Survival of patients with esophageal cancer depends on correct treatment. Usually it is a multimodality treatment: radiation therapy, chemotherapy and surgical operation. How to ensure correct tumor staging in esophageal cancer? Leading Swiss cancer surgeon explains surgical staging decisions for esophageal carcinoma.
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Esophageal cancer staging before surgery. 8. Dr. Anton Titov, MD. Esophageal cancer is often diagnosed at locally advanced stage. Correct staging of esophageal carcinoma is very important. It allows to personalize multimodality treatmaent for each esophageal cancer patient. We discussed precision medicine in esophageal cancer with Dr. Martin Schilling a while ago. How do you stage newly-diagnosed esophageal cancer? What are the main methods of esophageal cancer staging? How does correct staging affect optimal treatment strategy for patients with esophageal cancer? Dr. Christoph Maurer, MD. Most important two examinations in esophageal cancer staging are PET-CT scan and endosonography. With the PET-CT scan we are looking for a distant metastases from esophageal cancer. We also look for the local and regional lymph node cancer spread. You know that in PET-CT scan, you can see the locations with increased metabolism. They are always suspicious for tumorous tissue. A lymph node in the mediastinum or at the cervical level can have increased metabolism. Then you should think that these are lymph nodes have cancer metastases. And the same is true in endosonography. You look for the primary tumor stage. You determine if esophageal cancer is infiltrating already neighboring organs. Esophageal carcinoma could infiltrate the surrounding tissue from the esophagus. This makes it a T3 or T4 tumor stage. You also look for lymph node metastases near the esophageal cancer tumor and along the mediastinum. If you detect lymph node metastasis, it influences your surgical operation strategy to remove esophageal cancer. Because you have to remove these locoregional lymph nodes together with the primary esophageal cancer tumor. So, it’s very important that we do a accurate preoperative staging of esophageal cancer before surgery. Correct staging esophageal carcinoma also allows us to decide about chemotherapy. We should treat patients with more extensive esophageal cancer by the neoadjuvant therapy. Neoadjuvant therapy means chemotherapy and radiotherapy before surgical operation. Dr. Anton Titov, MD. You do chemotherapy and radiation therapy before doing the surgery? Dr. Christoph Maurer, MD. Exactly, exactly. The word “neoadjuvant” means the treatment before surgery. We always have intention to cure the patient. Dr. Anton Titov, MD. So staging of cancer before surgical operation is very important. First of all, correct staging helps the cancer surgeons to know the extent of surgical operation they have to do. And they are less likely to encounter any surprises during the surgery. That’s a critical part for the successful curative treatment of esophageal cancer. Dr. Christoph Maurer, MD. Absolutely. The correct indication for esophageal caner surgery is one of the most important things in these tumors. Dr. Anton Titov, MD. So, to summarize. There are two important modalities of preoperative staging of esophageal cancer. They are endoscopic ultrasound and the PET-CT scan. Dr. Christoph Maurer, MD. Correct, yes. Dr. Anton Titov, MD. Well, Dr. Maurer, thank you very much for this very interesting conversation. We had extensive conversation about colorectal cancer. We discussed about cancer resection and techniques of liver tumor resection. We also talked about esophageal carcinoma. It’s very informative and we hope to come back to you in the future. And it’s an informative discussion for all the patients who would consider your expertise in treatment or in opinion about these multiple and serious conditions. Thank you very much! Dr. Christoph Maurer, MD. Thank you also, Dr. Titov, for your kind invitation. Dr. Anton Titov, MD. Thank you! Esophageal cancer staging before surgery. PET-CT and endosonography are two critical modalities for correct staging of esophageal cancer. Esophageal cancer incorrect staging can significantly affect prognosis. Esophageal cancer staging also critically influences treatment options. Treatment options for esophageal cancer are increasing but correct staging by PET CT and ultrasound are critical. PET-CT scan looks for a distant metastases from esophageal cancer. Endosonography looks for the primary tumor stage. Ultrasound determines if esophageal cancer is infiltrating already neighboring organs. Esophageal cancer second opinion helps to find best treatment options. Get second opinion on esophageal cancer or Barrett’s esophagus from leading US and European experts. Be confident in your treatment plan and prognosis. Precision medicine today provides many options for esophageal cancer treatment. Second opinion on stage 4 cancer can result in cure or long-term survival.