NCCN Guidelines for Patients
: Esophageal Cancer
Part 3: Preparing for treatment
An EUS uses both imaging and an endoscope to see how
far the tumor has grown into the esophageal wall. Also,
signs of cancer within lymph nodes and other nearby
organs can be detected. Like an upper GI endoscopy,
you will likely be sedated for EUS, but sometimes local
anesthesia is used. An endoscope fitted with an ultrasound
device will be guided down your esophagus. The ultrasound
device bounces sound waves off organs to make pictures.
If it looks like the cancer has spread, the endoscope can
be used to do an FNA (
spiration). An FNA is
a type of biopsy in which a needle is inserted through the
esophageal wall and into tissue, such as a lymph node, to
get a sample.
EMR used along with EUS can help show how far a tumor
has grown into the esophageal wall. However, EMR is more
often used as treatment of very small tumors as discussed
in Part 4. Briefly, your doctor can remove tumors and nearby
tissues with tools inserted through an endoscope.
If the tumor is at or above the carina, a bronchoscopy can
be used to see if the tumor has grown into your trachea or
bronchi. This test is much like an endoscopy except that
the scope is guided down your trachea. There are two
types of scopes used. A rigid bronchoscope is straight and
doesn’t bend. A flexible bronchoscope is thinner and longer.
General anesthesia is needed for a rigid bronchoscopy.
Local anesthesia is used for a flexible bronchoscopy.
Like endoscopes, bronchoscopes have a light, camera,
and open channel. The light and camera allow your doctor
to guide the tube down your nose or mouth and see inside
your body. A small brush, needle, or tongs can be inserted
into the open channel to collect samples. Or, liquid may be
sprayed into the airway and suctioned back up. After the
biopsy, you may feel some swelling and sound hoarse.
You may have a laparoscopy if the tumor is an
adenocarcinoma and formed at the esophagogastric
junction or below it. A laparoscopy may help find cancer
spread to distant sites that wasn’t found by imaging tests.
Laparoscopy is a surgery done under general anesthesia.
For this surgery, a very small cut will be made in your
abdomen. A thin, long tool called a laparoscope will be
inserted through the cut. A laparoscope works much like
an endoscope allowing your doctor to see the area and
take a biopsy if needed. After the surgery, you will have a
small scar and some short-term pain and swelling.
Biopsy of distant sites
Stage IV cancer is defined as cancer spread to sites not
in direct contact with the esophagus. If tests suggest
stage IV cancer, a biopsy of the distant site may be
needed to confirm cancer spread. The type of biopsy
used depends on the site and other factors. An FNA,
laparoscopy, or other methods may be used.