NCCN Guidelines for Patients
Esophageal Cancer, Version 1.2016
Preparing for treatment
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 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.