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5 - CT in Esophageal Cancer

Published online by Cambridge University Press:  08 August 2009

Naama R. Bogot
Affiliation:
Department of Radiology, Hadassah Hebrew University, Medical Centre, Jerusalem, Israel; Lecturer, Department of Radiology, Division of Cardiothoracic Imaging, Division of Cardiothoracic Imaging, USA
Leslie Eisenbud Quint
Affiliation:
Professor of Radiology, Division of Cardiothoracic Imaging, University of Michigan Health System, USA
Sheila C. Rankin
Affiliation:
Guy's and St Thomas' Hospital
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Summary

Introduction

Cross-sectional imaging with computer tomography (CT) and magnetic resonance imaging (MRI) has no significant role in diagnosing esophageal cancer, although it is complementary to endoscopy, barium studies, endoscopic ultrasound (EUS), and positron emission tomography (PET) imaging in the staging of esophageal cancer. Accurate staging is necessary in order to prompt appropriate curative or palliative therapy. While CT and MRI are insensitive for delineating tumor invasion into and through the esophageal wall, these modalities play a role in estimating the esophageal tumor bulk, evaluating for local spread into adjacent structures, and diagnosing distant metastases, when present. Cross-sectional imaging also has an important role in the follow-up of esophageal cancer patients after treatment, to assess response to chemoradiotherapy and to evaluate recurrence after treatment.

Anatomy and staging

Knowledge of esophageal anatomy is important both for understanding how esophageal cancer spreads and for staging purposes. The esophageal wall consists of four layers: mucosa, submucosa, muscularis propria, and adventitia (Figure 5.1). There is no serosa to serve as a barrier between the esophagus and the surrounding structures; lack of a serosa facilitates tumor spread through the esophageal wall into adjacent structures. A rich plexus of lymphatics encircles the entire length of the esophagus, enabling lymphatic spread of tumor to mediastinal, cervical, and upper abdominal lymph nodes (Figure 5.2). An experimental study showed that dye injected into the esophageal wall at one level may drain to lymph nodes at all other levels of the esophagus in some patients and also frequently drains directly into the thoracic duct, potentially leading to hematogenous metastases.

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Publisher: Cambridge University Press
Print publication year: 2007

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References

Iyer, R. B., Silverman, P. M., Tamm, E. P., Dunnington, J. S., and DuBrow, R. A.. Diagnosis, staging, and follow-up of esophageal cancer. AJR Am J Roentgenol, 181 (2003), 785–93.CrossRefGoogle ScholarPubMed
Riquet, M., Saab, M., Barthes, F. Le Pimpec, and Hidden, G.. Lymphatic drainage of the esophagus in the adult. Surg Radiol Anat, 15 (1993), 209–11.CrossRefGoogle ScholarPubMed
Sharma, A., Fidias, P., Hayman, L. A., et al. Patterns of lymphadenopathy in thoracic malignancies. Radiographics, 24 (2004), 419–34.CrossRefGoogle ScholarPubMed
SEER NCI. Cancer of the Esophagus. http://seer.cancer.gov/statfacts/html/esoph.html (2006).
AJCC. Cancer Staging Handbook. (New York: Springer, 2002).
Patti, M. G., Gantert, W., and Way, L. W.. Surgery of the esophagus. Anatomy and physiology. Surg Clin North Am, 77 (1997), 959–70.CrossRefGoogle ScholarPubMed
NCCN Clinical Practice Guidelines in Oncology. www.nccn.org (2005).
Christie, N. A., Rice, T. W., DeCamp, M. M., et al. M1a/M1b esophageal carcinoma: clinical relevance. J Thorac Cardiovasc Surg, 118 (1999), 900–7.CrossRefGoogle ScholarPubMed
Quint, L. E., Hepburn, L. M., Francis, I. R., Whyte, R. I., and Orringer, M. B.. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer, 76 (1995), 1120–5.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Rice, T. W.. Clinical staging of esophageal carcinoma. CT, EUS, and PET. Chest Surg Clin N Am, 10 (2000), 471–85.Google ScholarPubMed
H. van Overhagen and C. D. Becker. Diagnosis and staging of carcinoma of the esophagus and gastroesophageal junction, and detection of postoperative recurrence, by computed tomography. In Neoplasms of the Digestive Tract. Imaging, Staging and Management, ed. Meyers, M. A.. (Philadelphia, PA: Lippincott-Raven, 1998), 31–48.Google Scholar
Halber, M. D. and Daffner, R. H.. Thompson, W M. CT of the esophagus: I. Normal appearance. AJR Am J Roentgenol, 133 (1979), 1047–50.CrossRefGoogle ScholarPubMed
Reinig, J. W., Stanley, J. H., and Schabel, S. I.. CT evaluation of thickened esophageal walls. AJR Am J Roentgenol, 140 (1983), 931–4.CrossRefGoogle ScholarPubMed
Panebianco, V., Grazhdani, H., Iafrate, F., et al. 3D CT protocol in the assessment of the esophageal neoplastic lesions: can it improve TNM staging?Eur Radiol, 16 (2006), 414–21.CrossRefGoogle ScholarPubMed
Umeoka, S., Koyama, T., Togashi, K., et al. Esophageal cancer: evaluation with triple-phase dynamic CT – initial experience. Radiology, 239 (2006), 777–83.CrossRefGoogle ScholarPubMed
Lefor, A. T., Merino, M. M., Steinberg, S. M., et al. Computerized tomographic prediction of extraluminal spread and prognostic implications of lesion width in esophageal carcinoma. Cancer, 62 (1988), 1287–92.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Quint, L. E., Glazer, G. M., Orringer, M. B., and Gross, B. H.. Esophageal carcinoma: CT findings. Radiology, 155 (1985), 171–5.CrossRefGoogle ScholarPubMed
Griffith, J. F., Kew, J., Chan, A. C., and Metreweli, C.. 3D CT imaging of oesophageal carcinoma. Eur J Radiol, 32 (1999), 216–20.CrossRefGoogle ScholarPubMed
Coulomb, M., Lebas, J. F., Sarrazin, R., and Geindre, M.. [Oesophageal cancer extension. Diagnostic contribution and effects on therapy of computed tomography. Report on 40 cases (author's trans.)]. J Radiol, 62 (1981), 475–87.Google ScholarPubMed
Rankin, S.. The role of computerized tomography in the staging of oesophageal cancer. Clin Radiol, 42 (1990), 152–3.CrossRefGoogle ScholarPubMed
Wayman, J., Chakraverty, S., Griffin, S. M., et al. Evaluation of local invasion by oesophageal carcinoma – a prospective study of prone computed tomography scanning. Postgrad Med J, 77 (2001), 181–4.CrossRefGoogle ScholarPubMed
Picus, D., Balfe, D. M., Koehler, R. E., Roper, C. L., and Owen, J. W.. Computed tomography in the staging of esophageal carcinoma. Radiology, 146 (1983), 433–8.CrossRefGoogle ScholarPubMed
Takashima, S., Takeuchi, N., Shiozaki, H., et al. Carcinoma of the esophagus: CT vs MR imaging in determining resectability. AJR Am J Roentgenol, 156 (1991), 297–302.CrossRefGoogle ScholarPubMed
Lehr, L., Rupp, N., and Siewert, J. R.. Assessment of resectability of esophageal cancer by computed tomography and magnetic resonance imaging. Surgery, 103 (1988), 344–50.Google ScholarPubMed
Saunders, H. S., Wolfman, N. T., and Ott, D. J.. Esophageal cancer. Radiologic staging. Radiol Clin North Am, 35 (1997), 281–94.Google ScholarPubMed
Kumbasar, B.. Carcinoma of esophagus: radiologic diagnosis and staging. Eur J Radiol, 42 (2002), 170–80.CrossRefGoogle ScholarPubMed
Balfe, D. M., Mauro, M. A., Koehler, R. E., et al. Gastrohepatic ligament: normal and pathologic CT anatomy. Radiology, 150 (1984), 485–90.CrossRefGoogle ScholarPubMed
Schroder, W., Baldus, S. E., Monig, S. P., et al. Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis. World J Surg, 26 (2002), 584–7.CrossRefGoogle ScholarPubMed
Wu, L. F., Wang, B. Z., Feng, J. L., et al. Preoperative TN staging of esophageal cancer: comparison of miniprobe ultrasonography, spiral CT and MRI. World J Gastroenterol, 9 (2003), 219–24.CrossRefGoogle ScholarPubMed
Yoon, Y. C., Lee, K. S., Shim, Y. M., et al. Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG PET for presurgical detection prospective study. Radiology, 227 (2003), 764–70.CrossRefGoogle ScholarPubMed
Kato, H., Miyazaki, T., Nakajima, M., et al. The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer, 103 (2005), 148–56.CrossRefGoogle ScholarPubMed
Romagnuolo, J., Scott, J., Hawes, R. H., et al. Helical CT versus EUS with fine needle aspiration for celiac nodal assessment in patients with esophageal cancer. Gastrointest Endosc, 55 (2002), 648–54.CrossRefGoogle ScholarPubMed
Valls, C., Lopez, E., Guma, A., et al. Helical CT versus CT arterial portography in the detection of hepatic metastasis of colorectal carcinoma. AJR Am J Roentgenol, 170 (1998), 1341–7.CrossRefGoogle ScholarPubMed
Kinkel, K., Lu, Y., Both, M., Warren, R. S., and Thoeni, R. F.. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology, 224 (2002), 748–56.CrossRefGoogle ScholarPubMed
Gollub, M. J., Lefkowitz, R., Moskowitz, C. S., et al. Pelvic CT in patients with esophageal cancer. AJR Am J Roentgenol, 184 (2005), 487–90.CrossRefGoogle ScholarPubMed
Halvorsen, R. A. Jr., Magruder-Habib, K., Foster, W. L. Jr., et al. Esophageal cancer staging by CT: long-term follow-up study. Radiology, 161 (1986), 147–51.CrossRefGoogle ScholarPubMed
Unger, E. C., Coia, L., Gatenby, R., et al. CT staging of esophageal carcinoma in patients treated by primary radiation therapy and chemotherapy. J Comput Assist Tomogr, 16 (1992), 235–9.CrossRefGoogle ScholarPubMed
Ampil, F. L., Caldito, G., Li, B. D., and Pelser, R.. Computed tomographic staging of esophageal cancer and prognosis. Radiat Med, 19 (2001), 127–9.Google ScholarPubMed
Quint, L. E., Glazer, G. M., and Orringer, M. B.. Esophageal imaging by MR and CT: study of normal anatomy and neoplasms. Radiology, 156 (1985), 727–31.CrossRefGoogle ScholarPubMed
Thompson, W. M.. Esophageal carcinoma. Abdom Imaging, 22 (1997), 138–42.CrossRefGoogle ScholarPubMed
Reed, C. E. and Eloubeidi, M. A.. New techniques for staging esophageal cancer. Surg Clin North Am, 82 (2002), 697–710, v.CrossRefGoogle ScholarPubMed
Hansen, C. P., Oskarsson, K., and Mortensen, D.. Computed tomography for staging of oesophageal cancer. Ann Chir Gynaecol, 89 (2000), 14–18.Google ScholarPubMed
Buenaventura, P. and Luketich, J. D.. Surgical staging of esophageal cancer. Chest Surg Clin N Am, 10 (2000), 487–97.Google ScholarPubMed
Wallace, M. B., Nietert, P. J., Earle, C., et al. An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg, 74 (2002), 1026–32.CrossRefGoogle ScholarPubMed
Miller, A. B., Hoogstraten, B., Staquet, M., and Winkler, A.. Reporting results of cancer treatment. Cancer, 47 (1981), 207–14.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Walker, S. J., Allen, S. M., Steel, A., Cullen, M. H., and Matthews, H. R.. Assessment of the response to chemotherapy in oesophageal cancer. Eur J Cardiothorac Surg, 5 (1991), 519–22.CrossRefGoogle ScholarPubMed
Griffith, J. F., Chan, A. C., Chow, L. T., et al. Assessing chemotherapy response of squamous cell oesophageal carcinoma with spiral CT. Br J Radiol, 72 (1999), 678–84.CrossRefGoogle ScholarPubMed
Beer, A. J., Wieder, H. A., Lordick, F., et al. Adenocarcinomas of esophagogastric junction: multi-detector row CT to evaluate early response to neoadjuvant chemotherapy. Radiology, 239 (2006), 472–80.CrossRefGoogle ScholarPubMed
Eloubeidi, M. A., Mason, A. C., Desmond, R. A., and El-Serag, H. B.. Temporal trends (1973–1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope?Am J Gastroenterol, 98 (2003), 1627–33.Google ScholarPubMed
Iizuka, T., Isono, K., Kakegawa, T., and Watanabe, H.. Parameters linked to ten-year survival in Japan of resected esophageal carcinoma. Japanese Committee for Registration of Esophageal Carcinoma Cases. Chest, 96 (1989), 1005–11.CrossRefGoogle ScholarPubMed
Mariette, C., Balon, J. M., Piessen, G., et al. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer, 97 (2003), 1616–23.CrossRefGoogle ScholarPubMed
Carlisle, J. G., Quint, L. E., Francis, I. R., et al. Recurrent esophageal carcinoma: CT evaluation after esophagectomy. Radiology, 189 (1993), 271–5.CrossRefGoogle ScholarPubMed
Kauczor, H. U., Mildenberger, P., Schweden, F., Heintz, A., and Schild, H. H.. [Patterns of recurrence of esophageal carcinoma after esophageal resection and gastric interposition: CT findings]. Rofo, 161 (1994), 113–19.Google ScholarPubMed
Morita, M., Kuwano, H., Ohno, S., Furusawa, M., and Sugimachi, K.. Characteristics and sequence of the recurrent patterns after curative esophagectomy for squamous cell carcinoma. Surgery, 116 (1994), 1–7.Google ScholarPubMed
Katayama, A., Mafune, K., Tanaka, Y., et al. Autopsy findings in patients after curative esophagectomy for esophageal carcinoma. J Am Coll Surg, 196 (2003), 866–73.CrossRefGoogle ScholarPubMed
Becker, C. D., Barbier, P. A., Terrier, F., and Porcellini, B.. Patterns of recurrence of esophageal carcinoma after transhiatal esophagectomy and gastric interposition. AJR Am J Roentgenol, 148 (1987), 273–7.CrossRefGoogle ScholarPubMed
Kantarci, M., Polat, P., Alper, F., et al. Comparison of CT and MRI for the diagnosis recurrent esophageal carcinoma after operation. Dis Esophagus, 17 (2004), 32–7.CrossRefGoogle ScholarPubMed

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  • CT in Esophageal Cancer
    • By Naama R. Bogot, Department of Radiology, Hadassah Hebrew University, Medical Centre, Jerusalem, Israel; Lecturer, Department of Radiology, Division of Cardiothoracic Imaging, Division of Cardiothoracic Imaging, USA, Leslie Eisenbud Quint, Professor of Radiology, Division of Cardiothoracic Imaging, University of Michigan Health System, USA
  • Edited by Sheila C. Rankin
  • Book: Carcinoma of the Esophagus
  • Online publication: 08 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545443.007
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • CT in Esophageal Cancer
    • By Naama R. Bogot, Department of Radiology, Hadassah Hebrew University, Medical Centre, Jerusalem, Israel; Lecturer, Department of Radiology, Division of Cardiothoracic Imaging, Division of Cardiothoracic Imaging, USA, Leslie Eisenbud Quint, Professor of Radiology, Division of Cardiothoracic Imaging, University of Michigan Health System, USA
  • Edited by Sheila C. Rankin
  • Book: Carcinoma of the Esophagus
  • Online publication: 08 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545443.007
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • CT in Esophageal Cancer
    • By Naama R. Bogot, Department of Radiology, Hadassah Hebrew University, Medical Centre, Jerusalem, Israel; Lecturer, Department of Radiology, Division of Cardiothoracic Imaging, Division of Cardiothoracic Imaging, USA, Leslie Eisenbud Quint, Professor of Radiology, Division of Cardiothoracic Imaging, University of Michigan Health System, USA
  • Edited by Sheila C. Rankin
  • Book: Carcinoma of the Esophagus
  • Online publication: 08 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545443.007
Available formats
×