Esophageal Cancer Diagnostics

Squamous cell carcinoma and adenocarcinoma are the two main types of esophageal cancer. At one time, squamous cell carcinoma was by far the more common of the two and responsible for almost 90 percent of all esophageal cancers. However, adenocarcinoma, typically caused by obesity and acid reflux, now ranks as the most common form of esophageal cancer in the Western world, and physicians at Mount Sinai see hundreds of these cases each year.

Risk Factors 

Caused by persistent acid injury, esophageal cancers generally affect people over the age of 40, and they are more common in men than in women. Other risk factors include smoking, heavy drinking, obesity and having acid reflux or Barrett’s esophagus.


Symptoms of esophageal cancer include weight loss, persistent heartburn, pain when swallowing, pain in the chest or back, a hoarse voice or cough lasting more than two weeks, and the feeling of food getting stuck or coming back into the throat.

Early Detection 

Early detection and treatment are vital to fighting esophageal cancer, and Mount Sinai offers the widest possible spectrum of diagnostic tests for this disease. These include:

  • Barium swallow (upper GI series): This procedure involves a series of x-rays of the esophagus. Patients drink a barium-containing liquid to coat the inside of the esophagus and highlight changes that will appear on x-ray. Ulcers, scar tissue, abnormal growths, hernias, or areas that block the path of food through the digestive system are also visible. Using a fluoroscope, the radiologist sees barium moving through the digestive tract, permitting diagnosis of abnormalities in function, such as swallowing disorders.

  • Endoscopy (also called esophagoscopy): This is an examination of the inside of the esophagus with a thin-lighted tube (?camera) called an endoscope. If an abnormal area is found, the doctor will collect cells and tissue through the endoscope for examination by a pathologist.

    • Confocal microendoscopy: Mount Sinai is the only medical center in New York offering this revolutionary new technique that provides both standard and microscopic images of the lining of the gastrointestinal tract. Patients are sedated throughout a ten-minute procedure, in which a catheter-based microscope, or an endoscope with an integrated microscope, is inserted into the esophagus. It produces sub-cellular imaging similar to what a pathologist would see under a microscope, permitting the doctor to see cancer, precancerous areas or infection without taking a biopsy.

  • Endoscopic Ultrasound: This study involves an ultrasound probe at the end of a specialized esophagoscope. The ultrasound allows assessment of the depth of invasion of the tumor and evaluation of locoregional lymph nodes. Biopsy of these lymph nodes can also be performed if any appear suspicious.

  • Biopsy: A biopsy is a diagnostic test that involves collecting small pieces of esophageal tissue through an endoscope, allowing examination under a microscope for cancer cells, tissue changes or other conditions.

  • Chest X-ray: This is an X-ray of the lungs, heart, and surrounding tissue.

  • CT Scan: A CT Scan is a type of X-ray that uses a computer to take pictures of structures inside the body. The computer analyzes the data to construct a cross-sectional (axial) image. These images can be stored, viewed on a monitor, or printed on film. In addition, three-dimensional models of organs can be created by stacking the individual images, or "slices."

  • Bone Scan: This test, employed by nuclear medicine, is used to identify abnormal processes involving the bone, including metastatic tumor, infection or fracture, by utilizing radioactive isotope technology to detect areas of increased or decreased bone metabolism (turnover).

  • PET scan: This test involves the injection of specially marked glucose. Cells which metabolize this display high activity and “light up” on the scan. These cells include tumor cells and infection. This study aids in the staging of esophageal cancer.