Esophageal cancer (summary)

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

Esophageal cancer is a relatively uncommon tumor that occurs within the esophagus 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 esophageal carcinoma.

Summary

  • anatomy
  • 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
      • localized disease: 5-year survival: 40%
      • distant metastatic disease: 5-year survival: ~5%
    • tumors that don't invade submucosa can be treated with endoscopic mucosal resection (EMR)
    • tumors that involve the submucosa require esophagectomy

Role of imaging

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

Radiographic features

CT
  • thickening of the esophageal wall
  • soft tissue with fat-stranding around the tumor
  • dilated proximal esophagus 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.

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