Esophageal cancer diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
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Overview
Esophageal cancer is best diagnosed using an endoscope to visualize the esophageal lesion, followed by a biopsy to confirm the diagnosis. Endoscopic biopsy is done in a single visit at the hospital.
Diagnostic Study of Choice
Gold standard/Study of choice:
- Endoscopic biopsy is the gold standard test for the diagnosis of esophageal cancer.
- The following result of endoscopic biopsy is a confirmatory of esophageal cancer:
- Friable lesion
- Superficial plaques
- Superfcial nodules
- Superficial ulcerations
- Strictures
- Ulcerated masses
- Circumferential masses
- Large ulcerations
- Even though large masses seen in the esophagus are almost pathognomonic for esophageal cancer, the diagnosis of squamous cell carcinoma or adenocarcinoma esophageal cancer is confirmed by biopsy.[1][2]
The comparison table for diagnostic studies of choice for esophageal cancer
- Studies have found that the greater the number of biopsies taken (up to seven), the higher the diagnostic accuracy. The addition of brush cytology specimens to seven biopsies increased the accuracy to 100%.[3]
| Diagnostic Test | Sensitivity | Specificity |
|---|---|---|
| One endoscopic biopsy | 90% | 95% |
| Four endoscopic biopsy | 95% | 97% |
| Seven endoscopic biopsy | 98% | 99% |
| With Cytology | 100% | 100% |
Sequence of Diagnostic Studies
- The endoscopic biopsy should be performed when:
- The patient presents with symptoms/signs of dysphagia, anemia or weight loss as the first step of diagnosis.
- A positive result is the visualization of an abnormal lesion in the esophagus.
Diagnostic Criteria
- There is no particular established diagnostic criteria for esophageal cancer.
- Diagnosis is based upon history, symptoms and endoscopic biopsy to confirm the diagnosis.
Staging
The American Joint Committee on Cancer has designated staging by TNM classification to define cancer of the esophagus and esophagogastric junction:[4][5]
Primary Tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: High-grade dysplasia
- T1: Tumor invades lamina propria, muscularis mucosa, or submucosa
- T1a: Tumor invades lamina propria or muscularis mucosae
- T1b: Tumor invades submucosa
- T2: Tumor invades muscularis propria
- T3: Tumor invades adventitia
- T4: Tumor invades adjacent structures
- T4a: Resectable tumor invading pleura, pericardium, or diaphragm
- T4b: Unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.
Regional Lymph Nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastases in 1–2 regional lymph nodes
- N2: Metastases in 3–6 regional lymph nodes
- N3: Metastases in ≥7 regional lymph nodes
Distant Metastasis (M)
- M0: No distant metastasis
- M1: Distant metastasis
American Joint Committee on Cancer stage groupings[6]
Squamous Cell Carcinoma
| Stage | T | N | M | Grade | Tumor Location |
| 0 | Tis | N0 | M0 | 1, X | Any |
| IA | T1 | N0 | M0 | 1, X | Any |
| IB | T1 | N0 | M0 | 2–3 | Any |
| T2–3 | N0 | M0 | 1, X | Lower, X | |
| IIA | T2–3 | N0 | M0 | 1, X | Upper, middle |
| T2–3 | N0 | M0 | 2–3 | Lower, X | |
| IIB | T2–3 | N0 | M0 | 2–3 | Upper, middle |
| T1–2 | N1 | M0 | Any | Any | |
| IIIA | T1–2 | N2 | M0 | Any | Any |
| T3 | N1 | M0 | Any | Any | |
| T4a | N0 | M0 | Any | Any | |
| IIIB | T3 | N2 | M0 | Any | Any |
| IIIC | T4a | N1–2 | M0 | Any | Any |
| T4b | Any | M0 | Any | Any | |
| Any | N3 | M0 | Any | Any | |
| IV | Any | Any | M1 | Any | Any |
Adenocarcinoma
| Stage | T | N | M | Grade |
| 0 | Tis | N0 | M0 | 1, X |
| IA | T1 | N0 | M0 | 1–2, X |
| IB | T1 | N0 | M0 | 3 |
| T2 | N0 | M0 | 1–2, X | |
| IIA | T2 | N0 | M0 | 3 |
| IIB | T3 | N0 | M0 | Any |
| T1–2 | N1 | M0 | Any | |
| IIIA | T1–2 | N2 | M0 | Any |
| T3 | N1 | M0 | Any | |
| T4a | N0 | M0 | Any | |
| IIIB | T3 | N2 | M0 | Any |
| IIIC | T4a | N1–2 | M0 | Any |
| T4b | Any | M0 | Any | |
| Any | N3 | M0 | Any | |
| IV | Any | Any | M1 | Any |
References
- ↑ Lightdale CJ (1999). "Esophageal cancer. American College of Gastroenterology". Am. J. Gastroenterol. 94 (1): 20–9. doi:10.1111/j.1572-0241.1999.00767.x. PMID 9934727.
- ↑ Yendamuri S, Swisher SG, Correa AM, Hofstetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA (2009). "Esophageal tumor length is independently associated with long-term survival". Cancer. 115 (3): 508–16. doi:10.1002/cncr.24062. PMID 19117343.
- ↑ Graham DY, Schwartz JT, Cain GD, Gyorkey F (1982). "Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma". Gastroenterology. 82 (2): 228–31. PMID 7054024.
- ↑ Rice TW, Rusch VW, Ishwaran H, Blackstone EH (2010). "Cancer of the esophagus and esophagogastric junction: data-driven staging for the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Cancer Staging Manuals". Cancer. 116 (16): 3763–73. doi:10.1002/cncr.25146. PMID 20564099.
- ↑ Rüdiger Siewert J, Feith M, Werner M, Stein HJ (2000). "Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients". Ann. Surg. 232 (3): 353–61. PMC 1421149. PMID 10973385.
- ↑ "Stages of Esophageal Cancer".