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NCCN Guidelines for Patients


Esophageal Cancer, Version 1.2016


Preparing for treatment

Cancer tests

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 (







An FNA is a type of biopsy. A needle will be inserted

through the wall of your esophagus and into nearby

tissue to get samples. Samples may be obtained from

lymph nodes or organs next to your esophagus. An

FNA may be done as long as the needle doesn’t go

through the primary tumor or major blood vessels.

After the FNA, the endoscopist will provide clinical

staging information. He or she will report the depth of

tumor growth (T stage) and whether cancer is present

in your lymph nodes (N stage). This information will

help your doctor plan the best treatment for you.

Endoscopic resection

Endoscopic resection is the removal of tumors with

small tools inserted through an endoscope. It is used

by doctors to assess how deep the tumor has grown

into the esophageal wall. It is more accurate than EUS.

Endoscopic resection is essential for correctly staging

tumors that appear to be T1. However, it is more often

used as a treatment than as a staging tool. Read

Part 4 for more details.


The carina is supportive tissue at the base of your

windpipe (trachea). 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 airways

(bronchi). This test is much like an endoscopy except

that the scope is guided down your trachea.

Bronchoscopy is done with one of two types of

scopes. 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


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. Otherwise, liquid may be sprayed into the

airway and suctioned back up. After the biopsy, you

may feel some swelling and sound hoarse.


This test is a type of surgery that allows your doctor to

look for diseases inside your abdomen. Laparoscopy

is advised for a esophageal adenocarconoma that

is in the area between the esophagus and stomach.

This area is called the EGJ (






unction). Laparoscopy may detect distant metastases

in the lining of the abdomen (peritoneum) or liver.

Laparoscopy is done under general anesthesia. It

involves the use of a tool called a laparoscope, which

is much like an endoscope. The tube-like part of the

laparoscope will be inserted through a tiny cut in your

abdomen. Your doctor will be able to look for signs of

cancer and obtain fluid for cancer testing (peritoneal


Laparoscopy is done in an operating room and takes

about 30 minutes. You will be able to go home about

one hour after the procedure is completed and can go

back to work the next day. After the surgery, you may

feel tired and may have some pain. You may also

have a small scar after the cut has healed.

Biopsy of distant sites

An M1 score is defined as cancer spread to sites

distant from the esophagus. If imaging suggests

a rating of M1, a biopsy of the distant site may be

needed to confirm there's cancer. The type of biopsy

used depends on the site and other factors.