Esophageal Cancer: Diagnostic Tests

Mandatory medical device diagnostics.

  • Esophago-gastro-duodenoscopy (EGD; endoscopy of esophagus, stomach, and duodenum) with biopsies (specimen collection) from all suspicious lesions; in Barrett’s esophagus, additional 4-quadrant biopsies [gold standard]Indications: New-onset dysphagia (dysphagia), gastrointestinal hemorrhage (gastrointestinal bleeding), weight loss, recurrent aspiration (entry of liquid or solid substances into the airway), recurrent vomiting, dyspepsia(irritable stomach), and/or inappetence (loss of appetite). Note on diagnostics: tumor foci or precancerous lesions can be detected much more reliably if the mucosa is stained before the examination (staining spray chromoendoscopy) or the color spectrum used is digitally altered in the context of a virtual chromoendoscopy [see below guideline].
  • Endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought directly into contact with the inner surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument)) of the esophagus (esophagus) – for staging’Note: accuracy esp. of a higher T category and local N staging has been increased to grade Ib [S3 guideline].
  • Endosonography of the mediastinum / stomach + fine needle aspiration (FNP), optional; in patients with curative therapy intention.
  • Computed tomography of the thorax/chest (thoracic CT) – for staging.
  • Computed tomography (CT) of the abdomen (abdominal CT) – for staging.
  • Magnetic resonance imaging (MRI of the thorax/abdomen – for staging (in contraindications for CT).
  • Abdominal ultrasonography (ultrasound examination of the abdominal organs) incl. liver – exclusion of metastases (daughter tumors).
  • B-scan ultrasonography of the neck – complementary to the exclusion of cervical lymph node metastases for staging.

Optional medical device diagnostics – depending on the results of the history, physical examination and mandatory laboratory parameters – for differential diagnosis.

  • Bronchoscopy (lung endoscopy), flexible – for locally advanced tumors with contact with the tracheobronchial system.
  • Skeletal scintigraphy (nuclear medicine procedure that can show functional changes in the skeletal system, in which regionally (locally) pathologically (pathologically) increased or decreased bone remodeling processes are present) – in suspected bone metastases.
  • If necessary, positron emission tomography (PET) /PET-CT (combined nuclear medicine (PET) and radiological (CT) imaging procedure in which the distribution pattern of radioactive substances (tracers) can be very precisely localized with the help of cross-sectional imaging) – in cT2-4 cN+.

Further notes

  • Positron emission tomography (PET; nuclear medicine imaging technique used to produce cross-sectional images of living organisms by visualizing the distribution patterns of weak radioactive substances) – To distinguish between treatment responders and nonresponders after the first few cycles of neoadjuvant (radio)chemotherapy.