Can Chest X-ray Detect Esophageal Cancer

Elaine Sutton
• Thursday, 24 December, 2020
• 8 min read

Having Barrett's esophagus increases the risk of the disease developing inside the person. However, it is recommended that a person use an esophageal, or barium swallow, instead, due to the test being especially suited for detecting anomalies in the esophageal tract.

ray chest common thorax nih disease dataset
(Source: academictorrents.com)


The data claims that there were more than 16,000 new patients diagnosed with esophageal cancer in the year 2010 in the United States alone. The experts believe that one American citizen out of 200 will develop cancer of the esophagus at some point in his or her life.

However, the situation is not that bad if the cancer is diagnosed in its early stages as there is more chance of it being treated then. Squamous cell carcinoma occurs in almost 50% of all patients diagnosed with esophageal cancer.

Adenocarcinoma develops in the gland cells, and it is most often seen in the lower parts of the esophagus. A certain condition called Barrett’s esophagus is almost always present when this type of esophageal cancer develops.

Those older than 65 years of age have a lot more chance of developing cancer of the esophagus. Barrett’s esophagus can also increase the risk of this type of cancer but not everyone who suffers from this condition will develop it.

Tobacco consumption is famous for increasing the risk of various types of cancer and the situation is the same with esophageal cancer. Alcohol consumption contributes to the increase of risk of cancer, but the situation is most severe if these two factors are combined.

ch fluorescence induced laser system
(Source: www.hon.ch)

Some of these risk factors are being overweight, drinking very hot liquids on a daily basis and following a diet high in processed meat. Limiting the consumption of alcohol is another sure way of lowering the risk of cancer of the esophagus.

Making sure that the weigh remains normal is essential as well and the best way to achieve that is to exercise regularly. Early detection will not only increase the chance of survival but will allow more treatment options to be used.

One of the main problems of esophageal cancer is that the first signs often remain unseen until the disease has advanced. In order to make a proper diagnosis, the doctor will look at the symptoms and medical history of the patient and perform a physical exam.

Your doctor may perform a physical exam, chestx-ray, chest CT, Upper GI, esophagoscopy, endoscopic ultrasound, or PET/CT to help determine if you have cancer and if it has spread. Treatment options depend on the extent of the disease and include surgery, radiation therapy and chemotherapy or a combination thereof.

Esophageal cancer occurs when cancer cells develop in the esophagus, a long, tube-like structure that connects the throat and the stomach. The esophagus carries swallowed food to the stomach and is part of the upper digestive system.

chest xray radiology ct
(Source: www.memorangapp.com)

The affected gland cells in Barrett's esophagus can become increasingly abnormal and lead to a precancerous condition called dysplasia. If dysplasia is present or if there is a family history of Barrett's esophagus, the risk of cancer is greater.

An upper GI examination that focuses on the esophagus is called a barium swallow or an esophageal. Esophagoscopy: This procedure allows the physician to view the esophagus directly through an esophagoscope, a thin, tube-like instrument with a light and a lens.

Some esophagoscopes are equipped with tools to remove tissue samples for inspection under a microscope for signs of cancer. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs to create echoes.

Positron Emission Tomography/Computed Tomography (PET/CT) : PET uses small amounts of radioactive materials called radiotracers, a special camera and a computer to help evaluate your organ and tissue functions. By identifying body changes at the cellular level, PET may detect the early onset of disease before it is evident on other imaging tests.

A biopsy may be done simultaneously during an upper endoscopy that reveals the presence of Barrett's esophagus to rule out dysplasia and adenocarcinoma. If these tests are not suspicious for cancer, no further steps may be needed, although your doctor may want to monitor the area during future visits.

infarction myocardial chest ray presentation case
(Source: www.slideshare.net)

Barrett's esophagus frequently requires six-month follow-up and/or monitoring via upper endoscopy to evaluate for progression to dysplasia. The optimal combination of these three treatment modalities will depend on the type, location and stage of the disease.

For patients undergoing surgical treatment for esophageal cancer, radiation therapy may be used before surgery to help shrink the cancer (called neoadjuvant treatment) or after surgery, to destroy any remaining cancer cells (called adjuvant therapy). It may also be used to help manage the symptoms and complications of advanced disease, including pain and tumor growth that prohibits food from passing to the stomach.

Chemotherapy : This treatment uses chemical substances or drugs to kill cancer cells or stop them from dividing. A drug known as trastuzumab (Herceptin) is a monoclonal antibody that attaches to the HER2 protein on cancer cells and interferes with their ability to grow.

Immunotherapy : This approach uses drugs to boost the patient's immune system to help control cancer. Chemo prevention: Drugs, vitamins and other agents are being studied in an effort to try and reduce the risk of cancer and/or delay its development or recurrence.

Does anyone if a standard chest ray (not barium) will show a tumor in the esophagus? I have awful reflux just like he does and for the past 4 months I have had pain between my shoulder blades (more to the left).

I have had 2 chest rays that were both normal, except for slight arthritis in my upper back, but it is on the opposite side that hurts. Symptoms are dysphagia or difficulty in swallowing, chest pain in the middle of chest, weight loss, hoarseness, constant cough and bone pain if metastasized.

CT scan would be a better choice since it takes many pictures of the same part while rotating, giving more detailed information about the pathology, which might be, missed on a simplex ray since it photographs in one plane only. Barium swallow, MRI, PET scan, upper GI endoscopy and guided biopsy would be needed.

I suggest that you consult a gastroenterologist for a detailed clinical evaluation immediately to rule out your doubts and detect the condition in time, if God forbid. Your doctor will also examine you closely to look for possible signs of esophageal cancer and other health problems.

You may also be referred to a gastroenterologist (a doctor specializing in digestive system diseases) for further tests and treatment. Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body.

In this test, you will be asked to swallow a thick, chalky liquid called barium to coat the walls of the esophagus. Early cancers can look like small round bumps or flat, raised areas (called plaques), while advanced cancers look like large irregular areas and can cause narrowing of the inside of the esophagus.

This occurs when the tumor destroys the tissue between the esophagus and the trachea(windpipe) and creates a hole connecting them. Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast.

CT-guided needle biopsy: If a suspected area of cancer is deep within your body, a CT scan might be used to guide a biopsy needle into this area to get a tissue sample to check for cancer. For a PET scan, a slightly radioactive form of sugar (known as FDP) is injected into the blood and collects mainly in cancer cells.

An endoscope is a flexible, narrow tube with a tiny video camera and light on the end that is used to look inside the body. Tests that use endoscopes can help diagnose esophageal cancer or determine the extent of its spread.

During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes an endoscope(a thin, flexible tube with a light and a small video camera on the end) down your throat and into the esophagus and stomach. The endoscope's camera is connected to a monitor, which lets the doctor see any abnormal areas in the wall of the esophagus clearly.

The doctor can use special instruments through the scope to remove (biopsy) tissue samples from any abnormal areas. It can also help show if nearby lymph nodes might be affected by the cancer.

If enlarged lymph nodes are seen on the ultrasound, the doctor can pass a thin, hollow needle through the endoscope to get biopsy samples of them. These exams let the doctor see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube and can be used to get biopsy samples.

A small incision (cut) is made in the side of the chest wall (for thoracoscopy) or the abdomen (for laparoscopy). The doctor then inserts a scope (a thin, lighted tube with a small video camera on the end) through the incision to view the space around the esophagus.

The surgeon can pass thin tools into the space to remove lymph nodes and biopsy samples to see if the cancer has spread. In a biopsy, the doctor removes a small piece of tissue with a cutting instrument passed through the scope.

Some people with esophageal cancer make too much of the HER2 protein or gene which helps the cells grow. A drug called trastuzumab (Herceptin) that targets the HER2 protein may help treat these advanced cancers when used along with chemotherapy.

Only cancers that have too much of the HER2 gene or protein are likely to benefit from this drug, which is why doctors may test tumor samples for it. MMR and MSI testing : Esophageal cancer cells might be tested to see if they show high levels of gene changes called microsatellite instability (MSI), or if they have changes in any of the mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2).

Esophageal cancers that test positive for MMR or high MSI and cannot be treated with surgery, have come back after initial treatment, or have spread to other parts of the body might benefit from immunotherapy with the drug pembrolizumab. Some people with esophageal cancer have low red blood cell counts because the tumor has been bleeding.

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