Esophageal Malignancy and Staging

Abstract

Introduction Esophageal cancer is one of the 10 most prevalent cancers in the world (4% of incidence rate) and also has ranked among the top 10 causes of cancer-related deaths (mortality rate of 5%) worldwide. The incidence of esophageal cancer differs by geographic regions and race, explaining the important role of environmental factors such as diet and nutrition. The highest incidence of esophageal cancer is observed in Southern and eastern Africa and Eastern Asia. Esophageal cancer is diagnosed by endoscopic biopsy with or without assistance of in vivo staining to detect fine mucosal changes and to determine the extent of the disease. Although endoscopic approach offers a detailed exploration of the mucosa, it cannot provide additional information on preoperative staging such as the depth of tumor invasion or distant metastasis. Accurate preoperative staging is needed to determine the most appropriate treatment, evaluate treatment results, assess the risk of tumor recurrence, and estimate patient prognosis. Therefore, we need to be familiar with staging system and particularly with multimodality approach for clinical staging because each modality has its own strengths and weaknesses for tumor, node, and metastasis staging. Computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET) are commonly used modality for the evaluation of distant metastasis. Endoscopic ultrasound (EUS) is an emerging tool for better evaluation of locoregional lymph node involvement and tumor invasion depth. In this article, the authors discuss the pathobiology and the staging system of esophageal cancer by displaying representative images taken with various diagnostic imaging modalities.