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Cervical Esophageal Cancer

What to Expect at Your Doctor’s Visit

Step 1: History

First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.

Your doctor might ask questions such as:

  • How long has the problem been there?
  • Is it getting worse, better or staying the same?
  • Does it come and go?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have numbness or tingling anywhere in your face or mouth?
  • Do you have any lumps or bumps in your neck?
  • Are you losing weight?
  • Do you have any other medical conditions?
  • Have you had any surgeries in the past?
  • What medications do you take? And do you have any allergies?
  • Have you ever been exposed to radiation in the head and neck?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?

Step 2: Physical Exam

Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern.

You should also expect the doctor to:

  • Feel your neck to carefully check for any lumps or bumps
  • Look inside your ears
  • Look inside the front of your nose
  • Check your cranial nerves by asking you to move your face, stick your tongue out, lift your shoulders, follow his or her fingers around with your eyes, do some simple hearing tests and test your sense of touch all over your face

A few special diagnostic tests might be required as part of your physical exam.

  • Pharyngo-laryngoscopy (looking at your oropharynx, hypopharynx and larynx): This can be done in a few ways, including with a headlight and mirror placed on the roof of your mouth to look down, or with a flexible camera placed through your nose.
  • Flexible pharyngo-laryngoscopy: Your doctor may spray your nose with some medications and then slowly and carefully place a flexible tube with a camera through your nose down into your throat. Just sit still, breathe slowly and listen to your doctor’s instructions.
  • Indirect mirror examination: Your doctor will distract you while placing a small mirror into the back of your throat through your mouth. The doctor will ask you to breathe through your mouth and make sounds as he or she examines your throat.
  • Transnasal esophagoscopy: While not all doctors will do this, it is technically possible to use a special flexible scope (a little longer than the flexible laryngoscope) to look past the pharynx into the esophagus. Actually, with most of these special cameras, it may even be possible to take a tiny biopsy right in the office. You should talk to your doctor to see if this is an option.
Indirect Transnasal Flexible Endoscopy (Laryngoscopy) Indirect Mirror Examination (Laryngoscopy)
 27_nasal_scope  Print
Your doctor may spray your nose with some medications and then slowly and carefully place a flexible tube with a camera through your nose down into your throat. Just sit still, breathe slowly and listen to your doctor’s instructions. Your doctor will distract you while placing a small mirror into the back of your throat through your mouth. The doctor will ask you to breathe through your mouth and make sounds as he or she examines your throat.

Step 3: Reviewing Tests

After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.

Step 4: Recommendations

Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.

If the tumor is very large and is putting your breathing at risk, your doctor might recommend you undergo a tracheotomy, which is a breathing tube placed into the front part of your neck directly into your windpipe.

28_1_tracheotomy

Also, if you are just not able to get enough nutrition by mouth because of the tumor, your doctor might recommend that you receive a feeding tube. This will help make sure you are in good shape to undergo the treatment that you will need to beat the cancer. If you have lost weight, your doctor may give you a choice of getting enough nutrition by mouth by increasing the number of calories in your diet or by undergoing placement of a feeding tube. There are a variety of nutritional supplements that you can eat or drink that can help to achieve that goal. You may want to meet with a nutrition expert early in the course of your treatment. Note that for esophageal cancers, your doctor will probably recommend a special type of feeding tube called a J-tube (or jejunal feeding tube). This is different from a G-tube (gastric tube). This is important because if surgical resection is a possible treatment for your cancer, sometimes your stomach is used as a new esophagus, and it is better if the stomach doesn’t have a feeding tube in it. The J-tube is placed in the jejunum, which is the organ further down the GI tract from the stomach.

References

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2 Moore C. Smoking and cancer of the mouth, pharynx, and larynx. JAMA: the journal of the American Medical Association. Jan 25 1965;191(4):283-286.

3 Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism. 2006;29(3):193-198.

4 Little MP. Cancer after exposure to radiation in the course of treatment for benign and malignant disease. The lancet oncology. Apr 2001;2(4):212-220.

5 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Esophageal and Esophagogastric Junction Cancers V.2.2016. ©National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 7, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

6 Modlin IM, Shapiro MD, Kidd M. An analysis of rare carcinoid tumors: clarifying these clinical conundrums. World J Surg. 2005 Jan;29(1):92-101.

7 Vinik, A. I., Thompson, N., Eckhauser, F., & Moattari, A. R. (1989). Clinical features of carcinoid syndrome and the use of somatostatin analogue in its management. Acta Oncologica, 28(3), 389-402.

8 Mariette C, Balon J-M, Piessen G, Fabre S, Van Seuningen I, Triboulet J-P. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer. 2003;97:1616-1623.

9 Key C and Meisner ALW. Chapter 3: Cancer of the Esophagus, Stomach, and Small Intestine. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.