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==Overview==
==Overview==
Esophageal cancer is best diagnosed using an endoscope to visualize the esophageal lesion, followed by a biopsy to confirm the diagnosis. These are performed in the same sitting.
Esophageal cancer is best diagnosed using an [[Endoscopy|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 ==
== Diagnostic Study of Choice ==
=== Gold standard/Study of choice: ===
=== Gold standard/Study of choice: ===
* Endoscopic biopsy is the gold standard test for the diagnosis of esophageal cancer.
* 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:
*The following result of endoscopic biopsy is a confirmatory of esophageal cancer:
**friable lesion
**Friable lesion
**superficial plaques  
**Superficial [[Plaque|plaques]]
**superfcial nodules
**Superfcial [[Nodule (medicine)|nodules]]
**superficial ulcerations  
**Superficial [[Ulcer|ulcerations]]
**strictures
**[[Stenosis|Strictures]]
**ulcerated masses  
**[[Ulcer]]<nowiki/>ated masses  
**circumferential masses  
**Circumferential masses  
**large ulcerations
**Large [[ulcer]]<nowiki/>ations
**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.<ref name="pmid9934727">{{cite journal |vauthors=Lightdale CJ |title=Esophageal cancer. American College of Gastroenterology |journal=Am. J. Gastroenterol. |volume=94 |issue=1 |pages=20–9 |year=1999 |pmid=9934727 |doi=10.1111/j.1572-0241.1999.00767.x |url=}}</ref><ref name="pmid19117343">{{cite journal |vauthors=Yendamuri S, Swisher SG, Correa AM, Hofstetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA |title=Esophageal tumor length is independently associated with long-term survival |journal=Cancer |volume=115 |issue=3 |pages=508–16 |year=2009 |pmid=19117343 |doi=10.1002/cncr.24062 |url=}}</ref>
**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]].<ref name="pmid9934727">{{cite journal |vauthors=Lightdale CJ |title=Esophageal cancer. American College of Gastroenterology |journal=Am. J. Gastroenterol. |volume=94 |issue=1 |pages=20–9 |year=1999 |pmid=9934727 |doi=10.1111/j.1572-0241.1999.00767.x |url=}}</ref><ref name="pmid19117343">{{cite journal |vauthors=Yendamuri S, Swisher SG, Correa AM, Hofstetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA |title=Esophageal tumor length is independently associated with long-term survival |journal=Cancer |volume=115 |issue=3 |pages=508–16 |year=2009 |pmid=19117343 |doi=10.1002/cncr.24062 |url=}}</ref>


====The comparison table for diagnostic studies of choice for esophageal cancer====
====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%.<ref name="pmid7054024">{{cite journal |vauthors=Graham DY, Schwartz JT, Cain GD, Gyorkey F |title=Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma |journal=Gastroenterology |volume=82 |issue=2 |pages=228–31 |year=1982 |pmid=7054024 |doi= |url=}}</ref>
*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%.<ref name="pmid7054024">{{cite journal |vauthors=Graham DY, Schwartz JT, Cain GD, Gyorkey F |title=Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma |journal=Gastroenterology |volume=82 |issue=2 |pages=228–31 |year=1982 |pmid=7054024 |doi= |url=}}</ref>
{|
{| class="wikitable"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diagnostic Test
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |One Endoscopic biopsy
|One endoscopic biopsy
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
|90%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |95%
|95%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Four Endosopic biopsies
|Four endoscopic biopsy
| style="background: #DCDCDC; padding: 5px; text-align: center;" |95
|95%
|style="background: #DCDCDC; padding: 5px; text-align: center;" |95%
|97%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |One Endoscopic biopsy
|Seven endoscopic biopsy
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
|98%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |95%
|99%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |One Endoscopic biopsy
|With Cytology
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
|100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |95%
|100%
|-
 
 
!Four Endoscopic biopsies
!95%
!
|-
!Seven Endoscopic biopsies
!
!
|-
!With Cytology
!
!
|}
|}
<small> </small>
==Diagnostic results==
The following result of endoscopic biopsy is confirmatory of esophageal cancer:
*friable lesion
*superficial plaques
*superfcial nodules
*superficial ulcerations
*strictures
*ulcerated masses
*circumferential masses
*large ulcerations


==Sequence of Diagnostic Studies==
==Sequence of Diagnostic Studies==
*The esophageal cancer should be performed when:
*The [[Endoscopy|endoscopic]] biopsy should be performed when:
**The patient presents with symptoms/signs of dysphagia, anemia or weight loss as the first step of diagnosis.
**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.
**A positive result is the visualization of an abnormal lesion in the [[esophagus]].


==Diagnostic Criteria==
==Diagnostic Criteria==
*There is no particular established diagnostic criteria for esophageal cancer.
*There is no particular established diagnostic criteria for esophageal cancer.
*Diagnosis is based upon history, symptoms and endoscopic biopsy to confirm the diagnosis.
*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:<ref name="pmid20564099">{{cite journal |vauthors=Rice TW, Rusch VW, Ishwaran H, Blackstone EH |title=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 |journal=Cancer |volume=116 |issue=16 |pages=3763–73 |year=2010 |pmid=20564099 |doi=10.1002/cncr.25146 |url=}}</ref><ref name="pmid10973385">{{cite journal |vauthors=Rüdiger Siewert J, Feith M, Werner M, Stein HJ |title=Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients |journal=Ann. Surg. |volume=232 |issue=3 |pages=353–61 |year=2000 |pmid=10973385 |pmc=1421149 |doi= |url=}}</ref>
===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<ref>{{Cite web | title =Stages of Esophageal Cancer | url =http://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq#section/_12 }}</ref>==
===Squamous Cell Carcinoma===
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Stage'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''T'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''N'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''M'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Grade'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''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===
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Stage'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''T'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''N'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''M'''
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''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==
==References==

Latest revision as of 18:27, 7 March 2019


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:

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
  • 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

Regional Lymph Nodes (N)

  • 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

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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ "Stages of Esophageal Cancer".


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