Esophageal cancer

Esophageal cancer is malignancy of the esophagus. There are various subtypes. Esophageal tumors usually lead to dysphagia (difficulty swallowing), pain and other symptoms, and is diagnosed with biopsy. Small and localized tumors are treated with surgery, and advanced tumors are treated with chemotherapy, radiotherapy or combinations. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor.

Staging

If biopsy suggests esophageal cancer, treatment is determined by the stage of the disease. Establishing the stage of the disease, a process termed staging, usually involves computed tomography (CT scan) of the chest and abdomen. If bone metastasis is suspected (e.g. pain or fracture), a bone scan may be performed, and bronchoscopy may be performed if the tumor is suspected to involve the trachea or bronchi. In recent years endoscopic ultrasound (EUS) has been used increasingly to assess local lymph node involvement, and is considered superior to CT for this indication.

Related Topics:
Staging - Computed tomography - Bone scan - Bronchoscopy - Trachea - Bronchi - Endoscopic ultrasound

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The TNM classification is used to express the extent of the cancer:

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• Tumor extent: TX (can't be assessed), T0 (cannot be detected), Tis (carcinoma in situ), T1 (invades lamina propria or submucosa), T2 (invades muscularis propria), T3 (invades adventitia), T4 (invades adjacent structures)
• Lymph node involvement: NX (can't be assessed), N0 (none), N1 (present)
• Metastasis elsewhere: M0 (no metastasis) or M1 (distal metastasis present). M1a is used for localised metastasis in some situations, with M1b indicating metastasis outside this area.

The TNM information is sometimes aggregated into AJCC stages:

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• Stage 0: Tis, N0, M0 (non-invasive tumor)
• Stage I: T1, N0, M0
• Stage IIA: T2 or T3, N0, M0
• Stage IIB: T1 or T2, N1, M0
• Stage III: T3, N1, M0 or T4, Any N, M0
• Stage IV: Any T, Any N, M1
• Stage IVA: Any T, Any N, M1a
• Stage IVB: Any T, Any N, M1b