Further tests for oesophageal cancer
If the biopsy shows you have oesophageal cancer, you will have some of the following tests to work out whether the cancer has spread to other areas of your body. This is called staging. Some of the tests may be repeated during or after treatment to check your health and see how well the treatment is working.
Learn more about these further tests:
You may have blood tests to assess your general health, check for a low red blood cell count (anaemia), and see how well your liver and kidneys are working. Blood tests can also help show if you are getting enough vitamins or minerals.
A computerised tomography (CT) scan uses x-ray beams to create detailed, cross-sectional pictures of the inside of your body. It helps show the size of the cancer and if it has spread. You may have a CT scan of your chest, abdomen and pelvis for stomach cancer.
Before a CT scan, you may have an injection of dye and/or be asked to drink a liquid dye. If you have an injection, a cannula is inserted into a vein on your arm.
This dye, known as contrast, helps ensure that anything unusual can be seen more clearly. The dye may cause a warm feeling throughout your body, and leave a metallic taste in your mouth for a few minutes. Rarely, more serious reactions may occur.
The CT scan machine is large and round like a doughnut. You will need to lie still on a table while the scanner moves around you. The scan itself is painless and takes only a few minutes, but it usually takes 10–30 minutes for the sonographer to prepare the CT machine and insert the cannula.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have or kidney disease or are pregnant or breastfeeding.
A positron emission tomography (PET) scan combined with a CT scan is a specialised imaging test. The CT scan helps pinpoint the location of any abnormalities found by the PET scan. As a PET–CT scan is not useful in finding some types of stomach cancers, Medicare does not currently cover the cost of this test.
To prepare for a PET–CT scan, you will be asked not to eat or drink (fast) for a period of time. Before the scan, you will be injected with a glucose solution containing a small amount of radioactive material. Cancer cells show up brighter on the scan because they take up more glucose solution than normal cells do.
You will be asked to sit quietly for 30–90 minutes as the glucose spreads through your body, then you will be scanned. The scan itself takes about 30 minutes. Let your doctor know if you are claustrophobic, as you need to be in a confined space for the scan.
This procedure allows your doctor to look for signs that the cancer has spread to the outer layer of the stomach and the lining of the wall of the abdomen, which are known as the peritoneum. A laparoscopy is used to stage stomach cancer. Your doctor will explain the risks before asking you to agree to the procedure.
A laparoscopy is usually done as day surgery under general anaesthetic. The doctor will make small cuts in your abdomen and pump in gas to inflate it. A tube with a light and camera attached (a laparoscope) will then be inserted into your body.
The camera projects images onto a monitor so the doctor can see cancers that are too small to be seen on CT or PET–CT scans. The doctor may take more tissue samples for biopsy. After the procedure you may feel bloated and the gas in your abdomen may cause pain in your shoulder.
If you are diagnosed with very early cancer in the oesophagus, you may have an endoscopic resection.
This procedure may help your doctor work out whether the cancer has spread to the lymph nodes. For some people, the resection also treats the cancer and further treatment is not needed. An endoscopic resection is often done as a day procedure but in some cases, you may stay in hospital overnight for observation.
If you are diagnosed with advanced cancer in the gastro-oesophageal junction, your doctor may test the biopsy sample to see whether one of the available targeted therapy or immunotherapy drugs would be suitable for you.
The test will look for particular features within the cancer, such as changes to the HER2 protein, a special protein known as PD-L1, or a marker called microsatellite instability (MSI). This type of testing is known as molecular testing
For more on this, see Immunotherapy for oesophageal cancer.
For an overview of what to expect during all stages of your care for oesophageal cancer, visit Cancer Care Guides: Oeophagogastric cancer. This is a short guide to what is recommended, from diagnosis to treatment and beyond.
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Dr Spiro Raftopoulos, Gastroenterologist, Sir Charles Gairdner Hospital, WA; Peter Blyth, Consumer; Jeff Bull, Upper Gastrointestinal Cancer Nurse Consultant, Cancer Services, Southern Adelaide Local Health Network, SA; Mick Daws, Consumer; Dr Steven Leibman, Upper Gastrointestinal Surgeon, Royal North Shore Hospital, NSW; Prof Michael Michael, Medical Oncologist, Lower and Upper Gastrointestinal Oncology Service, and Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Royal Brisbane Hospital, QLD; Rose Rocca, Senior Clinical Dietitian: Upper Gastrointestinal, Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, VIC; Letchemi Valautha, Consumer; Lesley Woods, 13 11 20 Consultant, Cancer Council WA.
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