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.
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Blood 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.
CT scan
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 and abdomen (belly).
Before a CT scan, you may be injected with dye and/or asked to drink a liquid dye. If you have an injection, a small, plastic tube (called a cannula) is inserted into a vein in your arm. This dye (called contrast) helps ensure that anything unusual in your body, like a tumour, 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. It usually takes 10–30 minutes to prepare the CT scan machine and insert the cannula, but the scan itself takes only a few minutes and is painless.
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.
PET–CT scan
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. A PET–CT scan can be used in staging oesophageal cancer, particularly in preparation for surgery.
To prepare for a PET–CT scan, you will be asked not to eat or drink (to fast) in the lead-up to having the scan. Your treatment team will talk to you about this. Before the scan, you will be injected with a glucose solution containing a small amount of short-acting radioactive material. Cancer cells usually show up brighter on the scan because they take up more glucose solution than normal cells do.
You will be asked to sit or lie 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 have claustrophobia, as you need to be in a confined space for the scan.
Laparoscopy
This procedure is a type of keyhole surgery. It 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 (called the peritoneum). Your doctor will explain the risks before asking you to agree to have 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 your abdomen. 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. Sometimes, the surgeon will wash some salt water (saline) into the peritoneal cavity and then remove the fluid for further testing for cancer cells. This is called a peritoneal lavage.
After the procedure you may feel bloated and the gas in your abdomen may cause pain in your shoulder.
Endoscopic resection
If you are diagnosed with very early cancer in the oesophagus, you may have an endoscopic resection, which aims to remove the whole tumour during the endoscopy.
For some people, the resection not only helps in diagnosis and staging, but also may treat 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.
For more information, see Endoscopic resection for oesophageal cancer.
Molecular testing
If you are diagnosed with advanced cancer in the oesophagus or 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.
→ READ MORE: Staging and prognosis for oesophageal cancer
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More resources
Prof David I Watson, Matthew Flinders Distinguished Professor of Surgery, Flinders University, and Senior Consultant Surgeon, Oesophago-Gastric Surgery Unit, Flinders Medical Centre, SA; Prof Bryan Burmeister, Senior Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD; Kieran Cahill, Consumer; Jessica Jong, Clinical Dietitian, Upper GI and Hepatobiliary Services, Peter MacCallum Cancer Centre, VIC; John Leung, Consumer; Prof Rajvinder Singh, Professor of Medicine, University of Adelaide, and Director, Gastroenterology Department and Head of Endoscopy, Lyell McEwin Hospital, SA; Dr Sarah Sutherland, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Paula Swannock, Upper GI Cancer Nurse Consultant, St Vincent’s Hospital Melbourne, VIC; Rebecca Yeoh, 13 11 20 Consultant, Cancer Council Queensland.
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