Esophageal cancer (summary)

Oesophageal cancer is a relatively uncommon tumour that occurs within the oesophagus of affected individuals. Patients present with symptoms of increasing dysphagia that progress from solid foods to liquids.

Reference article

This is a summary article for oesophageal cancer. However, we do have a more in-depth reference article: oesophageal carcinoma.

Summary

• epidemiology
  • < 1% of all cancers; 4-10% of GI malignancies
  • many risk factors including smoking and alcohol consumption
• presentation
  • increasing dysphagia
  • worsening reflux
  • hoarseness and cough
• pathology
  • multiple subtypes
    • commonest is squamous cell carcinoma (80-90%)
• radiology
  • local staging using CT, endoscopic-US and PET/CT
  • CT used for staging distant metastases
  • plain films and fluoroscopic studies are of limited use
• treatment
  • prognosis depends on the stage of disease
    • localised disease: 5-year survival: 40%
    • distant metastatic disease: 5-year survival: ~5%
  • tumours that don't invade submucosa can be treated with endoscopic mucosal resection (EMR)
  • tumours that involve the submucosa require oesophagectomy

Role of imaging

• confirm the presence of a tumour as the cause of symptoms
• determine the location of the tumour
• local staging (how deep does the tumour invade)
• distant staging

Radiographic features

CT

• thickening of the oesophagal wall
• soft tissue with fat-stranding around the tumour
• dilated proximal oesophagus with food debris
• tracheobronchial invasion
• aortic invasion

Endoscopic US

• determine the degree of invasion, e.g. into the submucosa

PET/CT

• limited use in T-staging
• helpful in lymph node and distant staging
• useful in the reassessment of disease in recurrence

Radiography/Fluoroscopy

There is little role for either chest radiography or fluoroscopy. A chest radiograph may demonstrate lung metastases, but it does not aid significantly in the diagnostic pathway.