Oesophageal cancer (summary)

This is a basic article for medical students and other non-radiologists

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; read more in our article on oesophageal carcinoma.

Summary

• anatomy
  • oesophagus
• 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
• pathophysiology
  • multiple subtypes
    • commonest is squamous cell carcinoma (80-90%)
• investigation
  • may be diagnosed on barium swallow study
  • CT used for staging distant metastases
  • local staging using CT, endoscopic-US and PET-CT
  • endoscopy for diagnosis and biopsy
  • plain films are of limited use in staging
• 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 oesophageal 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 in staging. A chest radiograph may demonstrate lung metastases, but it does not aid significantly in the diagnostic pathway. Cancers may initially be diagnosed on barium swallow studies, and fluoroscopy may be used to assess obstruction or fistulation when planning treatment.