Which specialist to diagnose esophagus?

@pabel1, I am SO sorry this happened to him.
Sadly it happens too often, even to people like you who try to do everything right. God bless you for sharing. . . .

I've read most of the responses to your question regarding which physician specialist is most commonly associated with the diagnosis of esophageal cancer. It generally a team approach to manage the patient through the clinical diagnosis and treatment pathways.

Most often, like you, patients will present to their primary care provider or to ERs/urgent care centers with their GI complaints. Generally their complaints are related as having a chronic history of an acid stomach (gastro-esophageal reflux/GERD), belching, persistent sore throats, weight loss, difficulty in swallowing foods etc. The PCP may attempt to manage the symptoms with suggestions of dietary changes, reduction or cessation of alcohol intake and smoking, elevated sleeping position etc. If the patient's symptoms persist or worsen or if they initially present with more severe- symptoms and accompanying weight loss, they should refer the patient to a gasteroenterologist (GI) for further clinical evaluation.

Initially, the GI will review the patients medical history, case notes, perform additional assessments including various scans and imaging of the chest and abdomen, and endoscopy to examine the patient's esophagus and stomach. They will take tissue biopsies samples from suspicious looking areas of the linings of the esophagus and stomach or from obvious tumors and strictures they may encounter. These biopsy samples are usually given an initial "wet" read by a pathologist to look for obvious signs of malignancies and remainder of the material is fixed in preservatives and embedded in paraffin and thin sectioned for staining, immunohistochemistry or florescent in-situ hybridization (FISH). These techniques are used for additional microscopic examination of the tissues to look for evidence of transformed or aberrant appearing cells, the presence or increased production/expression of various proteins or genes (onco-proteins/genes) to establish the presence and type of cancer (adeno or squamous cell).

Some of the remainng tissue is or should be examined by molecular genetic testing to identify the specific types, copy number, mutations,microsatillite stability and methylation patterns of the tumor's cells. This information is useful to the GIs and oncologist to whom they will refer the patient for further treatment and evaluations.

Generally, the oncologist will use an additional series of scans which may include X-rays, PET and CT-MIPS to determine whether the cancer has spread to the lymph nodes, bones and other organs. Generally, an interventional radiologist or radiation oncologist will be the physicians who will perform fine needle biopsies of any identified lymph nodes or other lesions seen in bone or other organs. These biopsies are subjected to the same analyses as described above.

Once all of this information is collected, the treating oncologist has a clearer picture as to the type, stage and spread (metastisis) of the patient's cancer and can plan the most effective targeted radiation, chemotherapy and immuno-oncology regimens to treat the patient's disease.

Often, the patient's clinical history, microscopic, immunohistochemistry and molecular characterization of the patient's tumor are reviewed and discussed by a tumor board. This is a group of physicians from the treating hospital/ cancer center that is usually composed of the treating oncologist, his fellow oncologists, pathologists, radiation oncogists and occasionally other physician specialists such as onco-thrasic surgeons.

The tumor board discusses the specific characteristics of the patient's cancer as well as the patient's age/sex, pre-existing co-morbidites and overall physical health and fitness/suitability for surgical procedures (esophagectomy/POEMs). They then make recommendations as to the most effective and tolerable treatment regimens to manage the patient's cancer.

Often, the patient will first undergo radiation therapy to target and de-bulk/reduce the tumor burden. After a variable period of recovery, the patient will begin treatments with the most effective chemo and immunotherapies as determined by the oncologist and tumor board. The patient's response to therapy is monitored by periodic scans and therapies may be modified as warranted to improve or maintain clinical responses.

At some point after several initial treatment cycles, the patient may be offered surgical treatment to remove the diseased esophagus if they are deemed eligible to benefit and fit enough to survive the procedure.

Today, most treatment is palliative, not curative. However, show complete clinical response and no evidence of active disease (NED) and go on to enjoy long productive lives. Newer diagnostic, targeted drugs and other treatment methods are indevelopment that have the potential to improve patients' long term survival prospects and quality of life.

What I've described above is essentially the care pathway that I experienced when I was diagnosed 4 years ago. Your experience should be similar. If not, I would suggest that you seek treatment elsewhere.

Gastroenterologist with esophageal disorder experience.