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Esophageal Cancer: Diagnosis and Treatment

Diagnosis
Diagnosis of Esophageal Cancer takes into consideration many factors factors including risk associated with the patient's lifestyle and pre-existing conditions. An accurate diagnosis is important because it will determine treatment going forward and is best conducted by a  team of experts that can provide a comprehensive evaluation. 

 
The risk factors for the two subtypes of esophageal cancer are different. Smoking and alcohol are major risk factors for squamous cell carcinima (SCC) while Barrett's esophagus, which is a complication of reflux disease (gastroesophageal reflux disease [GERD]), smoking , and obesity, are possible risk factors for Esophageal adenocarcinoma ( EAC). The occurance of EAC is a result of transformation of Barrett’s esophagus to cancer. At Winship and within the Emory Healthcare System patients have access to state of the art evaluation of Barrett’s esophagus, and a team of experts will determine individual risk for developing EAC. If our expert gastroenterologists discover a premalignant lesion (a risk factor for develping cancer) they will offer treatment options which may include non-surgical therapy or surgical therapy depending on the extent and severity of the condition.

Staging 
Once the diagnosis of an esophageal cancer is established, staging of the cancer is of importance in designing the treatment options. Staging usually begins with a CT scan of the chest and upper abdomen to both evaluate the region of the primary tumor and to search for any evidence that the cancer has spread (metastatic disease).

Other ways to assess the stage of esophageal cancer include:
  • PET scans,
  • PET with CT scan, and
  • Endoscopic ultrasound (EUS)
Both PET and CT scans have a lower accuracy for staging and evaluating if lymph nodes are involved compared to Endoscopic ultrasound (EUS). EUS uses a high frequency ultrasound transducer to provide detailed images of esophageal masses and their relationship with the five-layered structure of the esophageal wall. The Winship team at Emory use are skilled at all 3 modalities for staging esophageal cancer.