Oesophageal cancer remains one of the deadliest cancers, but survival rates are improving, thanks in part to advances in medical imaging. As we mark Oesophageal Cancer Awareness Month this February, it’s important to understand how cutting-edge imaging technologies are playing a vital role in early detection, treatment planning, and long-term monitoring. This article explores how tools like MRI, CT, and PET scans are helping patients live longer, healthier lives.
Oesophageal cancer affects around 9,400 people a year in the UK, making it the 14th most common type of cancer1. The lack of a national screening programme and the absence of early symptoms mean the disease is often discovered at an advanced stage, limiting treatment options. Only 13 per cent of patients survive 10 years after diagnosis1. Advanced imaging techniques like CT, MRI, and PET offer a non-invasive way to detect early signs of oesophageal cancer, allowing for earlier medical intervention. Beyond this, imaging is used to guide treatment plans, track disease progression, and monitor treatment success.
Why Imaging Matters in Oesophageal Cancer
The challenge of detecting it early
There is currently no nationwide screening service to detect oesophageal cancer, meaning that most diagnoses are driven by people reporting symptoms2. By which time, the cancer has progressed, and the treatment options are limited.
Oesophageal cancer has very few symptoms in its early stages. When symptoms do appear, they can include3,4
- Dysphagia (difficulty swallowing)
- Nausea
- Heartburn or acid reflux
- Indigestion
- Persistent cough
- Hoarse voice
- Unexplained loss of appetite or weight
- Fatigue
Because many of these symptoms can be attributed to less serious conditions or can be easily ignored, many people delay seeking medical advice, which can lead to later diagnoses.
Imaging techniques enable clinicians to detect early, subtle changes to the oesophageal lining which would be missed in a regular exam. Early detection enables oesophageal cancer to be diagnosed at an earlier and more treatable stage.
Better imaging = earlier, more accurate diagnosis
Some imaging techniques provide more detail than others. Each has strengths in different clinical situations, helping build a full picture of what is happening inside the oesophagus and beyond5.
Imaging can be used to5,6:
- Locate tumours
- Monitor changes in tumour size or shape
- Identify any spread of cancer to nearby tissue or other organs
- Inform treatment options
- Assess how well the treatment is working
By combining several imaging techniques, doctors can diagnose oesophageal cancer earlier and tailor treatment more precisely to each patient.
The Key Imaging Tools in Oesophageal Cancer
Endoscopic ultrasound (EUS)
EUS uses a long, thin tube (endoscope) with a built-in camera and ultrasound probe. The ultrasound probe sends out high-frequency sound waves that bounce off tissues and organs, creating detailed pictures7,8 of the oesophageal wall and nearby areas like lymph nodes.
Together, these can provide an in-depth look to identify abnormalities requiring further investigation6,7.
- EUS is ideal for early detection and staging5
- If an abnormality is spotted, some endoscopes can take a small tissue sample (biopsy) for lab analysis9
- The process is quick, lasting between15 and 45 minutes7
EUS is less effective at very advanced cases of oesophageal cancer, as the tumour may block the oesophagus and prevent the endoscope from seeing the whole picture5.
Computed Tomography (CT) scans
CT scanners take multiple X-rays from different angles, which are then compiled into a detailed 3D image of both bone and soft tissue. An iodine-based contrast agent can be used to see tiny details like blood vessels, for a more in-depth image5,10.
- CT is ideal for detecting tumours in the oesophagus or surrounding tissues like the lymph nodes, lungs, and liver10.
- They are routinely used to monitor cancer progression, how well treatment is working, and for follow-ups10.
- Scans are quick, lasting between 30 minutes and 1.5 hours, depending on what is being scanned11,12.
CT has relatively low sensitivity for earlier stages, especially for identifying the differences between Stage 1 (localised to one layer of the oesophagus) and Stage 2 (reached deeper into the muscle or started to spread to the lymph nodes) of oesophageal cancer5.
Positron Emission Tomography (PET) scans
During a PET scan, a mildly radioactive tracer (radiotracer) is injected and allowed to circulate around the body. Cells that are very active, like cancer cells, take up the radiotracer and light up on scans.
PET scans can be combined with CT scans to give information on how active these cancer cells are and give a detailed picture of the location of these cells5,13,14.
- PET is ideal for detecting early growths that have travelled from the oesophagus13.
- The more active these cells are, the more information they can give about how the disease might progress. This helps doctors decide the best treatment5.
- They are more sensitive than CT alone for early cancer staging and identification of areas where the cancer has spread5.
- Scans take between 30 minutes and an hour to allow for the tracer to circulate around the body, but are still relatively quick13.
PET and PET-CT scanning are expensive, there is limited equipment across the country, and the need for a radiotracer can exclude some patients, like those who are pregnant or breastfeeding, or those with allergies5.
Magnetic Resonance Imaging (MRI)
MRI uses powerful magnets and radio waves to create incredibly detailed images of soft tissues, like the oesophageal wall layers, without X-rays or radiation15.
- MRI allows you to see between the layers of the oesophagus, which means it can give the most detail in soft tissue for staging15.
- Can be combined with PET to give additional detail about cell activity5,16.
- MRI is ideal for identifying early signs of oesophageal cancer, monitoring disease progression, informing treatment plans, determining how well treatment has worked, and for follow-ups5.
- They are safe to do multiple times since they have no radiation (unlike CT/PET scans), are non-invasive (unlike EUS), and can be done without a contrast agent.
- Scans can take less than an hour, depending on which organs are being scanned.
Not widely used due to limited equipment availability and expense to NHS facilities5.
How Imaging Supports Treatment and Monitoring
Imaging is useful for more than diagnosis. It can be used to detect early warning signs for quick intervention, guide what treatment will be used, and monitor how successful those treatments are.
Planning treatment effectively
Accurate staging from EUS, CT, PET, MRI, or a combination can help inform which correct treatments should be carried out. The spread of the tumour to nearby tissues, like lymph nodes, may influence whether surgery, chemotherapy, radiotherapy, or a combination treatment is the best course of action17.
Using information from imaging can help avoid unnecessary treatment. For example, surgery on an inoperable tumour, or chemotherapy with harsh side effects that would provide little or no benefit.
Monitoring treatment response and recurrence
Scans are used to measure how successful the treatment is at reducing tumour size, activity, and limiting spread.
Routine follow-up imaging can catch early signs of cancer recurrence before symptoms appear. From this, treatment can be organised, and long-term treatment plans can be adjusted.
The Role of Multi-Organ MRI in Early Detection and Long-Term Health
MRI scans can image multiple organs at once and catch early signs of cancer and non-cancerous diseases. The earlier something is diagnosed, the more treatment options that are available. This helps preserve quality of life and improve chances of survival.
Early detection is vital for groups who are at particularly high risk of oesophageal cancer, even before symptoms arise. This includes18:
- Those with long-term acid reflux
- Smokers
- Men over 50
- Those with a close family history
Early multi-organ MRI screening can also provide a comprehensive view of other organs like the liver, lungs, lymph nodes, alongside the oesophagus. Early signs of cancer could be further investigated, and a treatment plan could be put in place.
MRI scans are quick, painless, and safe as they are non-invasive, use no radiation, and can be done without a tracer. This can be used to give you peace of mind and control over your health.
Conclusion
Advanced imaging is revolutionising oesophageal cancer care, enabling earlier detection, smarter treatment plans, and better monitoring for recurrence.
With tools like EUS, CT, PET, and MRI, survival rates are improving as doctors catch the disease sooner and tailor therapies precisely, helping to reduce the number of preventable deaths.
This Oesophageal Cancer Awareness Month, take control. If you have persistent reflux, swallowing issues, or risk factors like smoking, contact your GP immediately.
To learn more about proactive health screening, Ezra offers several imaging services that can identify early warning signs of several cancer types, as well as 500+ non-cancerous conditions. For more information, contact Ezra today.
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References
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13. Cancer Research UK. What is a PET scan? Accessed February 19, 2026. https://www.cancerresearchuk.org/about-cancer/tests-and-scans/pet-scan
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18. Huang FL, Yu SJ. Esophageal cancer: Risk factors, genetic association, and treatment. Asian J Surg. 2018;41(3):210-215. doi:10.1016/j.asjsur.2016.10.005
