Diagnosis

Mostly the oesophagus tumour is discovered because patients complain about the feeling that the food gets stuck during several seconds, weight loss, pain behind the sternum or pain when swallowing. In some cases the tumour is discovered by chance, and sometimes the discovery is made by in the a screening program for people with changes in the oesophagus caused by reflux Barrett’s oesophagus.

The following investigations are aimed to determining if the tumour is benign of malign. Also it is important to define the stage of the tumour in order to determine which treatment is best. In other words, these investigations will investigate if there is ingrowth into other organs or if there are metastases to other organs yet.

Here you can find information about the different investigations.

Gastroscopy

gastroscopie-2During a gastroscopy a thin, flexible tube is brought, via the mouth, into the oesophagus and stomach. The doctor is able to look through this tube with a video camera on the inside of the oesophagus and stomach. Doing so, disorders of the mucosa and tumours can be found. Also biopsies, taking tissue samples for examination under a microscope, can be taken to determine if there is cancer.

A gastroscopy is not painful and takes about 15 minutes. The patient can ask to be slightly sedated, in order to experience less of the investigation.

Endo-ultrasonography

During this investigation, just like gastroscopy, a flexible tube is brought into the oesophagus and stomach via the mouth. In the tip of this tube there is a small ultrasonography device with which it is possible to view through the wall of the oesophagus. This makes it possible to investigate whether the tumour grows through the wall of the oesophagus, and if it growths in or against surrounding organs. Also it is possible to investigate the lymph nodes around the oesophagus. If these are enlarged this can indicate a metastasis. It is possible to sample tissue surrounding the oesophagus for tissue investigation, guided by the ultrasonography.

An internal ultrasonography is not painful and takes about 15 minutes. The patient can ask to be slightly sedated, in order to experience less of the investigation.

Ultrasonography

Ultrasonography

Ultrasonography

Ultrasonography is an investigation that uses sound waves. It is not possible to hear these sound waves for human ears. The reflection of these sound waves by organs makes it possible to visualise these organs a screen.

For this investigation, first it is necessary to apply gel on the skin. Then a small device that makes and receives the sound waves is placed on the skin. This investigation is not painful. It may be necessary to fast before this investigation.

With ultrasonography the oesophagus itself cannot be investigated. It is used to determine if there are metastases in cervical lymph nodes. If a lymph node looks suspect, a small needle can be used to sample some cells in this lymph node (cytological puncture). These cells can be examined under a microscope. Sometimes ultrasonography is also used to examine the abdominal organs, such as the liver.

CT-scan

CT-scan

CT-scan

A CT-scan (computed tomography-scan) is made to determine if the tumour has metastasized to other organs, and if it growths into neighbouring organs. With x-rays cross-sectional photos of the body are made. With this investigation the location, size, and extend of the oesophageal tumour can be determined. Also possible metastases in other organs, such as the liver, lungs and lymph nodes, can be investigated.

During this investigation the patient lies on the table that moves slowly through the CT-scan. The investigation is not painful. In order to obtain good photos, it is necessary to use contrast fluid. This contrast fluid is infused through a tube in a vein in the arm. In some people this causes nausea. Some hours before the investigation the patient is asked to drink contrast so the intestines can be visualised better.

PET-scan

PET-scan

PET-scan

In some cases, mostly when other investigations are inconclusive, a PET-scan (positron emission tomography) can be performed. The advantage of this investigation is that the whole body is visualised. It makes use of a little bit of radio-active sugar, which is administered intravenously. Cancer cells use a lot of sugar. With a PET-scan tissues that use a lot of sugar can be visualised. After administration the sugar has to spread through the body, which takes about an hour. Then it can be visualised with the PET-scan. The radioactive sugar goes without adverse effects, and is harmless. Taking the photos is not painful. The patient is not allowed to eat for some time prior to the investigation.

Tissue examination

Microscope

Microscope

The tissue samples that have been taken during the gastroscopy or through cytological punctures are examined under a microscope. This can determine if it concerns cancer, or cells that might become cancer. After an operation for oesophageal cancer the resected tissue is examined carefully. Then the goal is to determine if the whole tumour has been taken out, and if there are lymph node metastases.

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