Info

*Based on findings in 907 patients.

tData from Galandiuk, S., Hermann, R. E., Cosgrove, D. M., et al.: Cancer of the esophagus. Ann. Surg., 203:101, 1980; Launois, B, Paul, J. L, Lygidakis, N. J., et al.: Results of the surgical treatment of carcinoma of the esophagus. Surg. Gynecol. Obstet., 150:753, 1983; Isolauri, J., Markkula, H., and Autio, V.: Colon interposition in the treatment of carcinoma of the esophagus and gastric cardia. Ann. Thorac. Surg., 43:420, 1987.

*Based on findings in 907 patients.

tData from Galandiuk, S., Hermann, R. E., Cosgrove, D. M., et al.: Cancer of the esophagus. Ann. Surg., 203:101, 1980; Launois, B, Paul, J. L, Lygidakis, N. J., et al.: Results of the surgical treatment of carcinoma of the esophagus. Surg. Gynecol. Obstet., 150:753, 1983; Isolauri, J., Markkula, H., and Autio, V.: Colon interposition in the treatment of carcinoma of the esophagus and gastric cardia. Ann. Thorac. Surg., 43:420, 1987.

cancer. These abnormalities include an air-fluid level in the prevertebral region, which signifies esophageal obstruction. Extensive local disease is indicated by the presence of a soft-tissue mass or by mediastinal lymphadenopathy with displacement or irregularity of the tracheal air shadow. More distant disease may be represented by a pleural effusion or pulmonary metastases. Barium Esophagogram

The barium swallow film provides staging information about the location of the primary tumor and its probable overall length. Single-contrast studies are useful for identifying exophytic masses ( Fig. 19-2 ). The double-contrast technique, which employs a high-density barium suspension with effervescent crystals, is more useful for delineating tumors of the infiltrating type ( Fig. 19-3 ). The identification of carcinoma in situ is difficult using either technique.

Barium studies allow an accurate estimate of the degree of obstruction caused by tumors of the esophagus. Such estimates are useful in selecting modes of palliative treatment to be used in patients ineligible for esophageal resection. The degree of obstruction is also a component of the stage of the primary tumor in some staging systems. Esophagoscopy

Esophagoscopy is usually performed on every patient who is being evaluated for the presence of an esophageal

Figure 19-2 Barium swallow demonstrating gross destruction of mucosa in the distal esophagus with associated shouldering and proximal dilatation.

Dimple Above Butthole

Figure 19-3 Superficial carcinomas may cause only small mucosal irregularities and are best demonstrated using double-contrast barium techniques. The only abnormality in this esophagogram was a persistent indentation 3 cm above the gastroesophageal junction (arrows).

Figure 19-4 CT is useful in assessing technical resectability, such as in this patient with probable infiltration of the aorta (Ao) by an esophageal carcinoma (Es).

Figure 19-6 Liver metastases can often be discerned as being the initial site of distant spread in patients with esophageal cancer (arrow).

TABLE 19-3 -- Definitions of TNM Classification for Esophageal Cancer

Primary tumor (T)

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