:
Bronchoscopy – A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
CT scan (computed tomography) – An X-ray procedure that creates detailed, highly accurate cross-sectional body images.
PET scan (positron emission tomography) – An imaging test used to light up cancer in different parts of the body. You get an injection of a short-lived radioactive substance before having the scan. Cancerous tissue will build up more of the substance and appear brighter than normal tissue on the PET images. Other non-cancerous tissues, such as areas of inflammation, can also sometimes “light up.”
Diagnostic Laparoscopy – A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen. Then a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to take tissue samples for biopsy or place a small tube in the intestines to help with nutrition later in the course of therapy or treatments.
Endoscopic ultrasound (EUS) – A procedure in which a thin, lighted tube, called an endoscope, is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes, which form a picture of body tissues called a sonogram.
Laryngoscopy – A procedure in which the doctor examines the larynx (voice box) with a mirror or with a laryngoscope (a thin, lighted tube).
Thoracoscopy – A surgical procedure similar to laparoscopy and performed to look at the organs inside the chest to check for abnormal areas.
Treatments & Therapies
Radiation Therapy (“Radiotherapy”):
Radiation therapy involves using X-rays and other types of medical radiation aimed at specific parts of the body to:
- Kill cancer cells
- Prevent cancer cells from developing or recurring
- Improve many of the symptoms caused by cancer
Radiation therapy can be:
- Used before surgery to make the operation easier (this is called “neoadjuvant” treatment)
- Used after surgery to reduce the chances of the cancer coming back (this is called “adjuvant treatment”)
- Almost as effective as surgery in people who are not fit enough for an operation
- Better than surgery when used together with chemotherapy for certain cancers (this is called “chemo-radiotherapy”)
Chemotherapy and other drug-based treatments:
Anti-cancer drug treatments: Chemotherapy-and new “targeted therapies”-involve using drugs that kill, slow down or damage cancer cells. Many new drugs are being developed. View current esophagus cancer clinical trials available at UCCC.
Anti-cancer drug treatments may involve:
- Single drugs or combinations of drugs
- Intravenous injections or tablets/capsules
- Taking the drugs in repeating patterns, called “cycles”, that usually last three to four weeks
- Taking some drugs every day or only on a few days within the cycles
- Taking other medicines to reduce or eliminate side effects associated with chemotherapy
- Taking targeted therapies, often with very little side effects, on their own or in combination with standard chemotherapy
- Access to new drugs or vaccines on their own, or added into standard treatments, in clinical trials
Chemotherapy and targeted therapies can:
- Be given before surgery to make the operation easier
- Be given in combination with radiotherapy to make both treatments more effective
- Be given after surgery to reduce the chances of cancer coming back
- Successfully control advanced cancer and many cancer-related symptoms
Surgery
Usually esophagus cancers respond very well to chemotherapy and radiation. Some cancers, however, can recur or persist. In this setting surgery becomes important for removing all the disease. A surgical oncologist-a doctor who specializes in cancer operations-will perform the operation.
Local excision – If the cancer is found at a very early stage, it can be removed without cutting into the abdomen.
Abdominoperineal resection – A procedure in which the anus, the rectum and part of the sigmoid colon are removed through an incision made in the abdomen. The doctor sews the end of the intestine to an opening made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. Lymph nodes that contain cancer may also be removed during this operation.
Esophagus cancer surgery with colostomy – The anus, rectum and part of the colon are removed, a stoma is created, and a colostomy bag is attached.
Groin dissection – If after chemotherapy or radiation, cancer is found in the lymph nodes of the groin, the cancerous lymph nodes are surgically removed.
Clinical Trials
The goal of clinical research is to improve treatment outcomes and reduce treatment side effects or long-term toxicities. Clinical trials provide the latest treatments because they evaluate:
- New drugs
- New combinations of therapies
- New treatment delivery methods
Because we’re the Rocky Mountain region's only National Cancer Institute (NCI)-designated Comprehensive Cancer Center – one of only 39 in the United States – your treatment will always include the latest and most comprehensive care options.
Learn more about clinical trials at UCCC.
Other types of treatments being tested in clinical trials include:
Radiosensitizers – Drugs that make tumor cells more sensitive to radiation therapy.