If you suspect you have esophageal cancer and you go to the hospital for the first time, what tests will your doctor give you? Do you really need all these tests? Is there an order of priority? These are questions that every patient wants to know.
In general, for patients with suspected esophageal cancer, when you first come to the hospital, your doctor will usually prescribe the following tests: blood tests, upper gastrointestinal barium angiography (commonly known as “barium meal”), electronic gastroscopy and pathology biopsy, which are all necessary for diagnosis. CT is also important in the diagnosis of esophageal cancer, but the decision to do it or not is usually based on the results of barium meal and gastroscopy.
There is no specific order for these tests to be done at the first visit, but in general, you can start with a blood test and barium meal depending on the queue; gastroscopy may need to be scheduled for another time depending on the hospital, so we recommend that you decide on a case-by-case basis and on the advice of your doctor.
What is the blood test for?
Blood tests include not only some routine tests (such as blood work, liver and kidney function, etc.), but also preparatory tests for certain tests. For example, infection screening, coagulation tests, etc., are tests that must be done before invasive tests such as gastroscopy.
What do you look for in an upper gastrointestinal barium angiogram?
An upper gastrointestinal barium study (barium meal) is a method to diagnose diseases of the upper gastrointestinal tract by having the subject swallow barium sulfate (contrast agent) and then passing the barium through the esophagus to the stomach and duodenum.
The barium meal is the preferred test for esophageal cancer, and can detect most early lesions, as well as confirm the diagnosis of mid- to late-stage esophageal cancer. It is a good indicator of mucosal lesions, ulcers, strictures, and tumor length, a dynamic view of the motion of the esophageal wall (e.g., functional abnormalities such as contraction, diastole, peristalsis), the relationship between the esophagus and surrounding tissues, and the presence of complications such as tracheoesophageal fistula and mediastinal infection.
Although gastroscopy has become popular, it is, after all, an invasive test. Therefore, barium meal still cannot be replaced, and it is especially suitable for screening or screening for esophageal cancer at all levels of hospitals.
If esophageal cancer is suspected, it is recommended that you first have a barium meal. You can rest assured that the barium meal test is non-invasive and that barium sulfate, which is insoluble in water and lipids, is not absorbed by the gastrointestinal mucosa and is essentially harmless to the body.
Barium meal examination also has some disadvantages, for example, it cannot visualize the image of the lesion like gastroscopy; it cannot observe small lesions in the mucosa or submucosa like CT. Especially for early lesions, barium meal can only play a suggestive role. To confirm the diagnosis, direct observation by gastroscopy or taking a pathological biopsy is still needed.
What does an eGastroscopy look for?
For patients with esophageal cancer-related symptoms, or for those who suspect but fail to diagnose esophageal cancer, doctors will recommend an early electrogastroscopy.
Electrogastroscopy helps detect early lesions by capturing image information from inside the esophagus through a miniature camera that is clearly displayed on the screen.
Gastroscopy is very visual compared to a “barium meal”. The most important thing is that the doctor can take a biopsy of the lesion directly through the gastroscope and do a pathological examination to confirm the diagnosis of esophageal cancer.
There are also special tests that can be performed with electronic gastroscopy, including endoscopic staining and ultrasound endoscopy. These are all things that the doctor can do in one visit during the gastroscopy.
Endoscopic staining: for lesions that are difficult to detect with the naked eye
Endoscopic staining is a procedure in which a dye is attached to a suspicious lesion by oral, spray, or direct injection to make the color of the lesion more visible in contrast to the normal mucosa, thus helping the physician identify the lesion and accurately biopsy it. This is especially important for lesions with diffuse roughness and unevenness of the esophageal mucosa that cannot be detected by visual observation alone.
Ultrasound endoscopy: scanning images in real time to assess whether surgery is possible
Ultrasound endoscopy combines endoscopy and ultrasound into one, using endoscopic ultrasound to scan in real time while directly observing mucosal lesions, obtaining histologic features of the structures of the gastrointestinal tract at all levels and ultrasound images of the surrounding adjacent organs.
It is useful for determining the level of esophageal cancer infiltration, the depth of outward extension, the presence of mediastinal and lymph node metastases, and for assessing whether surgery is possible.