eMedicine Specialties > Oncology > Carcinomas of the Gastrointestinal Tract

Esophageal Cancer: Differential Diagnoses & Workup

Author: Piero Marco Fisichella, MD, Assistant Professor of Surgery, Stritch School of Medicine, Loyola University; Director, Esophageal Motility Center, Loyola University Medical Center
Coauthor(s): Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Contributor Information and Disclosures

Updated: Oct 24, 2009

Differential Diagnoses

Achalasia
Esophageal Stricture
Gastric Cancer

Other Problems to Be Considered

Peptic strictures due to reflux
Benign esophageal tumors

Workup

Laboratory Studies

  • Complete blood cell count may demonstrate anemia secondary to iron deficiency or chronic disease.
  • Findings from a chemistry 18 panel may demonstrate liver function abnormalities due to ingestion of alcohol or may reflect hepatic metastases. Patients with squamous cell carcinomas may demonstrate hypercalcemia.
  • Prothrombin time and activated partial thromboplastin time coagulation study findings may demonstrate hepatic insufficiency or nutritional deficiencies and are part of preoperative screening.

Imaging Studies


Barium swallow demonstrating stricture due to can...

Barium swallow demonstrating stricture due to cancer.

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Barium swallow demonstrating stricture due to can...

Barium swallow demonstrating stricture due to cancer.


Barium swallow demonstrating an endoluminal mass ...

Barium swallow demonstrating an endoluminal mass in the mid esophagus.

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Barium swallow demonstrating an endoluminal mass ...

Barium swallow demonstrating an endoluminal mass in the mid esophagus.


Endoscopy demonstrating intraluminal esophageal c...

Endoscopy demonstrating intraluminal esophageal cancer.

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Endoscopy demonstrating intraluminal esophageal c...

Endoscopy demonstrating intraluminal esophageal cancer.


Chest CT scan showing invasion of the trachea by ...

Chest CT scan showing invasion of the trachea by esophageal cancer.

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Chest CT scan showing invasion of the trachea by ...

Chest CT scan showing invasion of the trachea by esophageal cancer.

  • Barium swallow is very sensitive for helping detect strictures (Media file 2) and intraluminal masses (Media file 3).
  • Performing esophagogastroduodenoscopy allows direct visualization and biopsies of the tumor (Media file 4).
  • Endoscopic ultrasound is the most sensitive test to help determine the depth of penetration of the tumor (T staging) and the presence of enlarged periesophageal lymph nodes (N staging).
  • Abdominal and chest CT scans are useful to help exclude the presence of metastases (M staging) to the lungs and liver and may be useful to help determine if adjacent structures have been invaded (Media file 5).
  • Bronchoscopy is indicated for cancers of the middle and upper third of the thoracic esophagus to help exclude invasion of the trachea or bronchi.
  • Bone scan is indicated in patients with complaints suggestive of bone metastases.
  • Laparoscopy and thoracoscopy have a greater than 92% accuracy in staging regional nodes.
  • A new modality for staging is positron emission tomography scanning, which can help elucidate hypermetabolic foci of disease activity. It may be particularly useful in detecting lymph node metastases and bone spread.

More on Esophageal Cancer

Overview: Esophageal Cancer
Differential Diagnoses & Workup: Esophageal Cancer
Treatment & Medication: Esophageal Cancer
Follow-up: Esophageal Cancer
Multimedia: Esophageal Cancer
References
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Further Reading

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Keywords

esophageal cancer, esophagus cancer, Barrett epithelium, Barrett's epithelium, Barrett esophagus, Barrett's esophagus, gastrointestinal reflux disease, GERD, esophageal adenocarcinoma, esophagus adenocarcinoma, esophagus carcinoma, esophageal carcinoma, reflux disease, squamous cell carcinoma

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Contributor Information and Disclosures

Author

Piero Marco Fisichella, MD, Assistant Professor of Surgery, Stritch School of Medicine, Loyola University; Director, Esophageal Motility Center, Loyola University Medical Center
Piero Marco Fisichella, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Philip Schulman, MD, Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center; Clinical Professor, Department of Medicine, New York University School of Medicine
Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, and Medical Society of the State of New York
Disclosure: celgene Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; genetech/idec Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wendy Hu, MD, Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center
Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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