Staging

Esophageal cancers are known for local invasion. The esophagus has a rich lymphatic plexus that allows for extension of a tumor beyond its macroscopic margins.

Work Up Includes

1. CT chest and abdomen

2. Bone scan (if symptomatic)

3. CT head (if symptomatic)

4. Pulmonary function studies (FEV1>2 liters)—a FEV1 <1.24 has an associated 40% risk of mortality within 4 years.

5. Cardiac evaluation (EF <40% have poor prognosis)

Cervical lesions are more common in women and if not extending into surrounding structures are amenable to surgery. Lesions at the thoracic inlet are typically advanced with extension into the great vessels. Only tumors in the thoracic esophagus that have not spread through the wall of the esophagus are resectable.

TNM Staging

Best outcomes are associated with early cancers (T1a-T1b Stage I). With 5 year survival approaching 90%. Most present at a later stage (II-IV) with an overall 5 year survival of 0-7% (Table 10.2).

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