Symptoms, Risk and Diagnosis of Esophageal Cancer

Esophageal cancer affects the squamous cells or mucous-secreting cells of the lining of the esophagus, the muscular tube that carries food from the mouth to the stomach. There are also cell changes considered to be pre-cancerous that must be watched or treated to prevent cancer. Barrett’s Esophagus is one such condition that can raise your esophageal cancer risk.

At Siteman, our goal is to correctly diagnose your condition and determine if treatment is needed. Some precancerous conditions may initially be handled with active surveillance, which involves careful monitoring instead of jumping right into treatment. Washington University Physicians at Siteman have lifetimes of experience and use advanced technology to make an accurate diagnosis. They are even able to identify key components of your genetic makeup and tailor treatment specifically to your needs.

Symptoms of esophageal cancer

  • Weight loss
  • Painful or difficult swallowing
  • Pain behind the breastbone
  • Hoarseness and cough
  • Indigestion and heartburn
  • Anemia
  • Upper GI bleed or vomiting blood

If you’re experiencing any of these symptoms, it doesn’t mean that you have esophageal cancer. All of these symptoms can be caused by other health problems. Still, it’s important to speak with your provider about any symptoms that last longer than two weeks. It could very well be nothing, but it’s best to know for sure what’s going on in your body so that you can get whatever care you may need.

Risk factors

  • Older age
  • Being male
  • Being African-American
  • Tobacco use
  • Heavy alcohol use
  • Having chronic acid reflux disease (GERD)
  • Obesity
  • Having Barrett’s Esophagus


Determining the exact type and stage of esophageal cancer often takes more than one approach. Your doctor may use one or more of the following tests to make a diagnosis:

  1. Physical exam and history: Your doctor will ask about your past illnesses and treatments. They will also look for any signs of disease, such as lumps, a history of gastric reflux or anything else that seems unusual.
  2. Chest X-ray with barium swallow (often called an upper GI series): This exam can show abnormalities in the esophagus and stomach.
  3. Esophagoscopy: This exam involves inserting an esophagoscope through the mouth or nose and down the throat into the esophagus to look for abnormal areas. This thin, tube-like instrument has a light and a lens for viewing. It can also accommodate a tool for biopsy.

Staging of esophageal cancer

Esophageal cancer is staged 0 through 4 and recurrent, meaning the cancer comes back after treatment. Staging also includes the grade of the cancer (1-3) because grade reflects how aggressive the tumor cells are and how quickly they are likely to spread. Because stage is an important factor in treatment options, additional testing to determine stage may include:

  1. CT scan with or without contrast dye: Your doctor will take detailed pictures of your organs to determine how deep the cancer is within the esophagus or if it has grown outside the esophagus.
  2. PET scan: Your doctor will inject a small amount of radioactive glucose (sugar) into a vein. The PET scanner makes a picture of where glucose is being used in the body. Cancer cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time (PET-CT).
  3. Endoscopic ultrasound (EUS): Your doctor will insert a thin tube (endoscope) into the esophagus through your mouth. A probe at the end of the endoscope bounces high-energy sound waves (ultrasound) off internal tissues or organs and makes echoes, forming a picture of body tissues.
  4. MRI: Some patients may benefit from magnetic resonance imaging, which uses magnets and radio waves instead of radiation to take detailed pictures of an area of the body.
  5. Bronchoscopy: In certain cases, a doctor will insert a thin, tube-like instrument with a light and a lens for viewing through the nose or mouth. It can also accommodate a tool for biopsy.


Chances of recovery and treatment options depend on the following:

  • The stage of the cancer and where it may have spread
  • The size of the tumor
  • The patient’s overall health

Finding esophageal cancer early gives you the best possible chances for a positive outcome. However, it is often in an advanced stage when diagnosed. Curing esophageal cancer is rare, but treatment is possible. Clinical trials are a great option for getting the latest treatment. Speak with your doctor to see if you’re eligible for a clinical trial.