Patients experiencing signs and symptoms of esophageal cancer should immediately notify their physician who will compile a thorough medical history and perform a complete physical examination. Certain screening tests are used to check for esophageal cancer in its early stages, before symptoms develop. People at high risk for the disease, especially those already diagnosed with Barrett’s esophagus or tylosis, are most likely to be screened.

Esophageal cancer is diagnosed using two primary methods:

• Barium swallow. The patient drinks a thick liquid (barium) that coats the lining of the esophagus, allowing it to be viewed on an x-ray. In some cases, air is blown into the esophagus to push the barium onto the esophageal walls. While this test – also known as an esophagram – can reveal growths including cancer of the esophagus, it may miss some lesions. The test cannot be used to determine how far the cancer may have spread (metastasized) beyond esophagus.
  
  
• Upper endoscopy. An endoscope – a thin, lighted tube with a miniature camera at the end – is used to examine the esophagus. Before the tube is inserted into the throat, a topical anesthetic is applied to make the procedure less uncomfortable. The camera sends back pictures of abnormalities that are viewed on a monitor. The physician can also use the endoscope to obtain tissue samples (biopsy) for analysis.
  
  In an endoscopic ultrasound, a probe may be inserted to determine the presence of and depth of penetration of the cancer. The probe sends out very sensitive sound waves that penetrate deep into the tissues to reveal close-up images of the esophagus and nearby tissues. Recent studies have suggested that this test may be more accurate than traditional endoscopy and CT scans in determining the size and shape of the cancer as well as the spread of the disease.

Although endoscopy and barium swallow are used for diagnosis, other tests may be performed to stage the disease. These tests include:

• Bronchoscopy. This test is similar to an esophagoscopy, except that the endoscope is used to examine the windpipe (trachea) and air passages leading to the lungs (bronchi). It can reveal whether or not the cancer has spread from the esophagus to these areas or visa versa.
  
  
• Computed axial tomography (CAT) scan.  A CAT scan uses multiple x-ray images and computerized technology to create cross-sectional images of the body. CAT scans can confirm the location of tumors in the esophagus and reveal whether the cancer has spread to the lymph nodes or other organs.
  
  
• Magnetic resonance imaging (MRI). Test that produces clear cross-sectional or three dimensional images of the body's tissues and organs. MRI can be used to help detect the location of cancer in the body.

• Positron emission tomography (PET) scan. During a PET scan, a small amount of radioactive tracer is injected into the body. Cancerous tumors absorb greater amounts of the tracer and these areas appear as bright spots on the scan.
  
  
• Thoracoscopy and laparoscopy. Allow the physician to see the lymph nodes and other organs near the esophagus in the chest (thoracoscopy) or in the abdomen (laparoscopy). A biopsy sample may be obtained using these methods, which require the patient to undergo general anesthesia.