The diagnostic tests or scans you have depend on your symptoms and treatment centre and most tests can be performed on an outpatient basis. It is likely your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a gastroenterologist who will arrange further tests and advise you about treatment options.
These generally include:
Barium swallow and barium meal
A barium swallow and a barium meal are types of medical imaging tests used to examine the upper GI tract. You may have one or both of these tests after an endoscopy. The results help the doctor see how you are swallowing and how well the oesophagus and stomach empty their contents. Each test takes about an hour.
You will be asked not to eat for several hours beforehand. For both tests, you will need to drink a thick, chalky liquid (barium). The barium coats your oesophagus, stomach and part of your small bowel. It shows up white on x-ray pictures, allowing the doctor to see abnormalities such as narrowing in the digestive tract.
You may need to drink the barium through a tube or straw, or you may be given another substance to swallow to create air in the digestive tract. This helps the images become clearer. You will lie on an examination table, usually in a darkened room.
During a barium swallow, x-ray pictures are taken of your throat. In a barium meal, x-rays are taken of your stomach and small bowel. The examination table may be tipped to help the barium flow through your body. You might find this uncomfortable.
For a few days after the test, your bowel movements may be light in colour due to the barium. Some people also get constipation. Drink plenty of water to help prevent this.
CAT SCAN (CT)
A CT scan of the chest, abdomen and pelvis may be necessary in order to get good views of where the tumour lies.
For the CT scan you will be required to fast for 2 hours before the scan, and to drink 1 litre of water an hour before your appointment. You are able to empty your bladder during this time and there is no need for you to have to hold on to the water.
Just prior to the scan you will receive an injection of contrast through a vein in your arm and this often gives you a hot flush throughout your body.
PET (POSITRON EMISSION TOMOGRAPHY)
You will also require a PET scan, which will be performed at Royal North Shore Hospital. The Nuclear Medicine Department will contact you with an appointment time and instructions.
During the PET scan you will be injected with a small amount of radioactive tracer via a vein in the arm. It takes 30 – 90 minutes for the tracer to go through your body and during this time you will be asked to rest quietly. The whole body is then scanned to look for any cancer in your body. Cancer areas are called “hot spots” and show up as bright areas on the scan.
GASTROSCOPY AND LAPAROSCOPY
The gastroscopy and laparoscopy are performed under a general anaesthetic in the operating theatre. Usually patients will be able to be discharged from the hospital on the same day. Most patients will have already had an endoscopy performed by a gastroenterologist to diagnose their stomach cancer.
A surgeon performs a gastroscopy to accurately identify the position of the cancer in order to plan surgery. It is also important to exclude other conditions that may influence the treatment plan.
A laparoscopy involves the examination of the lower end of the oesophagus, stomach and abdominal cavity using a small telescope that is inserted through an incision just below the navel. Other small incisions are made in the abdomen in order to facilitate the procedure.
It is normal to experience some pain and discomfort from these incisions however simple analgesia should be sufficient to treat this. The incisions will have dissolvable stitches in them and will be covered by a small dressing These dressing are able to be removed after one week. They are waterproof and you are able to bathe and shower.
You will meet the anaesthetist on the morning of your surgery. If there are any points the anaesthetist needs to clarify prior to you admission he will contact you.
Other investigations may include: Endoscopic ultrasound
Very occasionally in this test an endoscope with a probe on the end is put down the throat. The probe releases high-frequency soundwaves. which echo when they bounce off anything solid such as an organ or tumour.
This creates pictures so the doctor can see inside your GI tract. Very occasionally a biopsy is necessary when the CT or PET scan shows that there might be cancer else where in the body. A biopsy of this area would be taken in a Radiology department and normally under a local anaesthetic.
The stage describes how far the cancer has spread. At first, your medical team will estimate the stage of the cancer, based on the results of the diagnostic tests. However, if you have tissue removed during surgery, it will be examined to give a more accurate stage.
Doctors commonly use an international staging system called TNM to describe different stages of cancer. The TNM system is based on certain criteria:
• T – refers to the size of the tumour
• N – is whether the lymph nodes (glands) have cancer in them
• M – stands for metastasis, or how far the cancer has spread.
Each letter is given a number indicating how advanced the cancer is.
Grading cancer describes how quickly the cancer cells are growing. This is determined by assessing their appearance and rate of growth. Low-grade cancer cells tend to grow slowly, while high-grade cancer cells look abnormal and grow very quickly.
MULTI-DISCIPLINARY TEAM MEETING
The results of all of these investigations are discussed in a multidisciplinary team meeting, which will offer the best treatment plan for you.
The specialists involved include:
- Upper Gastrointestinal surgeons
- Radiation oncologists
- Nuclear Medicine physician
- Cancer Nurse Coordinator
The choice of treatment depends upon the exact type of oesophageal cancer, its stage, position and size, as well as your age and general health.
In many cases the treatments are used in combination.
All treatments have benefits as well as side effects and these will be discussed during your consultations. This will help you to decide what treatment is best and which will most appropriately suit your particular situation.