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Diagnosis and Staging

Because esophageal cancer often doesn’t cause symptoms until the tumor has reached a certain size, getting the cancer diagnosed (esophageal cancer may be one of two types, adenocarcinoma or squamous cell) and staged (clarifying the type of cancer and how far or where it has spread) is critical for the best possible outcome.

That’s why turning to experts like those at Johns Hopkins can make a difference in a patient’s treatment and prognosis. The doctors who diagnose and stage esophageal cancer here are specialists in treating esophageal cancer. In fact, the esophageal cancer experts at Johns Hopkins often treat more than 50 cases in a year—a number far higher than a community practitioner would see. Doctors who treat esophageal cancer at Johns Hopkins participate in a specialized multidisciplinary clinic for esophageal cancer patients.

In addition, because they work in a comprehensive cancer center, our screening and diagnostic experts use the most effective diagnostic tools, providing an accurate diagnosis and correct staging, both critical to life-saving treatment.

The endoscopists at Johns Hopkins are experts in the use of endoscopic ultrasonography, or EUS, which provides high-resolution detailed images. While it is in use at other medical centers, because our endoscopists specialize in diagnosing and staging esophageal cancer, they have a depth of experience and expertise that is hard to match.

Our esophageal cancer patients also benefit from the use of endoscopic confocal microscopy, which allows the endoscopist to make a tissue diagnosis during the endoscopy.

Our radiologists and endoscopists work in a research environment, so that they are ready to take advantage of more advanced technology and the most effective procedures as soon as they are safe and proven effective. In many cases, they or their colleagues pioneered procedures that are in common use today.

Diagnostic and staging procedures

When you come to Hopkins for diagnosis and staging, you may receive one or several of these procedures. The most commonly used is the endoscopy with biopsy.

Barium swallow X-ray, or esophogram: This procedure may be used to diagnose cancer and also in staging the extent of the cancer.

CT scan, or computed tomography: A CT scan is used after the cancer is diagnosed to see how locally advanced the cancer is or if it has spread to areas near the esophagus or to distant sites.

Endoscopic ultrasonography (EUS): EUS combines endoscopy with high-frequency ultrasound to provide high-resolution, detailed images of the tumor, the esophageal wall, and adjacent structures. It is used in some cases to diagnose and more often to stage the cancer locally—to see if it has spread beyond the initial tumor to other places around the esophagus.

Endoscopic confocal microscopy: This technology allows doctors to obtain “smart” biopsies (which use laser technology to provide immediate results) and produce detailed cross-sectional images of the esophagus during endoscopy, allowing the endoscopist to make a tissue diagnosis during endoscopy without a biopsy or pathology.

Endoscopy with biopsy (sometimes called a esophagogastroduodenoscopy): This is the most common test an endoscopist will do. With this technique, the endoscopist can use the endoscope to target abnormal areas to biopsy.

PET scan (positron emission topography): In cases of esophageal cancer, a PET scan is used to determine if the cancer has spread to areas beyond the esophagus.

For an appointment and answers to your questions

As a leading treatment center for esophageal cancer, Johns Hopkins sees between 50 and 100 newly diagnosed patients a year, providing a depth of experience that assures our patients that they will receive the best possible treatment plan for their diagnosis.

To make an appointment or if you have questions, call 410-933-5420.