Screening for Esophageal Cancer

Executive Summary

Screening is used to check for Esophageal cancer occurrence before having any signs or symptoms. Screening for cancer occurrence aims to lower the number of people who may develop the disease and those who die due to the condition or eliminate deaths from cancer. People with Barrett’s esophagus are advised to have endoscopic examinations regularly. Biopsies may be taken to remove a small tissue area through a microscope during these examinations. It helps find cancer early or find modifications that could become cancerous over time.

Screening for Esophageal Cancer

Screening is used to check for cancer before having any signs or symptoms. Scientists have created and continue to develop tests that can screen a person for certain types of cancer before symptoms or signs appear. The goals of cancer screening are to:

• Lower the number of people who may develop the disease
• Lower the number of people who die due to the disease or eliminate deaths from cancer altogether

Regular screening tests to find esophageal cancer in people without symptoms are not used in the United States. People with Barrett’s esophagus are advised to have endoscopic examinations regularly ^​1​. An endoscopic examination uses a lighted, flexible tube to look inside the esophagus. Biopsies may be taken to remove a small tissue area for examination through a microscope during these examinations ^​2​. This type of screening can help find cancer early or find modifications that could become cancerous over time.

• Tests are used to screen for different types of cancer when a person does not have symptoms.
• There is no standard or routine screening test for esophageal cancer.
  • Esophagoscopy
  • Biopsy
  • Brush cytology
  • Balloon cytology
  • Chromoendoscopy
  • Fluorescence spectroscopy
• Screening tests for esophageal cancer are being studied in clinical trials.

Tests are used to screen for different types of cancer when a person does not have symptoms.

Scientists study screening tests to find those with the fewest harms and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) helps a person live longer or decreases a person’s chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.

There is no standard or routine screening test for esophageal cancer.

Although there are no standard or routine screening tests for esophageal cancer, the following tests are being used or studied to screen for it:

Esophagoscopy

A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Biopsy

The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Taking biopsy samples from several different areas in the lining of the lower part of the esophagus may detect early Barrett esophagus. This procedure may be used for patients who have risk factors for Barrett esophagus.

Brush cytology

A procedure in which cells are brushed from the lining of the esophagus and viewed under a microscope to see if they are abnormal. This may be done during an esophagoscopy.

Balloon cytology

A procedure in which cells are collected from the lining of the esophagus using a deflated balloon that is swallowed by the patient. The balloon is then inflated and pulled out of the esophagus. Esophageal cells on the balloon are viewed under a microscope to see if they are abnormal.

Chromoendoscopy

A procedure in which a dye is sprayed onto the lining of the esophagus during esophagoscopy. Increased staining of certain areas of the lining may be a sign of early Barrett esophagus.

Fluorescence spectroscopy

A procedure that uses a special light to view tissue in the lining of the esophagus. The light probe is passed through an endoscope and shines on the lining of the esophagus. The light given off by the cells lining the esophagus is then measured. Malignant tissue gives off less light than normal tissue.

Screening tests for esophageal cancer are being studied in clinical trials.

Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Risks of Esophageal Cancer Screening

• Screening tests have risks.
• The risks of esophageal cancer screening tests include the following:
  • Finding esophageal cancer may not improve health or help a person live longer.
  • False-negative test results can occur.
  • False-positive test results can occur.
  • Side effects may be caused by the test itself.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of esophageal cancer screening tests include the following:

Finding esophageal cancer may not improve health or help a person live longer.

Screening may not improve your health or help you live longer if you have advanced esophageal cancer or if it has already spread to other places in your body.

Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. It is not known if treatment of these cancers will help you live longer than if no treatment were given, and treatments for cancer may have serious side effects.

False-negative test results can occur.

Screening test results may appear to be normal even though esophageal cancer is present. A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn’t) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks.

Side effects may be caused by the test itself.

There are rare but serious side effects that may occur with esophagoscopy and biopsy. These include the following:

• A small hole (puncture) in the esophagus.
• Problems with breathing.
• Heart attack.
• Passage of food, water, stomach acid or vomit into the airway.
• Severe bleeding that may need to be treated in a hospital.

References