PET/CT scans may reveal cancer anywhere in the body, sometimes before tumors or structural changes in the esophagus are present.
During a PET/CT scan, the patient is first injected with a glucose (sugar) solution that contains a very small amount of radioactive material. The substance is absorbed by the particular organs or tissues being examined. The patient rests on a table and slides into a large tunnel-shaped scanner. The PET/CT scanner is then able to "see" damaged or cancerous cells where the glucose is being taken up (cancer cells often use more glucose than normal cells) and the rate at which the tumor is using the glucose (which may help determine the tumor grade). The procedure is painless and varies in length, depending on the part of the body that is being evaluated.
By combining information about the body's anatomy and metabolic function, a PET/CT scan provides a more detailed picture of cancerous tissues than either test does alone. The images are captured in a single scan, which provides a high level of accuracy.
Combining a PET scan and a CT scan, the PET-CT takes x-ray pictures with a radioactive drug to show overactive cells.
A PET-CT scan combines a CT scan and a PET scan into one to give detailed information about your cancer. The CT scan takes a series of x-rays from all around your body. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal.
You’ll usually have a PET-CT scan in the x-ray (radiology) department as an outpatient. These scanners tend to be only in the major cancer hospitals. So you might have to travel to another hospital to have one. A radiographer operates the scanner. It usually takes between 30 and 60 minutes.
Doctors use a PET-CT scan to find out more about exactly where a cancer of the food pipe (oesophagus) is. It also shows whether it has spread. This scan can look at your tummy (abdomen) and lungs, or other parts of your body. It can help doctors work out whether tissue is active cancer or not.
Call the number on your appointment letter if not eating is a problem for you, for example if you’re diabetic. You might need to adapt your diet and sugar control and your appointment time could change.
Some people feel claustrophobic when they‘re having a scan. Contact the department staff before your test if you’re likely to feel like this. They can take extra care to make sure you’re comfortable and that you understand what’s going on.
Your doctor can arrange to give you medicine to help you relax, if needed.
You have an injection of a dye called a radiotracer about an hour before the scan. You have this injection through a small plastic tube called a cannula in your arm.
You need to rest and avoid moving too much during this hour. This allows the drug to spread through your body and into your tissues.
You have most scans lying down on the machine couch on your back.
Once you’re in the right position, your radiographer leaves the room. They can see you on a TV screen or through a window from the control room. You can talk to each other through an intercom.
The scan is painless but can be uncomfortable because you have to stay still. Tell your radiographer if you’re getting stiff and need to move.
It’s not particularly noisy but you’ll hear a constant background noise.
When it’s over, your radiographer will come back into the room and lower the couch so you can get up.
This 3-minute video shows you what happens when you have a PET-CT scan. Click Here to watch Youtube video.
You can then eat and drink normally.
Someone will need to take you home if you’ve had medicine to help you relax. You won’t be able to drive for the rest of the day as you might be drowsy.
The radiotracer gives off very small levels of radiation that go away very quickly. But for the rest of the day you shouldn’t have close contact with pregnant women, babies or young children.
Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.
Exposure to radiation during a CT scan can slightly increase your risk of developing cancer in the future. Talk to your doctor if this worries you.
What is a PET/CT scan?
This advanced nuclear imaging technique combines positron emission tomography (PET) and computed tomography (CT) into one machine. A PET/CT scan reveals information about both the structure and function of cells and tissues in the body during a single imaging session.During a PET/CT scan, the patient is first injected with a glucose (sugar) solution that contains a very small amount of radioactive material. The substance is absorbed by the particular organs or tissues being examined. The patient rests on a table and slides into a large tunnel-shaped scanner. The PET/CT scanner is then able to "see" damaged or cancerous cells where the glucose is being taken up (cancer cells often use more glucose than normal cells) and the rate at which the tumor is using the glucose (which may help determine the tumor grade). The procedure is painless and varies in length, depending on the part of the body that is being evaluated.
By combining information about the body's anatomy and metabolic function, a PET/CT scan provides a more detailed picture of cancerous tissues than either test does alone. The images are captured in a single scan, which provides a high level of accuracy.
PET-CT scan
Combining a PET scan and a CT scan, the PET-CT takes x-ray pictures with a radioactive drug to show overactive cells.
A PET-CT scan combines a CT scan and a PET scan into one to give detailed information about your cancer. The CT scan takes a series of x-rays from all around your body. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal.
You’ll usually have a PET-CT scan in the x-ray (radiology) department as an outpatient. These scanners tend to be only in the major cancer hospitals. So you might have to travel to another hospital to have one. A radiographer operates the scanner. It usually takes between 30 and 60 minutes.
Doctors use a PET-CT scan to find out more about exactly where a cancer of the food pipe (oesophagus) is. It also shows whether it has spread. This scan can look at your tummy (abdomen) and lungs, or other parts of your body. It can help doctors work out whether tissue is active cancer or not.
Preparing for your PET-CT scan
For most PET-CT scans, you need to stop eating about 6 hours beforehand. You can usually drink water during this time. You might have instructions not to do any strenuous exercise for 24 hours before the scan.Call the number on your appointment letter if not eating is a problem for you, for example if you’re diabetic. You might need to adapt your diet and sugar control and your appointment time could change.
Some people feel claustrophobic when they‘re having a scan. Contact the department staff before your test if you’re likely to feel like this. They can take extra care to make sure you’re comfortable and that you understand what’s going on.
Your doctor can arrange to give you medicine to help you relax, if needed.
What happens
When you arrive at the scan department
Your radiographer might ask you to change into a hospital gown. You have to remove any jewellery and other metal objects such as hair clips. Metal interferes with the images produced by the scanner.You have an injection of a dye called a radiotracer about an hour before the scan. You have this injection through a small plastic tube called a cannula in your arm.
You need to rest and avoid moving too much during this hour. This allows the drug to spread through your body and into your tissues.
In the scanning room
Your radiographer takes you into the scanning room. The PET-CT machine is large and shaped like a doughnut.You have most scans lying down on the machine couch on your back.
Once you’re in the right position, your radiographer leaves the room. They can see you on a TV screen or through a window from the control room. You can talk to each other through an intercom.
Having the PET-CT scan
The couch slowly slides backwards and forwards through the scanner. The machine takes pictures as you move through it.The scan is painless but can be uncomfortable because you have to stay still. Tell your radiographer if you’re getting stiff and need to move.
It’s not particularly noisy but you’ll hear a constant background noise.
When it’s over, your radiographer will come back into the room and lower the couch so you can get up.
This 3-minute video shows you what happens when you have a PET-CT scan. Click Here to watch Youtube video.
Transcript
Voiceover: PET and PET-CT scans help to diagnose and stage some cancers. They can also help your doctor decide which treatment you need and whether your treatment is working. PET and PET-CT scans show slightly different things but the process of having them is the same.
Radiographer: Okay, so first of all I’d like you to get changed.
Voiceover: For some scans you should not eat for 4 to 6 hours beforehand, for others there is no preparation. Your appointment card will give you details of what you need to do. One you have changed into your gown the radiographer will weigh and measure you. Then you have an injection of a very small amount of a radioactive drug called a tracer. This is what shows up on the scan. The drug is usually a form of glucose.
Radiographer: Right, I am starting now. Does that feel okay?
Girl: Yeah, that’s fine.
Radiographer: Is it comfortable?
Girl: Yeah.
Radiographer: Right, that’s all in now. I am going to take the needle away, because we don’t need that any more.
Voiceover: After the injection you rest for about an hour. This allows the tracer to spread through your body. The scan shows up cancer because they use glucose in a different way from normal tissue. When you are ready for the scan the radiographer helps you lie on the couch in the correct position.
Radiographer: I am just going to pop this under your knee, just to help your back stay comfortable. You’re going to move in and out of the scanner. Nothing is going to touch you or anything like that. You must keep very still. Close your eyes, because this light is quite bright.
Voiceover: Once you are in position and comfortable the radiographer will leave the room. You need to lie as still as possible while you are having the scan. You won’t feel anything, but it can be difficult to lie still for up to an hour. If you begin to feel unwell or want some help you will be able to get the radiographers attention.
Radiographer: Are you okay in there, Charlotte?
Girl: Yeah.
Voiceover: The radiographer control the scan from a separate room, but they will be able to hear and see you all the time you are having the scan and will check you are okay.
Radiographer: We won’t be long now. Okay, that’s all done now; we will get you out of there. Are you ok? Good. You can pop your arms down now.
Voiceover: One the scan is finished you can go home. As a precaution you should avoid contact with pregnant women and small babies for six hours after your scan. Your specialist will give you the results usually within a couple of weeks.
Radiographer: Okay, so first of all I’d like you to get changed.
Voiceover: For some scans you should not eat for 4 to 6 hours beforehand, for others there is no preparation. Your appointment card will give you details of what you need to do. One you have changed into your gown the radiographer will weigh and measure you. Then you have an injection of a very small amount of a radioactive drug called a tracer. This is what shows up on the scan. The drug is usually a form of glucose.
Radiographer: Right, I am starting now. Does that feel okay?
Girl: Yeah, that’s fine.
Radiographer: Is it comfortable?
Girl: Yeah.
Radiographer: Right, that’s all in now. I am going to take the needle away, because we don’t need that any more.
Voiceover: After the injection you rest for about an hour. This allows the tracer to spread through your body. The scan shows up cancer because they use glucose in a different way from normal tissue. When you are ready for the scan the radiographer helps you lie on the couch in the correct position.
Radiographer: I am just going to pop this under your knee, just to help your back stay comfortable. You’re going to move in and out of the scanner. Nothing is going to touch you or anything like that. You must keep very still. Close your eyes, because this light is quite bright.
Voiceover: Once you are in position and comfortable the radiographer will leave the room. You need to lie as still as possible while you are having the scan. You won’t feel anything, but it can be difficult to lie still for up to an hour. If you begin to feel unwell or want some help you will be able to get the radiographers attention.
Radiographer: Are you okay in there, Charlotte?
Girl: Yeah.
Voiceover: The radiographer control the scan from a separate room, but they will be able to hear and see you all the time you are having the scan and will check you are okay.
Radiographer: We won’t be long now. Okay, that’s all done now; we will get you out of there. Are you ok? Good. You can pop your arms down now.
Voiceover: One the scan is finished you can go home. As a precaution you should avoid contact with pregnant women and small babies for six hours after your scan. Your specialist will give you the results usually within a couple of weeks.
After your PET-CT scan
Your radiographer removes the tube from your arm before you go home.You can then eat and drink normally.
Someone will need to take you home if you’ve had medicine to help you relax. You won’t be able to drive for the rest of the day as you might be drowsy.
The radiotracer gives off very small levels of radiation that go away very quickly. But for the rest of the day you shouldn’t have close contact with pregnant women, babies or young children.
Getting your results
You should get your results within 1 or 2 weeks.Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.
For information and support, you can also call the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.
Possible risks
A PET-CT scan is a safe test for most people. But like all medical tests it has some risks. Your doctor and radiographer make sure the benefits of having the test outweigh these risks.Exposure to radiation during a CT scan can slightly increase your risk of developing cancer in the future. Talk to your doctor if this worries you.
Radioactive tracer
The radiation in the radioactive tracer is very small. Drinking plenty of fluids after your scan will help to flush the drug out of your system.Pregnancy
Pregnant women should only have the scan in an emergency. There’s a risk that the radiation could harm the baby. Contact the department as soon as you can before the scan if you are, or think you might be, pregnant.Tests for Esophageal Cancer
Esophagus cancers are usually found because of signs or symptoms a person is having. If esophagus cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, further tests will be done to help determine the extent (stage) of the cancer.
Your doctor will also examine you to look for possible signs of esophageal cancer and other health problems. He or she will probably pay special attention to your neck and chest areas.
If the results of the exam are abnormal, your doctor will probably order tests to help find the problem. You may also be referred to a gastroenterologist (a doctor specializing in digestive system diseases) for further tests and treatment.
This is sometimes the first test done to see what is causing a problem with swallowing. Even small, early cancers can often be seen using this test. 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 test can also be used to diagnose one of the more serious complications of esophageal cancer called a tracheo-esophageal fistula. This occurs when the tumor destroys the tissue between the esophagus and the trachea (windpipe) and creates a hole connecting them. Anything that is swallowed can then pass from the esophagus into the windpipe and lungs. This can lead to frequent coughing, gagging, or even pneumonia. This problem can be helped with surgery or an endoscopy procedure.
Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the esophagus and intestines. If you are having any trouble swallowing, you need to tell your doctor before the scan.
The picture from a PET scan is not as detailed as a CT or MRI scan, but it provides helpful information about whether abnormal areas seen on these other tests are likely to be cancer or not.
If you have already been diagnosed with cancer, your doctor may use this test to see if the cancer has spread to lymph nodes or other parts of the body. A PET scan can also be useful if your doctor thinks the cancer may have spread but doesn’t know where.
PET/CT scan: Some machines can do both a PET and CT scan at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed picture of that area on the CT scan.
The doctor can use special instruments through the scope to remove (biopsy) samples from any abnormal areas. These samples are sent to the lab to see if they contain cancer.
If the esophageal cancer is blocking the opening (called the lumen) of the esophagus, certain instruments can be used to help enlarge the opening to help food and liquid pass.
Upper endoscopy can give the doctor important information about the size and spread of the tumor, which can be used to help determine if the tumor can be removed with surgery.
These procedures are done in an operating room while you are under general anesthesia (in a deep sleep). A small incision (cut) is made in the side of the chest wall (for thoracoscopy) or the abdomen (for laparoscopy). Sometimes more than one cut is made. The doctor then inserts 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. This information is often important in deciding whether a person is likely to benefit from surgery.
HER2 testing: If esophageal cancer is found but is too advanced for surgery, your biopsy samples may be tested for the HER2 gene or protein. Some people with esophageal cancer have too much of the HER2 protein on the surface of their cancer cells, which helps the cells grow. A drug that targets the HER2 protein called trastuzumab (Herceptin®) may help treat these cancers when used along with chemotherapy. Only cancers that have too much of the HER2 gene or protein are likely to be affected by this drug, which is why doctors may test tumor samples for it. (See Targeted Therapy for Esophageal Cancer.)
Complete blood count (CBC): This test measures the different types of cells in your blood. It can show if you have anemia (too few red blood cells). Some people with esophageal cancer become anemic because the tumor has been bleeding.
Liver enzymes: You may also have a blood test to check your liver function, because esophageal cancer can spread to the liver.
In early 2001, I was the only "old man" on a 4x4 basketball team of twentysomethings. My team, Glenn's Gunners, was the league champ, with a 20–0 record. However, I didn't feel totally well. I had chronic acid reflux, but a checkup showed I had perfect blood pressure and low cholesterol. My lab results were excellent.
Medication eliminated my acid reflux, and I felt better until one day when some popcorn got stuck in my lower esophagus and caused me great pain. My family physician ordered further tests, which led to an endoscopy and a stunning diagnosis—a stage III adenocarcinoma mass measuring over 7 centimeters by 3 centimeters in my lower esophagus, extending into my stomach with several enlarged lymph nodes.
It was determined that surgery was not an option and I was advised to find a clinical trial (experimental medicine). My wife of 28 years, Ann, immediately started to search for the "best" place for treatment.
Just as we were heading to one of the country's premier cancer hospitals, the staff there halted my admission until further tests could be done. However, the first gastroenterologist who diagnosed me, as well as experts at a leading medical center, deemed these tests unnecessary. They even said the tests could lead to potential complications that could delay or compromise my treatment. In fact, we were told any delay in starting treatment could be fatal.
We had never heard of Cancer Treatment Centers of America® (CTCA) until Ann saw one of its television ads. She searched the Internet for more information about CTCA®, and after intense prayer and a miraculous sequence of events (that’s another story), it was very clear I was supposed to get treatment at CTCA.
After we spoke with the Oncology Information Specialists at CTCA, they immediately began my admission process and scheduled appointments for me to meet with the appropriate doctors at CTCA at Southwestern Regional Medical Center the following week.
From May through August 2001, we stayed in the CTCA guest hotel so that I could have round-the-clock medical care. CTCA doctors used state-of-the-art treatment and were very positive and compassionate. They also treated the "whole person" through nutrition and naturopathic counsel, and provided emotional and spiritual support. The entire staff—from top to bottom—was kind and caring. Our impression was that their employment seemed to be more of a "calling" than a job.
We also had a prayer support team of thousands around the world that Ann kept updated almost daily through an e-mail report called "Chuck G.'s 23rd Psalm Walk." I could not have gotten through the cancer experience without my faith in God.
My treatment consisted of three sessions of photodynamic therapy (PDT), a new treatment, at the time, for esophageal cancer. My PDT treatment was followed by six weeks of radiation and six months of an effective chemotherapy.
Due to the site of my cancer, I was unable to eat as I normally would, so I had PEG tube feedings for a while. Honestly, the treatment took its toll. I don't remember much about that summer; I spent most of it in bed and lost 47 pounds from an already, relatively lean body. Thankfully, Ann kept a journal detailing my walk through this difficult time.
It was a difficult time in my life. I simply trusted God, without any questions about "why." Psalm 23 became my lifeline. Proverbs 3:5–6 became Ann's lifeline.
By early October 2001, I was cancer free. I have remained cancer free ever since. I finished my last chemotherapy treatment the last week of November 2001. I returned to work part time in August of that year, with Ann driving me there and back. By January 2002, I was back to work full time and driving myself. That summer I was also back playing softball, even in an “all-night” tournament.
My recovery defies all statistics. But I agree with my doctor that "statistics mean nothing to believers." I eat a normal diet, have regained all the weight I lost and have gone from being unable to swallow water without great pain to eating steak without any problems! I still ride my motorcycle and fish, and have developed a love for snowmobiling. I recently retired from Tinker AFB and work part time for my neighbor's mechanical contracting company. Life is good.
I can't say enough about the doctors and nurses who cared for me at CTCA. I look forward to my checkup scopes with my doctor. A couple times a year, my esophagus has to be dilated (stretched) due to scarring from the aggressive treatment I received. But I consider it a minor inconvenience for a couple of days. That aggressive treatment saved my life.
My radiation oncologist and his staff administered my radiation so precisely that I have had no collateral damage to any of the tissues surrounding my cancer. I also had great confidence in my doctor because of his studious, unhurried, contemplative, kind demeanor. Equally important, the pain management staff did everything possible to relieve my pain and never quit until they found an effective medication for my extreme nausea. And Mickey and Wanda in the Outpatient Accommodations Department were very kind and accommodating.
A cancer diagnosis, even one as dire as mine, does not automatically mean life is over. There were many times I could have given up. But if I had, I would not have been able to be best man at my son's wedding in 2003; I would have missed years with my wife; and I would have missed the blessing of having my first grandchild, Brooklyn McKenzie, who was born on my birthday in 2006! And, I would not be able to encourage others in their cancer battle, including veterans of the Vietnam War like myself. I have so much admiration and respect for them.
Make no mistake about it—it is a battle. No one should fight it alone and it must be fought with doctors who are fully committed to winning the war. CTCA may not be for you; but it is worth your consideration. It certainly was the right place for me.
I enjoy an active life and normal diet. Having come through the "valley of the shadow of death" during cancer treatment, I am amazed that my greatest health issues years later are hearing loss and total knee replacement. But you won't hear any complaints from me!
I am fully retired and enjoy the time I get to spend with Ann and my family. I am blessed to have three grandchildren, Brooklyn, Kayley and Joey. Since they live a block away from us, we're very involved in their lives. I still enjoy snowmobiling, four-wheeling and fishing in Colorado several times a year. And I am an avid Oklahoma Sooners fan. I remain active in my church, Trinity Baptist, as a member of the safety/security team, greeter and in children's church.
I'm grateful that the Lord gave me these past years. I'm living proof that only God knows the number of "all the days ordained for me" (Psalm 139:16). I thank God for each day He gives me.
Medical history and physical exam
If you have symptoms that might be caused by esophageal cancer, the doctor will ask about your medical history to check for possible risk factors and to learn more about your symptoms.Your doctor will also examine you to look for possible signs of esophageal cancer and other health problems. He or she will probably pay special attention to your neck and chest areas.
If the results of the exam are abnormal, your doctor will probably order tests to help find the problem. You may also be referred to a gastroenterologist (a doctor specializing in digestive system diseases) for further tests and treatment.
Imaging tests to look for esophagus cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for many reasons, such as:- To help find a suspicious area that might be cancer
- To learn if and how far cancer has spread
- To help determine if the treatment is working
- To look for possible signs of cancer coming back after treatment
Barium swallow
In this test, a thick, chalky liquid called barium is swallowed to coat the walls of the esophagus. When x-rays are then taken, the barium clearly outlines the esophagus. This test can be done by itself, or as a part of a series of x-rays that includes the stomach and part of the intestine, called an upper gastrointestinal (GI) series. A barium swallow test can show any abnormal areas in the normally smooth surface of the inner lining of the esophagus, but it can't be used to determine how far a cancer may have spread outside of the esophagus.This is sometimes the first test done to see what is causing a problem with swallowing. Even small, early cancers can often be seen using this test. 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 test can also be used to diagnose one of the more serious complications of esophageal cancer called a tracheo-esophageal fistula. This occurs when the tumor destroys the tissue between the esophagus and the trachea (windpipe) and creates a hole connecting them. Anything that is swallowed can then pass from the esophagus into the windpipe and lungs. This can lead to frequent coughing, gagging, or even pneumonia. This problem can be helped with surgery or an endoscopy procedure.
Computed tomography (CT or CAT) scan
A CT scan uses x-rays to produce detailed cross-sectional images of your body. This test can help tell if esophageal cancer has spread to nearby organs and lymph nodes (bean-sized collections of immune cells to which cancers often spread first) or to distant parts of the body.Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the esophagus and intestines. If you are having any trouble swallowing, you need to tell your doctor before the scan.
Magnetic resonance imaging (MRI) scan
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium may be injected into a vein before the scan to see details better. MRI can be used to look at abnormal areas in the brain and spinal cord that might be due to cancer spread.Positron emission tomography (PET) scan
PET scans usually use a form of radioactive sugar (known as fluorodeoxyglucose or FDG) that is injected into the blood. Normal cells use different amounts of the sugar, depending on how fast they are growing. Cancer cells, which grow quickly, are more likely to absorb larger amounts of the radioactive sugar than normal cells. These areas of radioactivity can be seen on a PET scan using a special camera.The picture from a PET scan is not as detailed as a CT or MRI scan, but it provides helpful information about whether abnormal areas seen on these other tests are likely to be cancer or not.
If you have already been diagnosed with cancer, your doctor may use this test to see if the cancer has spread to lymph nodes or other parts of the body. A PET scan can also be useful if your doctor thinks the cancer may have spread but doesn’t know where.
PET/CT scan: Some machines can do both a PET and CT scan at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed picture of that area on the CT scan.
Endoscopy
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.Upper endoscopy
This is an important test for diagnosing esophageal cancer. During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes an endoscope down yourthroat and into the esophagus and stomach. The 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) samples from any abnormal areas. These samples are sent to the lab to see if they contain cancer.
If the esophageal cancer is blocking the opening (called the lumen) of the esophagus, certain instruments can be used to help enlarge the opening to help food and liquid pass.
Upper endoscopy can give the doctor important information about the size and spread of the tumor, which can be used to help determine if the tumor can be removed with surgery.
Endoscopic ultrasound
This test is usually done at the same time as the upper endoscopy. For an endoscopic ultrasound, a probe that gives off sound waves is at the end of an endoscope. This allows the probe to get very close to tumors in the esophagus. This test is very useful in determining the size of an esophageal cancer and how far it has grown into nearby 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. This helps the doctor decide if the tumor can be removed with surgery.Bronchoscopy
This exam may be done for cancer in the upper part of the esophagus to see if it has spread to the windpipe (trachea) or the tubes leading from the windpipe into the lungs (bronchi).Thoracoscopy and laparoscopy
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.These procedures are done in an operating room while you are under general anesthesia (in a deep sleep). A small incision (cut) is made in the side of the chest wall (for thoracoscopy) or the abdomen (for laparoscopy). Sometimes more than one cut is made. The doctor then inserts 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. This information is often important in deciding whether a person is likely to benefit from surgery.
Lab tests of biopsy samples
Usually if a suspected esophageal cancer is found on endoscopy or an imaging test, it is biopsied. In a biopsy, the doctor removes a small piece of tissue with a special instrument passed through the scope. See Testing Biopsy and Cytology Specimens for Cancer to learn more about the types of biopsies, how the tissue is used in the lab to diagnose cancer, and what the results may show.HER2 testing: If esophageal cancer is found but is too advanced for surgery, your biopsy samples may be tested for the HER2 gene or protein. Some people with esophageal cancer have too much of the HER2 protein on the surface of their cancer cells, which helps the cells grow. A drug that targets the HER2 protein called trastuzumab (Herceptin®) may help treat these cancers when used along with chemotherapy. Only cancers that have too much of the HER2 gene or protein are likely to be affected by this drug, which is why doctors may test tumor samples for it. (See Targeted Therapy for Esophageal Cancer.)
Blood tests
Your doctor might order certain blood tests to help determine if you have esophageal cancer.Complete blood count (CBC): This test measures the different types of cells in your blood. It can show if you have anemia (too few red blood cells). Some people with esophageal cancer become anemic because the tumor has been bleeding.
Liver enzymes: You may also have a blood test to check your liver function, because esophageal cancer can spread to the liver.
Chuck Glenn
Esophageal cancer - Stage III
This testimonial includes a description of this patient’s actual medical results. Those results may not be typical or expected for the particular disease type described in this testimonial. You should not expect to experience these results.
View CTCA treatment results for esophageal cancer
View CTCA treatment results for esophageal cancer
Overview
- Cancer: Stage III Esophageal cancer
- Diagnosed: 2001
- Treatments received:
- Photodynamic therapy
- Chemotherapy
- Radiation therapy
- Supportive Care received:
- Nutrition therapy
- Treatment at: CTCA at Southwestern Regional Medical Center
- Care Team:
- James Flynn, MD, FACR, FACRO
My story
I began 2001 going about my usual active lifestyle in Norman, Oklahoma. I was a "young" 52 years of age. I worked long hours at Tinker Air Force Base in an Industrial Engineering position as a planner, volunteered and taught in the elementary ministry area of Norman's Trinity Baptist Church, fished, rode my motorcycle and played competitive sports.In early 2001, I was the only "old man" on a 4x4 basketball team of twentysomethings. My team, Glenn's Gunners, was the league champ, with a 20–0 record. However, I didn't feel totally well. I had chronic acid reflux, but a checkup showed I had perfect blood pressure and low cholesterol. My lab results were excellent.
Medication eliminated my acid reflux, and I felt better until one day when some popcorn got stuck in my lower esophagus and caused me great pain. My family physician ordered further tests, which led to an endoscopy and a stunning diagnosis—a stage III adenocarcinoma mass measuring over 7 centimeters by 3 centimeters in my lower esophagus, extending into my stomach with several enlarged lymph nodes.
It was determined that surgery was not an option and I was advised to find a clinical trial (experimental medicine). My wife of 28 years, Ann, immediately started to search for the "best" place for treatment.
Just as we were heading to one of the country's premier cancer hospitals, the staff there halted my admission until further tests could be done. However, the first gastroenterologist who diagnosed me, as well as experts at a leading medical center, deemed these tests unnecessary. They even said the tests could lead to potential complications that could delay or compromise my treatment. In fact, we were told any delay in starting treatment could be fatal.
We had never heard of Cancer Treatment Centers of America® (CTCA) until Ann saw one of its television ads. She searched the Internet for more information about CTCA®, and after intense prayer and a miraculous sequence of events (that’s another story), it was very clear I was supposed to get treatment at CTCA.
After we spoke with the Oncology Information Specialists at CTCA, they immediately began my admission process and scheduled appointments for me to meet with the appropriate doctors at CTCA at Southwestern Regional Medical Center the following week.
From May through August 2001, we stayed in the CTCA guest hotel so that I could have round-the-clock medical care. CTCA doctors used state-of-the-art treatment and were very positive and compassionate. They also treated the "whole person" through nutrition and naturopathic counsel, and provided emotional and spiritual support. The entire staff—from top to bottom—was kind and caring. Our impression was that their employment seemed to be more of a "calling" than a job.
We also had a prayer support team of thousands around the world that Ann kept updated almost daily through an e-mail report called "Chuck G.'s 23rd Psalm Walk." I could not have gotten through the cancer experience without my faith in God.
My treatment consisted of three sessions of photodynamic therapy (PDT), a new treatment, at the time, for esophageal cancer. My PDT treatment was followed by six weeks of radiation and six months of an effective chemotherapy.
Due to the site of my cancer, I was unable to eat as I normally would, so I had PEG tube feedings for a while. Honestly, the treatment took its toll. I don't remember much about that summer; I spent most of it in bed and lost 47 pounds from an already, relatively lean body. Thankfully, Ann kept a journal detailing my walk through this difficult time.
It was a difficult time in my life. I simply trusted God, without any questions about "why." Psalm 23 became my lifeline. Proverbs 3:5–6 became Ann's lifeline.
By early October 2001, I was cancer free. I have remained cancer free ever since. I finished my last chemotherapy treatment the last week of November 2001. I returned to work part time in August of that year, with Ann driving me there and back. By January 2002, I was back to work full time and driving myself. That summer I was also back playing softball, even in an “all-night” tournament.
My recovery defies all statistics. But I agree with my doctor that "statistics mean nothing to believers." I eat a normal diet, have regained all the weight I lost and have gone from being unable to swallow water without great pain to eating steak without any problems! I still ride my motorcycle and fish, and have developed a love for snowmobiling. I recently retired from Tinker AFB and work part time for my neighbor's mechanical contracting company. Life is good.
I can't say enough about the doctors and nurses who cared for me at CTCA. I look forward to my checkup scopes with my doctor. A couple times a year, my esophagus has to be dilated (stretched) due to scarring from the aggressive treatment I received. But I consider it a minor inconvenience for a couple of days. That aggressive treatment saved my life.
My radiation oncologist and his staff administered my radiation so precisely that I have had no collateral damage to any of the tissues surrounding my cancer. I also had great confidence in my doctor because of his studious, unhurried, contemplative, kind demeanor. Equally important, the pain management staff did everything possible to relieve my pain and never quit until they found an effective medication for my extreme nausea. And Mickey and Wanda in the Outpatient Accommodations Department were very kind and accommodating.
A cancer diagnosis, even one as dire as mine, does not automatically mean life is over. There were many times I could have given up. But if I had, I would not have been able to be best man at my son's wedding in 2003; I would have missed years with my wife; and I would have missed the blessing of having my first grandchild, Brooklyn McKenzie, who was born on my birthday in 2006! And, I would not be able to encourage others in their cancer battle, including veterans of the Vietnam War like myself. I have so much admiration and respect for them.
Make no mistake about it—it is a battle. No one should fight it alone and it must be fought with doctors who are fully committed to winning the war. CTCA may not be for you; but it is worth your consideration. It certainly was the right place for me.
May 29, 2012
I am doing very well. After nearly 11 years since I completed treatment, cancer is no longer a fear. We take every opportunity we can to encourage other cancer patients. We are grateful for the blessings we have received.I enjoy an active life and normal diet. Having come through the "valley of the shadow of death" during cancer treatment, I am amazed that my greatest health issues years later are hearing loss and total knee replacement. But you won't hear any complaints from me!
I am fully retired and enjoy the time I get to spend with Ann and my family. I am blessed to have three grandchildren, Brooklyn, Kayley and Joey. Since they live a block away from us, we're very involved in their lives. I still enjoy snowmobiling, four-wheeling and fishing in Colorado several times a year. And I am an avid Oklahoma Sooners fan. I remain active in my church, Trinity Baptist, as a member of the safety/security team, greeter and in children's church.
I'm grateful that the Lord gave me these past years. I'm living proof that only God knows the number of "all the days ordained for me" (Psalm 139:16). I thank God for each day He gives me.
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