The main methods for diagnosing esophageal cancer are instrumental research methods - radiography and esophagoscopy. They make it possible to determine the location, growth pattern, size of the tumor and the condition of the walls of the esophagus near it.

The most accurate way to diagnose esophageal cancer is esophagoscopy (Fig. 51, 52, 53). This research method is indicated for suspected cases of any functional or organic disease of the esophagus. Refusal to use esophagoscopy even with minimal local clinical symptoms should be considered a gross mistake.

With the development of fiber optics, this research method has become practically safe for patients. Various severe complications, previously observed when performing examinations with a rigid (tube) device, are extremely rare when using fiber endoscopes. Esophagoscopy allows you to identify tumors, ulcers, erosions, and stenoses of the esophagus, which explain the cause of esophageal pain. The main advantage of esophagoscopy is the ability to obtain a biopsy of altered areas of the mucosa.

Rice. 51.Esophagoscopy. Squamous cell carcinoma of the esophagus with endophytic growth

Rice. 52.Esophagoscopy. Esophageal cancer with exophytic growth and superficial esophageal cancer.

Rice. 53.Esophagoscopy. Infiltrative-stenotic cancer of the esophagus.

In the process of esophagoscopy, the following tasks are solved:

1) identification of tumor lesions of the esophagus and assessment of its macroscopic picture;

2) identification of inflammatory and non-tumor changes in the mucous membrane of the esophagus;

3) determination of the upper and, if possible, lower border of the lesion;

4) establishing the presence of a circular lesion of the walls of the esophagus;

5) performing endoscopic biopsy (forceps, puncture, excisional, brush biopsy);

6) assessment of the immediate effect of radiation or chemoradiotherapy;

7) assessment of the possibility of using photodynamic therapy or laser destruction of the tumor (in cases of small tumors of the esophagus that do not grow into the muscle layer of the wall);

8) identifying the presence of early esophageal cancer using diagnostic drugs of the hematoporphyrin series.

The location of the zone of pathological changes in the esophagus is recorded as the distance from the incisors to its proximal and distal boundaries. If only the proximal margin of the tumor is accessible for endoscopic evaluation, it is important to determine whether the esophageal changes are secondary. In such cases, the importance of the x-ray method in clarifying the features of esophageal damage increases.

The esophagoscopic picture of esophageal cancer is very diverse and depends primarily on the form of tumor growth and its size (Fig. 51, 52).

During endoscopic examination, the following types of tumor lesions are distinguished:

1) tumors with predominantly exophytic growth (Fig. 52) - polypoid, papillomatous, large-tuberous, saucer-shaped cancer;

2) tumors with predominantly endophytic growth (Fig. 51) - focal flat infiltrate, ulcerative-infiltrative cancer, infiltrative-stenotic cancer;

3) mixed and ulcerative forms of the tumor.

With exophytic growth, lumpy tumor masses are revealed, protruding into the lumen of the esophagus (Fig. 52), which bleed easily when touched with an esophagoscope. In the endophytic form (Fig. 51), the mucous membrane remains intact for a long time, only local rigidity of the esophageal wall or a change in the color of the mucous membrane is noted. Ulcerated forms (Fig. 53) are characterized by the presence of irregularly shaped ulcers with uneven, tuberous edges.

Chromoesophagoscopy. This study is intended to visualize, clarify the nature, location and size of the lesion, as well as to perform a targeted biopsy. For vital coloring of the esophageal mucosa, dyes are used, which, according to their mechanism of action, are divided into 3 groups:

I. Contrast dyes (indigo carmine) do not stain normal cells of the mucous membrane of the esophagus; they are distributed over the surface of the mucosa and stain only its altered areas.

II. Absorbable dyes:

1) Lugol’s aqueous solution (2-3%) is used to visualize minimal changes in the mucous membrane of the esophagus, it stains normal squamous epithelium brown, altered areas of the mucous membrane of the esophagus remain unstained and are thus visualized (Fig. 54, 55);

2) the methylene blue solution is absorbed by the cells of metaplastic and dysplastic epithelium, areas of the changed mucous membrane are painted blue or violet and become clearly visible against the background of the unchanged pale pink mucous membrane of the esophagus;

3) a solution of toluidine blue stains the nuclei of the prismatic epithelium of the stomach and columnar intestinal epithelium and is used to identify areas of metaplastic epithelium in Barrett's esophagus, against which esophageal cancer often occurs.

III. Reactive dyes (Congo red and phenol red) are not used for vital staining of the esophageal mucosa. They are intended to study acid-producing zones (Congo red) and Helicobacter pylori infection of the gastric mucosa (phenol red).

Rice. 54.Esophagoscopy. Foci of glycogen ocanthosis.

Staining with Lugol's solution 3%.

According to S. Yoshida, chromoesophagoscopy radically changes the unfavorable situation. Irrigation of the esophageal mucosa with Lugol's solution allows you to visualize invisible pathological foci, perform a targeted biopsy, obtain adequate biopsy material for morphological examination, clarify the true nature of the changed areas of the esophageal mucosa, plan and carry out treatment of the patient taking into account the real extent of the tumor, improve treatment results and prognosis of the disease . The use of this technique made it possible, by increasing the proportion of patients with early cancer, to increase the 5-year survival rate to 44%.

Rice. 55.Esophagoscopy. Visualization of invisible pathological foci.
Staining with Lugol's solution 3%.

The basis for active detection of esophageal cancer is dynamic endoscopic observation with repeated biopsies from areas of altered mucous membrane. Therefore, one of the modern screening methods for early diagnosis of cancer is esophagoscopy with vital staining of the esophageal mucosa.

Thus, a thorough assessment of changes in the esophageal mucosa using chromoesophagoscopy makes it possible to identify a significantly larger number of patients with early cancer. Endoscopic examination as a screening test to detect Barrett's metaplasia and early esophageal cancer is indicated for: patients over 40 years of age with symptoms of GERD for more than 3 years, patients with esophagitis, patients with esophageal stricture, patients after surgery on the esophagus and stomach. Conducting mass screening remains an unresolved problem. Today, it is advisable to identify risk groups and conduct dispensary observation. When identifying BE, a thorough search for dysplastic changes is carried out. If dysplasia is not detected, endoscopic examination is performed once a year. If low-grade dysplasia is detected, conservative therapy with repeated biopsies is prescribed. Detection of high-grade dysplasia is an indication for surgical treatment.

All patients with established esophageal cancer undergo tracheobronchoscopy. Since the wall of the esophagus within the mediastinum lacks a well-defined outer membrane, invasive tumor growth of the esophagus spreads quite early to the trachea and bronchi. The study is aimed at searching for the involvement of the walls of the tracheobronchial tree in the tumor infiltrate, as well as the presence of a possible malignant esophageal-respiratory fistula.

Objectives of tracheobronchoscopy:

1. Assessment of the condition of the mucous membrane of the bronchial tree.

2. Identification of narrowing of the lumen of the trachea and bronchi and the degree of its severity due to germination or compression from the outside by metastatic lymph nodes. If narrowing of the lumen of the trachea or bronchi is detected due to compression by the tumor by more than 1/3, the resectability of the tumor is very doubtful.

3. Determination of the distance to the tracheal bifurcation.

4. Detection of the primary multiplicity of the tumor process (damage to the bronchial tree by synchronous lung tumors).

Sonoesophagoscopy. In the early 1980s, Olympus Optical Co. Ltd. A fundamentally new diagnostic device was developed - an echoendoscope, which combined an ultrasound sensor and a flexible fiber endoscope. The research technique is called endoscopic ultrasonography - sonoesophagoscopy, synonyms: endosonography, echoendoscopy, endoscopic ultrasound, endo-ultrasound. The combination of standard endoscopic examination and sonography in a single diagnostic procedure allows the doctor, under visual control, to bring an ultrasound sensor to the object of study and obtain an echogram of not only the pathologically changed area of ​​the organ wall, but also, depending on the scanning frequency used, adjacent organs, lymph nodes and others anatomical structures.

When using echoendoscopes, it is possible to change the scanning frequency during the study from 5 to 20 MHz. High-frequency (15-20 MHz) scanning is more sensitive in determining the depth of tumor invasion, especially with superficial lesions (early cancer), but is inferior to low-frequency (5-12 MHz) in assessing the condition of regional lymph nodes.

There are also ultrasound probes passed through the biopsy channel of standard endoscopes. This study is especially valuable for narrowing of the esophagus of various etiologies. In turn, when using the probe technique of endoscopic ultrasound, scanning is performed only at high frequencies, which limits its diagnostic capabilities (Fig. 56).

Rice. 56.Endoscopic picture and endosonogram
with squamous cell carcinoma of the esophagus.

Ultrasound examination in the diagnosis of esophageal cancer with the development of intracavitary sensors is becoming much more important than computed tomography (CT), magnetic resonance (MRI) and positron emission tomography (PET). The accuracy of this technique for category T ranges from 77 to 92%, for category N - 50-88%. Endosonography is especially informative when describing tumors limited to the mucous and submucosal layer, that is, in cases where CT, MRI, PET cannot reliably reflect the tumor lesion.

When determining the condition of regional lymph nodes, the accuracy of endoscopic ultrasound is 81% (sensitivity - 95%, specificity - 50%). The priority of intracavitary ultrasound in determining the depth of tumor lesions in the early stages, when CT and MRI are not very informative, was especially noted.

The importance of differentiating the layers is that the likelihood of lymph node involvement increases dramatically for tumors that spread to the submucosal layer. When only the mucous layer is affected, metastases in the lymph nodes are usually absent, while when the submucosal layer is affected, the frequency of metastasis to the lymph nodes increases to 30-40%.

With radial scanning, the wall of the unchanged esophagus is uniformly 5-layered; some authors distinguish 7 layers. The first, thin hyperechoic layer represents the mucous membrane itself. Directly below it, a thin hypoechoic layer is visualized, which corresponds to the muscular plate of the mucous membrane. The next hyperechoic layer is the submucosa. The muscular layer of the esophagus is well defined as a hypoechoic layer, then the hyperechoic adventitia and surrounding tissues are visualized (Fig. 57). The layered structure of the esophagus with ESG is less clear than that of the stomach. Passive movement of the esophagus associated with breathing and cardiac function also distorts endosonograms to some extent.

Rice. 57.Endosonography. Radial scanning of the wall of the esophagus and the corresponding lining of the organ.

Collection of biopsy material for histology and cytology. Taking a fragment of tumor tissue for histological examination is an integral part of the endoscopic examination. However, not all patients can obtain morphological confirmation of the diagnosis. This is due to the fact that in a number of cases, predominantly submucosal tumor growth is observed. In such situations, a repeat esophagobiopsy is necessary.

Cytological examination of lavage water from the esophagus is very effective. Many authors believe that this method is more effective in diagnosing esophageal cancer than histological examination of a tumor biopsy. The value of cytological examination is especially great in the diagnosis of early esophageal cancer, when routine radiography and esophagoscopy are not able to identify specific signs of a tumor disease. In the absence of pronounced stenosis, it is also advisable to study the gastric lavage water, where desquamated cells from the esophageal tumor enter.

When analyzing the histological picture of biopsy samples of the esophageal mucosa, changes in the epithelium, expressed to varying degrees, can be detected. The epithelial layer rarely retains its usual thickness; this happens only with catarrhal esophagitis and the duration of the disease ranges from several months to 1-2 years. More often, epithelial atrophy and thinning of the epithelial layer are detected, but occasionally, along with atrophy, areas of hypertrophy of the epithelial layer can be detected. The layering of the epithelium is disrupted in places, while the epithelial cells (epitheliocytes) are in a state of dystrophy, expressed to varying degrees. In some cases, dystrophy ends with cell necrosis, especially pronounced in the superficial layers of the epithelium. The basement membrane of the epithelium in most cases retains its normal size, but in some patients it can be thickened and sclerotic.

Along with pronounced dystrophic-necrotic changes in the epithelium, vascular hyperemia is noted; in all cases, the number of papillae is significantly increased, and in most patients with a long history, the number of papillae is increased in direct proportion to the duration of the disease. In the thickness of the epithelium and in the subepithelial layer, focal (usually perivascular) and in some places diffuse lymphoplasmacytic infiltrates with an admixture of single eosinophils and polynuclear neutrophils are detected. Infiltrates are located both in the area of ​​the papillae and in the deeper layers under the epithelium, and disintegration of muscle fibers is noted. In some cases of long-term disease, vessels with symptoms of productive vasculitis may be found among the inflammatory infiltrates. The infiltrate, as a rule, is extremely polymorphic, dominated by monocytes, plasma cells, lymphocytes, macrophages, and in long-term esophagitis - fibroblasts. With actively ongoing esophagitis, the number of neutrophils turns out to be significant, and some of the neutrophils are found in the thickness of the epithelial layer inside the cells (leukopedesis of the epithelium). This picture can be observed mainly in the lower third of the epithelial layer. In isolated cases, along with neutrophils, interepithelial lymphocytes and erythrocytes are found.

The esophagus is part of the digestive system, the main functions of which are to move the bolus of food from the upper (laryngeal) zone to the diaphragmatic opening into the stomach.

This organ is a hollow intramuscular tube that pushes the lump towards the stomach through reflexive compression/relaxation of muscle areas or under pressure.

Some negative qualitative characteristics of food and/or liquid entering the esophagus can cause injury or burns, which can lead to the further development of a cancerous tumor.

Esophageal cancer is a malignant tumor that forms on the walls of the organ. The most common are lesions of its lower part (half of the cases), as well as the middle (40%), and the least common tumors are in the upper part (10%).

At the initial stages of growth, the cancerous formation does not manifest itself in any way (it is asymptomatic). And only at the stage of narrowing the lumen of the esophagus by half, the first signs appear in the form of difficulty swallowing.

There are three forms of esophageal neoplasia:

• first– tumors formed from squamous epithelium (97-98 percent);
• second– glandular neoplasms (adenocarcinoma);
• third– undifferentiated cancer.

The main factors that provoke tumor growth are hard, poorly chewed or too hot food, abuse of alcohol or its surrogates (which increases the risk of cancer by 12 times) and smoking (which increases the risk of the disease by 4 times).

Esophageal cancer accounts for about 6 percent of all cancers and most often affects men (4 times) at retirement age - 55-65 years. According to statistics, out of 10 thousand people, 7 people have this disease.

Types of examinations

To confirm suspicions of a malignant tumor of the esophagus, determine its classification, size, stage of development, as well as the possible onset of metastasis, a number of diagnostic measures are carried out.

The most effective ways to detect cancer are: testing the patient’s blood, X-rays with a contrast agent, tomography (computer, magnetic resonance and others), endoscopy and, of course, biopsy.

You can learn about the latest advances in the field of early diagnosis of esophageal tumors from the report of Professor M.Yu. Byakhova:

Blood tests

A general blood serum test is taken for laboratory testing of certain indicators that will indicate the presence of a malignant formation in the esophagus. These include:

• Hemoglobin level, a decrease to 130 g/l in men and 120 g/l in women indicates iron deficiency anemia, which is a characteristic symptom of esophageal tumors;
• ESR indicators(erythrocyte sedimentation rate), a significant increase in which is higher than normal (more than 20 mm/s for adults and elderly people), in the presence of other determining factors, will indicate cancer;
• Decreased eosinophils, which are a type of white cells (leukocytes). If the rate is less than 500 eosinophils per microliter, this confirms the possibility of neoplasia growth;
• Shift to the left of the leukocyte formula, which indicates the predominance of a certain type of leukocyte over others and indicates the development of an oncological process.

To clarify the diagnosis, the blood is also examined using immunodiagnostic methods to determine tumor markers, which are certain protein structures characteristic of oncological processes. Esophageal cancer is determined by the presence of the following antibodies: SCC, CYFRA 21-1, and TPA, the number of which increases as the disease progresses.

X-ray with barium

Due to the fact that it is not possible to distinguish the esophagus on ordinary x-rays, a special staining (contrast) substance is used to visualize its walls - a suspension of barium suspension. They begin taking pictures immediately with the first sip of liquid, and all the time as the organ fills.

The presence of a malignant tumor looks like this on the pictures:

• narrowing of the lumen of the food tube at the site of localization of formation, which often has an asymmetry character;
• filling defect with uneven (as if corroded) contours;
• focus of lack of peristalsis;
• accumulation of barium suspension over the narrowing;
• change in the relief of the mucous membrane.

Also, from the images it is possible to determine spastic (convulsive) phenomena, retroperistaltic movements and the throwing of barium into the respiratory organs due to the presence of a fistula.

The early stages of development of esophageal neoplasia on x-ray films will correspond to a small protrusion (similar to a step) with an overall smooth contour. In order to visualize the extent of the tumor, they use the method of throwing barium back into the esophagus from the stomach, which occurs in an oblique position.

CT (PET) and MRI

When diagnosing esophageal cancer, tomography shows high efficiency: computed tomography, magnetic resonance imaging and positron emission tomography. They allow you to visualize an organ with its possible pathologies in three-dimensional space, but are based on different operating principles.

MRI by layer-by-layer scanning of the esophagus based on harmless nuclear magnetic fields, combines and digitizes the obtained data, which makes it possible to obtain a real model of the organ.

It is possible to visualize pathological changes by different tissue reactions to the magnetic field. Thus, the location of the tumor, its size (from 1 mm in diameter) and possible metastases are determined with high accuracy.

MRI is a non-contact diagnostic method, which, if necessary, can be performed using a tinting (contrast) substance. But there are a number of contraindications for the procedure:

• the presence of metal implants (not only devices, but also rods and bolts);
• epileptic diseases (or convulsive seizures), which can complicate long-term (up to half an hour) stay in one position;
• the use of a coloring agent during pregnancy.

CT is based on the results of layer-by-layer x-rays, which are produced from a sensor rotating around the patient. Next, the information obtained from the thinnest slice images is compared in a computer, which makes it possible to accurately determine the condition, thickness and elasticity of the walls of the esophagus.

To improve imaging performance, a contrast agent is used. In this way, not only the presence/absence of a neoplasm is assessed, but also its size and the degree of spread to other tissues and organs. Similar conclusions are drawn based on:

• tumor component visualized in the lumen;
• displacement or change in the shape of the tracheobronchial tree, pericardium, aorta or other neighboring organs/tissues;
• spread beyond the border of the posterior plane of the trachea at the level of the aortic arch.

CT scan allows you to detect cancer in the early stages of formation.

PET (positron emission tomography) allows detection of tumors up to 2 mm in depth. This is thanks to a laser beam that is sent from a special emitter located at the end of the probe (endoscope). There is also an optical sensor that reads the received data and sends it for analysis.

This method is similar to ultrasound, but is injected directly into the esophagus and uses longer wavelengths, which makes it possible to accurately diagnose cancer at a preclinical stage of development, without resorting to a biopsy.

Endoscopy

Endoscopy (esophagoscopy or esophagogastroduodenoscopy) of esophageal cancer is carried out by introducing a flexible hose (probe) with a backlit camera at the end into the patient through the mouth under local anesthesia.

The endoscope is also equipped with a special device for collecting material from the mucous membrane (biopsy) for the purpose of its subsequent examination. In this case, the esophagus, stomach, and then the duodenum are simultaneously checked from the inside. The resulting image is displayed on the monitor.

Endoscopy has two sections: the first is the identification of a spread tumor, which is already clinically manifested; the second is the detection of cancer in the early stages, which is asymptomatic.

The first section does not imply difficulties in diagnosing a neoplasm, which looks like an exophytic growth (pedunculated inside the lumen), saucer-shaped ulceration, or an infiltrative tumor widespread in the submucosal layer and stenosing the lumen without visual manifestation.

You can see what a tumor looks like on an endoscope camera in this video:

Whereas in the early stages, esophageal cancer is characterized by an asymptomatic course with minimal mucosal lesions, which can visually be interpreted as inflammation. In this case, you can increase the effectiveness of the method using:

1. studying the smallest changes in the mucosa membranes with mandatory biopsy;
2. use of ultrasound endoscopes (endosonography) to determine the depth of neoplasia and the presence of metastases in regional lymph nodes;
3. use of chromoendoscopy(using vital dyes), which allows you to confirm the size and nature of the lesion;
4. endoscopic microscopy, which, using multiple image magnification, allows you to examine visual changes in the mucous membrane;
5. endoscopic optical coherence tomography, which uses light waves (infrared rays) to study the cellular structure of the formation and its depth (up to 2 mm), without resorting to a biopsy, since the emitter with an optical sensor is mounted directly at the end of the probe.

Thus, endoscopy makes it possible to study a parietal neoplasm, a cancerous ulcer, a circular structure and a limited focus of wall infiltration, being one of the most effective methods for diagnosing esophageal cancer.

Biopsy

A diagnostic method such as esophageal biopsy provides a 95% guarantee of detecting a malignant tumor. The biomaterial is taken during esophagoscopy and examined by a specialist pathologist under a microscope, which allows one to confirm or exclude the presence of a tumor, as well as establish its type.

Before the endoscopy procedure with biomaterial collection, you must:

• examine the pharynx, larynx, esophagus and stomach using x-rays to clarify their anatomical features and the absence of contraindications;
• don't eat within eight hours;
• rinse the stomach(using a probe).

The possibility of injuring the mucous membrane of the organ is minimal, since the procedure is carried out under strict visual control. But sometimes bleeding is observed at the site where the material is taken, which can be controlled with hemostatic drugs.

There are several diagnostic methods:

• X-ray examination;
• esophagoscopy;
• laparoscopic diagnostics;
• ultrasound examination.

Radiography

The main method for diagnosing esophageal cancer is X-ray examination. When using it, it is possible to determine what form the disease is and what the extent of tumor formation is. Also carry out localization and determine the occurrence of complications.

During a standard examination of the chest, the esophagus is not visible as a separate organ; everything merges into one mass. To solve this problem, they began to use only X-ray examination of the esophagus. We found a special method in which contrasting solutions are used that do not allow the passage of the sent rays.

One of them is barium sulfate. The patient drinks it, then an X-ray is immediately taken, in which the outlines of the esophagus are clearly visible.

If there is a malignancy, the outline will be changed and this will be clearly shown. Therefore, if a diagnosis of esophageal cancer is suspected, X-ray reading is an effective diagnostic method.

X-ray of the esophagus with barium

Endoscopy

When esophageal cancer is detected, diagnosis is also carried out by esophagoscopy. Using this method, it is possible to clarify the location of the tumor formation and determine its size. In addition, you can find out the background condition of the esophageal mucosa and the multiplicity of lesions.

In many cases, endoscopy examines the stomach, esophagus, and duodenum at the same time. The patient undergoing endoscopy is exposed to local anesthesia.

Then the device is placed in the patient’s throat, it enters the esophagus, stomach, and duodenum. Thus, it becomes possible to check all human organs from the inside. On one side of the device there is a video camera with backlight. The image obtained during the examination appears on the monitor. This makes it possible to examine every millimeter of the esophagus.

Esophageal endoscopy procedure

The endoscope also has a device that can be used to take a sample of skin tissue.

Today, endoscopy is considered a reliable way to detect esophageal cancer in the early stages.

Video: Preparing for endoscopy. Diagnosis of cancer

Positron emission tomography

This diagnostic method allows you to see the structure of tissue up to two millimeters deep. An endoscope is used for this examination. It is equipped with an emitter that sends out a laser beam and a special optical sensor that receives the reflected signal and sends it for analysis.

Endoscopic tomography is similar in its method to ultrasound. The only difference is the use of waves. Endoscopic tomography uses light waves. This radiation is absolutely safe. Light waves have such a length that allows a diagnosis to be made. Even during the onset of the disease, it is possible to recognize esophageal oncology.

Positron emission tomography of the esophagus

Tumor markers for esophageal cancer were found in the following types: CYFRA 21-1, TPA, SCC. The level of their indications increases in the last stage of the disease, however, not in all patients. Their growth is accompanied by an increase in other pronounced symptoms.

Analysis for tumor markers

Ultrasound examination

The doctor prescribes it to determine the shape of the lymph nodes, to see if they are enlarged. To assess the spread of the tumor, its internal wall state.

Laparoscopic diagnosis

This examination is carried out to confirm or refute the spread of metastases to the liver and abdominal cavity.

Clarifying the diagnosis

After the diagnosis is completed, a number of examinations are carried out to help determine the stage of the disease and the extent of tumor spread:

1. checking the condition of the lungs with radiography. This test will show whether there are metastases there;
2. computed tomography will determine the boundaries of the esophageal lesion and show whether the tumors are growing into other organs that are located nearby;
3. A bronchoscopy is performed by a doctor to examine the patient's airways. This examination method will show whether the pathology has spread to the larynx and bronchi.

Tests for esophageal cancer

To determine the correct diagnosis of esophageal cancer, a blood test is taken to check: find out the ESR level, check the number of eosinophils. This is checked by taking a general blood test. It will also show hypochromic anemia.

Urine analysis shows by its density the development of oliguria.

When making a presumptive diagnosis: esophageal cancer, tests are taken from the walls of the esophagus to detect an oncological formation. This analysis is called histological.

Video: Esophageal cancer - diagnosis and treatment methods

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Diagnosis of esophageal cancer

Esophageal cancer can be detected by endoscopic or contrast X-ray examination of the esophagus, but a definitive diagnosis can only be made after histological examination of tumor samples.

Radiography

In a standard chest x-ray, the esophagus merges with the surrounding organs - it is not visible in the final image. To solve this problem, a method of radiography of the esophagus was developed - for this procedure, contrast solutions are used that do not transmit x-rays. The most commonly used solution is barium sulfate, a thick white liquid.

The patient drinks the solution, while an X-ray is taken. The resulting image clearly shows the barium solution, which follows the contours of the stomach and esophagus. If there is an oncological lesion of the esophagus, the relief of its contours changes significantly, as can be seen in the image.

Endoscopy

An endoscopic examination of the esophagus is called esophagogastroduodenoscopy (EGD). In most cases, during this procedure the esophagus, duodenum and stomach are examined simultaneously. The examination is performed under local anesthesia.

The doctor inserts an endoscope through the patient's mouth and passes it into the pharynx, esophagus, stomach and duodenum, which allows one to examine the inner surface of these organs. An endoscope is a thin and flexible hose equipped with a video camera and lighting at the end. The resulting image is displayed on a monitor, which allows for a detailed examination of every centimeter of the esophagus.

In addition, the endoscope is equipped with a device for taking tissue samples. At the moment, endoscopic examination and subsequent biopsy is the only method that makes it possible to absolutely reliably determine esophageal cancer at an early, asymptomatic stage.

Endoscopic optical coherence tomography

A method that allows the doctor to see the cellular structure of the patient’s tissues to a depth of 2 millimeters. To carry out the examination, an endoscope equipped with a special emitter and an optical sensor is used. The emitter sends an infrared laser beam, and the sensor receives the reflected signal and transmits information for analysis.

The principle of the study is similar to ultrasound, but light waves rather than sound waves are used. Infrared radiation is harmless to tissue, and the wavelength makes it possible to make a diagnosis without resorting to a biopsy. The method makes it possible to detect esophageal cancer at the preclinical stage.

Determination of blood marker levels

This technique is based on identifying special substances in the patient’s blood that the tumor secretes. For esophageal cancer, markers CYFRA 21-1, TPA, SCC were identified. But, unfortunately, the level of these markers increases in only 40% of patients with esophageal cancer and, as a rule, such an increase is observed only in the later stages of the disease, accompanied by a large number of other, more obvious symptoms.

The discovery of markers suitable for detecting cancer at a preclinical stage is one of the subjects of modern research.

Clarifying the diagnosis

After esophageal cancer is diagnosed, doctors conduct a number of additional examinations necessary to determine the stage of the pathological process and the boundaries of damage to the esophagus:

• Chest X-ray. Allows you to determine the presence of distant metastases in the lungs;
• X-ray of the esophagus. Makes it possible to determine the size of the tumor and the areas of the esophagus affected by the disease;
• Computed tomography (CT). Allows you to determine the boundaries of damage to the esophagus, detect lymph nodes and organs affected by metastases, and also suspect the growth of a tumor into neighboring organs;
• Ultrasound. For esophageal cancer, it is used to detect metastases in distant lymph nodes and in the abdominal organs;
• Endoscopic ultrasound. An endoscope equipped with an ultrasound sensor is inserted into the patient's esophagus. This allows you to determine the depth of growth of the tumor and identify the affected lymph nodes. Also, under ultrasound control, you can go through the wall of the esophagus with a thin needle and take a biopsy of the affected lymph node;
• Bronchoscopy. Using an endoscope, the doctor examines the patient's airway. In this case, a thinner endoscope is used, which can be inserted both through the mouth and through the nose. The larynx, pharynx, trachea, bronchi and vocal folds are sequentially examined. For esophageal cancer, this method makes it possible to determine the spread of the pathological process to the bronchi or trachea;
• Positron emission tomography (PET). A study that allows you to determine all malignant neoplasms present in the patient’s body that are larger than 5-10 mm. The importance of PET in the diagnosis and treatment of esophageal cancer is currently the subject of a number of studies.

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Methods for diagnosing esophageal cancer at an early stage

Like any oncology, esophageal cancer is a serious illness with serious consequences. A favorable prognosis is possible only if it is detected at the preclinical stage. Therefore, timely diagnosis is extremely important. There are a number of methods for this.

Oncology of the esophagus is confirmed based on the results of several examination methods.

Diagnosis of early stage esophageal cancer

Timely detection of esophageal cancer is difficult. This is explained by the asymptomatic nature of the process and the small number of effective methods for diagnosing preclinical stages. Therefore, it is important for people with a high risk factor to undergo regular examinations and examinations in order to timely detect a tumor and differentiate it from other pathologies.

If a diagnosis of Barrett's esophagus was previously made, when the normal squamous epithelium of the walls is replaced by columnar epithelium, the patient must undergo endoscopy every few years to take a biopsy from suspicious areas of the organ's mucosa, since the condition is precancerous.

Once a year you need to undergo an examination if cell dysplasia (improper development of mucosal tissue) is detected. If the condition is severe, partial removal of the esophagus is indicated, which reduces the risk of malignancy (transformation into cancer).

Diagnostic methods

If you notice symptoms of esophageal cancer, you should contact your family physician. After examination and general tests, the doctor will refer the patient for a consultation with an oncologist. Common diagnostic methods include:

1. physical examination with palpation of the abdomen, lymph nodes in the neck in the axillary region;
2. window tests;
3. X-ray examination;
4. endoscopic methods (esophagoscopy, etc.);
5. minimally invasive diagnostics (laparoscopy);

X-ray with barium

X-ray with a contact substance is used because of the difficulty of viewing the contours of the esophagus.

Since visualization of the contours of the esophagus is difficult on general x-rays, the use of a contrast agent in the form of a barium suspension is recommended. The patient should drink a white, chalky liquid. With the first sips, a series of pictures will be taken as the esophagus fills with the suspension. Barium will color the contours of the inside walls of the digestive system. This will allow you to visualize the inner edges of the tumor.

After the examination, the patient may experience constipation and white stool. This phenomenon is considered normal and does not require treatment.

If esophageal cancer is detected, other tests will be needed to assess how far the disease has spread.

Metastases are often found in the liver, lungs, stomach, and lymph nodes.

Endoscopy

The essence of the technique:

1. a thin tube made of flexible material - a probe - is inserted into the esophagus;
2. the internal walls of the esophagus are examined with a camera that is attached to the end of the endoscope;
3. if a suspicious area is detected on the mucosa, tissue is taken for further histological examination;
4. When a pathological narrowing is detected, the esophagus is dilated.

As the examination proceeds, the doctor decides which treatment tactics to choose.

CT and MRI

Computed tomography is a highly effective diagnostic method; it can be used to detect a tumor as small as 1 mm and identify metastases. The essence of the technique: layer-by-layer examination of the internal structure of the esophagus.

Magnetic resonance imaging is designed to create images of soft tissue by applying a powerful magnetic field. Allows you to obtain a more accurate image than in CT images.

PAT

Positron emission tomography allows you to study the structure of tissues at a depth of up to 2 mm. For these purposes, an endoscope with an emitter is used. The study is carried out with laser beams. The device is equipped with a powerful optical system that receives the reflected signal from the walls of the organ and sends it for analysis.

The essence of the endoscopic tomography technique is similar to ultrasound examination with a difference in the length of the waves used. PET scan uses laser light waves, which are safe for the body. The wavelength of the light waves allows for an accurate diagnosis in the preclinical stages.

Endosonography

A complex technique using an endoscope and an ultrasound scanner. The probe is inserted into the patient's throat, and an ultrasound sensor attached to the device scans the inner walls of the esophagus. The method allows you to assess the extent of the spread of cancer cells on the surface of the organ mucosa.

Tumor marker test

There are several types of antibodies for esophageal cancer: CYFRA 21-1, TPA, SCC. Their concentration increases as oncology develops, but not in every patient. Typically, an increase in the number of tumor markers in a blood test is accompanied by an increase in other signs of cancer.

Ultrasound

Ultrasound examination is used to assess the condition of the lymph nodes, which are primarily affected by cancer. The extent of the tumor and its condition are also assessed.

EOCT

Endoscopic optical coherence tomography is used to assess the state of the cellular structure of tissues at a depth of up to 2 mm. The technique provides the opportunity to detect cancer at a preclinical stage. The procedure is performed using an endoscope equipped with an infrared emitter and an optical sensor. The essence of the technique is similar to ultrasound scanning. But the infrared radiation used is harmless to the body, and the wavelength makes it possible to make a diagnosis without taking a biopsy.

Laparoscopy

The minimally invasive technique is performed under general anesthesia. To do this, the following manipulations are carried out:

1. a small incision is made in the abdominal wall;
2. a flexible probe with a camera is inserted through the hole;
3. the surgeon examines the insides for signs of cancer spreading;
4. After the procedure, the wounds are sutured.

The test is performed if cancer is suspected in the lower part of the esophagus and if metastases are suspected in other internal organs.

Clarifying the diagnosis

Clarifying the oncology of the esophagus often requires examining the condition of other organs.

To determine the exact stage and severity of cancer, the following examinations are carried out:

• X-ray examination of the lungs, which allows to exclude metastases;
• CT scan, performed to determine clear boundaries of damage to the esophagus and assess the degree of tumor ingrowth into nearby organs and tissues;
• bronchoscopy, performed to examine the respiratory tract for cancer metastasis to the larynx and bronchi.

Laboratory research

Additionally, general tests are performed, such as:

• blood serum examination for ESR, eosinophil concentration, anemic signs;
• assessment of the condition of urine and feces taken to determine the general condition of the body and assess the density of the development of oliguria;
• histological examination of tissue from the inner walls of the esophagus to detect cancer cells, the condition of which determines the type of cancer.

Differentiation

Differential diagnosis of esophageal cancer is carried out between cancer and benign tumors, precancer, polyps, ulcers, tuberculosis, syphilis, papilloma, esophageal spasms, burns, fibroids.

pishchevarenie.ru

Endoscopic diagnosis of esophageal cancer

UDC 616.329-006.6-072.1

B. K. Poddubny, Yu. P. Kuvshinov, A. N. Gubin, G. V. Ungiadze,

O. A. Malikhova, I. P. Frolova, S. S. Pirogov

ENDOSCOPIC DIAGNOSTICS OF ESOPHAGAL CANCER

RONC named after. N. N. Blokhin RAMS, Moscow

Esophageal cancer (EC) is a common type of malignant tumor and has a poor prognosis, which is primarily due to its late diagnosis. Despite the successes of surgical, radiation and drug treatment, 5-year survival rate for RP remains low. The vast majority of patients seek medical help for dysphagia of varying severity, which indicates a significant prevalence of the tumor process.

Currently, the leading method for diagnosing RP is endoscopic, which allows visual assessment of the nature of the process and its prevalence. It is necessary to distinguish two fundamentally different sections of endoscopic diagnosis of RP: the first is the diagnosis of widespread RP with clinical manifestations, the second is the identification of early asymptomatic RP.

Endoscopic diagnosis of advanced RP in most cases does not present difficulties, since its semiotics are well known. According to the modern classification proposed by the Japanese Society for Diseases of the Esophagus in 1992, there are 5 macroscopic types of esophageal cancer: exophytic, ulcerative, ulcerative-infiltrative, diffuse-infiltrative and mixed (unclassified type).

During endoscopic examination, RP is determined in the form of exophytic growths, a saucer-shaped lesion or ulceration with tumor infiltration, stenosing the lumen of the esophagus. Targeted biopsy, according to our data, provides morphological confirmation of the diagnosis in more than 90% of cases. Difficulties in differential diagnosis may arise with the diffuse-infiltrative type of RP, when the tumor spreads proximally along the submucosal layer, leading to stenosis of the esophageal lumen in the absence of a visually detectable tumor. In such cases, a biopsy of the proximal border of the stenotic portion of the esophagus reveals normal squamous epithelium. In this situation, it is necessary to perform a biopsy of more distal parts of the esophagus, passing the forceps into the stenotic area blindly. This must be done with caution, since it is not always possible to obtain informative material, and in the presence of a deep ulcerative defect, perforation of the esophagus is possible. If it is impossible to confirm the diagnosis using a “blind” biopsy, the lumen of the stenotic area of ​​the esophagus is expanded using laser, electrical or combined destruction, and then a targeted biopsy is performed.

© Podtsubny B.K., Kuvshinov Yu.P., Gubin A.N., Ungiadze G.V., Malikhova O.A., Frolova I.P., Pirogov S.S., 2003

Diagnosis of early forms of RP presents significant difficulties due to the asymptomatic course and minimal changes in the mucous membrane of the esophagus. The latter are not detected during standard examination using an optical endoscope or are interpreted as inflammatory. According to our data, over the past 10 years, the endoscopic diagnosis of “early RP” based on visual data was made in only 7 patients. During morphological examination it was confirmed in 2 patients.

Early, or superficial, RP includes tumors with invasion no deeper than the submucosal layer. In accordance with the classification of the Japanese Society for Diseases of the Esophagus, there are 6 degrees of invasion of the superficial esophagus (Fig. 1).

Rice. 1. Depth of invasion in superficial RP.

t 1 - tumor within the epithelium; T2 - invasion within the lamina propria of the mucous membrane; TZ - the tumor reaches the muscular plate of the mucous membrane; eggI - invasion within the upper third of the submucosal layer; et2 - invasion within the middle third of the submucosal layer; et3 - the tumor occupies most of the submucosal layer, but does not reach the muscular layer.

According to most experts, significant improvement in the results of endoscopic diagnosis of early RP can be achieved only if the following conditions are met:

1) a thorough visual assessment of minimal changes in the mucous membrane of the esophagus with mandatory biopsy;

2) the use of vital dyes (chromoendoscopy) during endoscopic examination to clarify the nature and size of the lesion;

3) use of ultrasound endoscopes to assess the depth of tumor invasion and identify metastases in regional lymph nodes;

4) the use of “endoscopic microscopy” techniques using modern electronic endoscopes that provide multiple image magnification;

5) development of new promising techniques (optical coherence tomography, fluorescence endoscopy, etc.).

In accordance with the classification of superficial RP, proposed in 1992 by the Japanese Society for Diseases of the Esophagus, there are 3 macroscopic types: elevated, flat and indented (Fig. 2). The second type of superficial RP is divided into 3 subtypes:

Rice. 2. Macroscopic types of superficial RP.

I - towering; II - flat; III - in-depth.

1) superficially elevated, when there is a slight thickening of the mucous membrane;

2) flat, when only a change in the structure and color of the mucous membrane is determined;

3) superficial-in-depth, when changes in the form of flat erosion are detected.

The detection of changes corresponding to types I and III allows us to speak with a sufficient degree of confidence about the presence of superficial RP. Meanwhile, with II, flat, type of superficial RP, significant diagnostic difficulties are usually observed. Often, the endoscopist interprets the detected changes as inflammatory and does not perform a targeted biopsy.

In recent years, various techniques have begun to be used to increase the efficiency of endoscopic diagnosis of superficial RP. The most common and cheapest is vital staining of the esophageal mucosa with Lugol's solution. The method is based on staining squamous epithelial cells containing glycogen brown. Areas devoid of normal epithelium due to scar-inflammatory changes or tumor growth are not stained. Lugol's solution was first used in 1933 by Shiller to diagnose cervical cancer. This technique was used in 1966 by Voegeli, and in 1971 G. Brodmerkel reported its successful use for diagnosing esophageal pathology. Lugol's solution contains glycerin. The viscosity of the latter makes it difficult to use the solution for staining the esophageal mucosa. A solution similar to Lugol's solution but without glycerol has been proposed for endoscopy by Yoshida in Japan, Lambert in France, and Lightdale in the United States.

The research methodology is as follows. After cleaning the mucous membrane with isotonic sodium chloride solution or soda solution, it is stained with 1.5-3.0% aqueous Lugol's solution using a special catheter with a spray at the distal end. Immediately after treatment, the unchanged esophageal mucosa turns dark brown, while the changed areas remain unpainted. Thus, despite its nonspecificity, this method makes it possible to identify minimal pathological changes in the esophagus for subsequent in-depth study. This significantly increases the possibility of early detection of RP.

Assessing minimal changes in the mucous membrane of the esophagus using chromoesophagoscopy allows, according to B. Vas1^a, to radically change the current situation. When analyzing the results of treatment of RP from 1965 to 1994, it was noted that in parallel with the improvement in the diagnosis of superficial RP, the 5-year survival rate of patients also increases. Over the past 5 years analyzed by the author, the detection rate of superficial RP has reached 42%, and the 5-year survival rate for RP has reached 44%. Of the 241 patients who were diagnosed with superficial RP over the past 10 years, in 102 the tumor was located intraepithelially or within the mucosa. These results became possible due to the widespread use of staining the mucous membrane of the esophagus with Lugol's solution to detect superficial changes that are nonspecific at first glance.

The use of special ultrasound endoscopes or ultrasound probes passed through the biopsy channel of the endoscope allows, depending on the frequency of ultrasound, to study the fine structure of the wall of the esophagus, as well as the periesophageal region to a depth of 6-10 cm. Comparison of high-frequency (15-20 MHz) ultrasound probes, carried out through the biopsy channel, with conventional echoendoscopes (7.5-12 MHz) showed that the former provide more valuable information about the condition of the esophageal wall, inferior to the latter in assessing the condition of the lymph nodes.

Using an ultrasound probe, 11 layers of the esophageal wall can be identified. The diagnostic accuracy is generally 75%, and the differential diagnosis of lesions of the mucous and submucosal layers is 94%.

N. "Nayaschyaa et al., comparing the results of diagnosing superficial RP using ultrasound probes and endoscopes, showed that the reliability of determining the depth of invasion with their help is 92 and 76%:

86 and 71% for invasion within the mucous membrane, 94 and 78% for invasion within the submucosal layer, respectively. When assessing the condition of the lymph nodes, the diagnostic accuracy was 56 and 67%, respectively.

N. Uovykape et al. , using ultrasound endoscopy in early RP, showed that with invasion within the mucous membrane of the esophagus, in no case was damage to the lymph nodes or vascular invasion observed, while with invasion within the submucosal layer, metastases in the lymph nodes were detected in 71% of patients, invasion lymphatic and blood vessels - in 58 and 21%, respectively.

A promising direction in the diagnosis of early RP is the use of magnifying endoscopes. This brings endoscopic examination closer to intravital microscopy and makes it possible to determine changes characteristic of early cancer that are inaccessible for study using standard endoscopes.

N. 1poie et al. , combining chromoscopy with the use of endoscopes from 01utrsh (Japan), providing 80-150-fold magnification, revealed characteristic changes in the capillary pattern in esophagitis, dysplasia and early RP. In dysplasia and RP, vascular changes were combined with the absence of staining of the altered

areas with Lugosch solution, which, according to the authors, is a sensitive and specific method for diagnosing dysplasia and early RP (Fig. 3).

A new promising direction is endoscopic optical coherence tomography, based on identifying the optical heterogeneity of tissues by measuring the backscattering of low-intensity infrared radiation in 2 planes, followed by computer processing and obtaining cross-sections of the mucous membrane with a penetration depth of up to 1 mm and a resolution of up to 10 μm. Irradiation of the surface and capture of the reflected signal is carried out using a sensor inserted into the esophagus through the biopsy channel of the endoscope. B. Iak1e et al. , having studied the normal structure of the esophageal wall using endoscopic optical coherence tomography, reported that they were able to identify all layers of the esophageal wall down to the muscular layer, namely: epithelium, lamina propria and muscularis mucosa, submucosal and muscular layers. The picture obtained from this study is similar to an ultrasound image, but

Type 1 (normal)

Normal intrapapillary capillaries

loops against the background of stained esophageal mucosa

Type 2 (esophagitis)

Lengthening and expansion of intrapapillary capillary loops against the background of stained esophageal mucosa

Type 3 (moderate dysplasia)

Minimal changes in intrapapillary capillary loops against the background of unstained mucosa

Type 4 (severe dysplasia)

Pronounced changes in intrapapillary capillary loops (2-3 signs characteristic of type 5 changes) against the background of unstained mucosa

Type 5 (cancer)

Pronounced changes in intrapapillary capillary loops against the background of unstained mucosa: expansion; winding passage; uneven thickness different shape

Rice. 3. Changes in intrapapillary capillary loops in esophagitis, dysplasia and early RP.

provides more detailed information due to greater resolution. Images consistent with esophagitis, esophageal dysplasia, and RP were later obtained. According to the authors, the ability to analyze the fine structure of the esophageal wall and identify changes specific to precancerous conditions and tumors significantly increases the efficiency of endoscopic examination and identifies areas for targeted biopsy with high reliability. This method is undoubtedly promising, but requires further development and accumulation of material.

A promising method for early diagnosis of RP is fluorescent endoscopy. This study is based on recording the fluorescence of endogenous fluorophores or exogenous photosensitizers introduced into the body and accumulating predominantly in tumor tissue. Fluorescence is caused by light of different wavelengths. Among the endogenous fluorophores, collagen, NAD/NADP, flavins, tryptophan, elastin, porphyrins, lipofuscin, etc. should be noted. Of greatest clinical importance is the determination of the fluorescence intensity of endogenous porphyrins, the concentration of which in the tumor is 2-4 times higher than in normal tissues. Depending on the type of fluorophore, the wavelength of the excitation light ranges from 300 to 450 nm, while the wavelength of the emitted radiation is 359-600 nm. When studying the fluorescence of endogenous porphyrins, the excitation light is in the blue range, and the fluorescence is in the red range. Lasers are mainly used as a source of exciting light, making it possible to obtain fairly intense radiation of a narrow spectrum. The use of exogenous photosensitizers increases the sensitivity of fluorescent diagnostics. Derivatives of hematoporphyrins and 5-aminolevulinic acid are most often used as photosensitizers. Spectral analysis of fluorescent radiation using special probes passed through the biopsy channel of the endoscope allows one to obtain accurate qualitative and quantitative characteristics of this radiation.

Literature data on fluorescent endoscopic diagnosis of RP, dysplasia and adenocarcinoma of early stages against the background of Barrett's esophagus indicate the high sensitivity and specificity of this method. A high correlation was noted between fluorescent diagnostics of RP and the results of morphological examination of biopsy material.

Thus, modern endoscopic diagnostic methods open up the possibility of significantly improving the diagnosis and precancerous changes in the mucous membrane of the esophagus and esophagus, which is the main condition for its radical treatment. Early diagnosis of RP creates the prerequisites for (subject to certain conditions) organ-preserving endoscopic interventions, such as endoscopic resection of the esophageal mucosa and photodynamic therapy, which are gaining an increasingly strong position in clinical oncology.

LETTER OF THE TOUR

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There is increasing dysphagia - difficulty passing food through the esophagus.

If at first discomfort is noted only when eating dry and rough foods, then over time difficulties arise even when swallowing liquid cereals and liquids.

Other signs of esophageal cancer are coughing, frequent choking while eating, hoarseness, and enlarged lymph nodes: cervical and supraclavicular.

These signs do not necessarily indicate esophageal cancer, but should be a reason to immediately contact a specialist. It must be remembered that the success of treatment for esophageal cancer directly depends on timely diagnosis of the pathology and high-quality therapy.

In diagnostic measures for suspected esophageal cancer, the main role is given to radiography of the esophagus, as well as esophagoscopy with.

X-ray of the esophagus

X-rays of the esophagus are carried out using contrast solutions (most often barium sulfate) that do not transmit x-rays. The patient is asked to drink the solution, and at this moment an x-ray is taken. On an x-ray, barium clearly outlines the contours of the organs being examined. If the esophagus is affected by a malignant tumor, the contour relief of the affected area changes significantly.

X-ray examination allows:

Detect the area of ​​​​the tumor lesion,
- determine its location and size,
- determine the growth form of the neoplasm - exophytic, endophytic or mixed growth form,
- detect narrowing and expansion of the lumen of the esophagus,
- identify ulcerations in the area of ​​the neoplasm with an accurate determination of their size, depth of invasion,
- identify concomitant pathologies of the esophagus (diverticula, hiatal hernia, reflux esophagitis, etc.).

Esophagoscopy

Esophagogastroduodenoscopy (EGDS), esophagoscopy or endoscopy of the esophagus is carried out using an endoscope - a thin, long and flexible tube with a lighting device and a miniature video camera at the end. The device is inserted through the patient's mouth into the pharynx and esophagus under local anesthesia. The device allows you to carefully examine the mucous membranes of these organs and assess the depth of tissue damage by the tumor.

The video image is transmitted to the other end of the device and displayed on the monitor screen. Endoscopic examination in modern medicine is the only reliable way to diagnose an esophageal tumor at the onset of the disease, when it is asymptomatic.

The endoscope, in addition to this, has a device for taking a piece of tumor tissue for further study in the laboratory.

Biopsy

A biopsy is the removal of tumor tissue for further histological and cytological studies. For esophageal cancer, the biopsy procedure is performed during esophagogastroduodenoscopy. Analysis of a tissue sample allows you to confirm or refute the presence of cancer and identify its type. The study also makes it possible to detect diseases in the esophagus that precede the development of diseases.

Endoscopic optical coherence tomography

Endoscopic optical coherence tomography is an innovative technique for diagnosing esophageal cancer; is carried out using an endoscope equipped with a special emitter that emits infrared radiation into the tissue being examined, and a sensor that receives the reflected signal and transmits it to a computer for processing and analysis. Since different tissues reflect waves differently, the method makes it possible to study the structural features of internal organs. The operating principle of the device is reminiscent of the operation of an ultrasonic scanner, with the only difference being that it uses light rather than ultrasonic signals.

Endoscopic optical coherence tomography is absolutely harmless to the body. The method allows you to obtain a highly accurate image of the structure of tissue cells and detect esophageal cancer at the earliest stages.

Determination of blood marker levels

The method is based on special substances (markers) indicating the presence of a tumor. To date, the following tumor markers have been identified for esophageal cancer - CYFRA 21-1, TPA, SCC. However, the content of these markers in the blood is increased only in a part of people suffering from esophageal cancer, and increased levels are observed at advanced stages of the process, when the disease is easily detected by other methods. Unfortunately, this diagnostic method does not work for early, asymptomatic stages of the disease. Today, scientists are working to identify other, more informative markers.

Additional diagnostic methods

After a malignant process is detected in the esophagus, additional studies are prescribed to identify the boundaries of the esophageal lesion and the affected area outside the organ. For this, the following diagnostic measures are used:

Chest X-ray - the technique allows you to detect in,

It is carried out using many methods, the most widely used are x-ray examination, endoscopic examination, computed tomography and others.

X-ray diagnosis of esophageal cancer

The nature of tumor growth (exophytic, infiltrative or primary ulcerative form) determines the radiological picture. With exophytic cancer growing into the lumen of the esophagus, a filling defect is determined, varying in length and depth, with uneven, jagged contours. The mucous membrane at the level of the defect is not traced; the relief is represented by shapeless accumulations of contrast material, which fills the depressions on the tuberous surface of the tumor. There is no peristalsis at the level of the esophageal lesion. In oblique projections, against the background of the posterior mediastinum, according to the location of the tumor, a sharply thickened wall of the esophagus of the periesophageal soft tissue “muff” is visible.

In the infiltrating form of cancer, the wall is rigid and straightened. If the infiltration is one-sided, then when examining with thick barium, the expansion of the lumen occurs due to the opposite side. When the tumor spreads to all walls, sometimes a uniform, and more often an asymmetrical concentric narrowing is revealed. With a limited extent of the process and a small degree of narrowing, the rapid passage of the contrast mass when examining the patient in an upright position does not allow one to detect such changes. A detailed study of the walls of the esophagus is possible only in a horizontal position. With infiltrative tumor growth, also against the background of the mediastinum in oblique projections, it is possible to see a tumor “sleeve” around the esophagus. These changes are especially clearly revealed during tomographic examination in conditions of pneumomediastinum. In the primary ulcerative form, a flat barium depot is determined that does not extend beyond the contour of the esophagus. These changes are revealed when the affected area is outlined; otherwise, flat ulcerations may be mistaken for a groove between the folds. In these cases, diagnosis of esophageal cancer must be made by slowly rotating the patient around a vertical axis, using vertical and always horizontal positions.

With a combination of exophytic and infiltrative growth, the x-ray picture consists of features inherent in each type. Tumors of the esophagus, growing extraesophageal and disintegrating, give fistulas in the trachea and bronchi. However, the finding of traces of barium in the bronchial tree does not allow us to categorically speak in favor of an esophageal-tracheal or esophageal-bronchial fistula, since disturbances in the act of swallowing due to paralysis or paresis of the laryngeal nerve can lead to the entry of a contrast mass into the airways.

Endoscopic diagnosis of esophageal cancer

In all cases of diagnosing esophageal cancer, it is necessary to resort to esophagoscopy, in which the diagnosis can be made based on examination of the esophagus and biopsy. Morphological verification of the diagnosis is necessary to select an adequate treatment method. During esophagoscopy, a cancerous tumor often appears as a cyanotic tumor with a gray coating or a pale, sometimes disintegrating and easily bleeding mass that covers the lumen of the esophagus. In ulcerative forms of cancer, the edge of the ulcer is visible with dense, rigid edges and decay. The walls above the ulcer are often infiltrated. examination of tissue taken from the tumor makes it possible to make a definitive diagnosis of esophageal cancer. Sometimes, during esophagoscopy, direct signs of the disease (tumor or ulcer) cannot be seen. This happens with pronounced submucosal infiltration by the tumor. In such cases, the organ wall infiltrated above the main mass of the tumor looks pale, compacted, without folds and inactive.