How to check for esophageal cancer?

Written by Liu Liang
Oncology
Updated on May 13, 2025
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One clinical symptom of esophageal cancer is primarily dysphagia, especially progressive aggravation of dysphagia and difficulty swallowing. When these symptoms occur, the possibility of esophageal cancer should be considered, and one should seek medical attention at a hospital. An esophagoscope examination, which is an endoscopy, should be performed. Usually, under endoscopy, morphological changes in the esophagus can be observed, and if a biopsy is taken and cancer cells are found, esophageal cancer can be diagnosed. Therefore, the primary diagnostic approach for esophageal cancer involves an endoscopic examination and biopsy of the esophageal mass, which is the gold standard for diagnosis. After diagnosis, it is also necessary to perform comprehensive examinations such as chest and full abdominal CT scans, superficial lymph node ultrasound of the whole body, barium meal tests for the esophagus, and other examinations like ultrasound and esophagoscopy to assess the stage of the cancer and decide upon further treatment plans.

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Typical symptoms of esophageal cancer

The most typical symptom of esophageal cancer is progressive difficulty swallowing, and a progressive sensation of swallowing obstruction is the most typical symptom. It's actually quite simple; the esophagus is akin to a water pipe or a tubular cavity. Esophageal cancer is like having a tumor grow inside this cavity, similar to something blocking the pipe, which causes the flow of water to be impeded. However, not only water passes through this esophagus, but also food. Therefore, if there's something inside the cavity, both water and food cannot pass through, leading to this difficulty swallowing and discomfort while swallowing.

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The difference between esophagitis and esophageal cancer

The differences between esophagitis and esophageal cancer are significant. Esophagitis is an inflammation and is benign, but esophageal cancer is malignant, marking a stark contrast between the two. However, both esophagitis and esophageal cancer can have similar clinical symptoms, such as acid reflux, hiccups, heartburn, pain behind the breastbone, discomfort, and a burning sensation behind the breastbone, so symptoms can be similar. However, a more typical symptom of esophageal cancer is a sensation of swallowing obstruction, since there is actually something in the esophagus. Inflammation, after all, is just that, and it does not involve a mass forming inside the esophagus that could block it, hindering the ability to drink water, eat food, or swallow.

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The main metastatic pathways of esophageal cancer

The main metastatic pathways of esophageal cancer include firstly, hematogenous spread, which can transfer to distant organs such as bones and the lungs or liver via the bloodstream. The second pathway is via the lymphatic system, which can lead to the metastasis of regional lymph nodes and other non-regional lymph nodes. For example, cervical esophageal cancer tends to metastasize to the supraclavicular and adjacent esophageal lymph nodes; in thoracic esophageal cancer, metastases may occur in the subcarinal, upper periesophageal, and lower periesophageal lymph nodes; metastasis can also be achieved through local spread and invasion of the tumor.

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Esophageal cancer screening methods

The screening methods for esophageal cancer primarily involve checks of the esophagus, including upper gastrointestinal barium meal and gastroscopy. Gastroscopy, in particular, is a relatively accurate method for examining patients. This is because during a gastroscopy, biopsy samples can be taken, and pathology can definitively determine whether cancer is present. There might be issues regarding whether a patient can undergo a gastroscopy as it requires significant patient tolerance. Therefore, depending on the patient's health condition, if a gastroscopy is not feasible, an upper gastrointestinal barium meal can be conducted first.

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Written by Zhou Zi Hua
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What are the early signs of esophageal cancer?

The early symptoms of esophageal cancer are often nonspecific and intermittent, thus many patients do not take them seriously and delay the condition. Clinically, common early symptoms of esophageal cancer include a choking sensation when swallowing food, which is more noticeable in patients who swallow dry food or other foods that are not well chewed in large bites. Additionally, there is discomfort or a feeling of fullness behind the sternum. Thirdly, there is a sensation of a foreign body in the esophagus, with about 20% of patients experiencing this sensation when swallowing, as well as dryness and a feeling of tightness in the throat. Furthermore, there is a slow passage and a sense of retention of food.