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Esophageal Cancer

The esophagus is the muscular tube that connects the throat to the stomach. Cancer of the esophagus starts from its inner layer and grows outward, originating in either the squamous cells that routinely line the inner surface of the esophagus or glandular tissue that develops within the esophagus.

The American Cancer Society has indicated that in the U.S. an estimated 17,000 cases of esophageal cancer are expected to be diagnosed annually. The number of deaths from esophageal cancer is estimated to be 14,700 each year.

Source: American Cancer Society. Cancer Facts & Figures 2011. Atlanta: American Cancer Society; 2011

Esophageal Cancer Diagnosis

Early cancers of the esophagus have no symptoms and there are no tests that can be used to screen for esophageal cancer. The presence of symptoms usually indicates that the cancer is at an advanced stage when a cure will be unlikely. Difficulty swallowing is the most common symptom, which is noticed when the diameter of the esophagus has been narrowed substantially.

Both adenocarcinomas and squamous carcinomas occur, but the relative frequency of adenocarcinomas has been rapidly increasing, possibly related to gastric reflux disease. Squamous cell carcinoma tends to occur more frequently in the upper esophagus, whereas adenocarcinoma generally occurs at the gastroesophageal junction secondary to Barrett’s esophagus.

For diagnosis of esophageal cancer, endoscopy with biopsy is usually indicated and endoscopic ultrasound is then used to assess depth of tumor invasion. PET/CT is useful in evaluating for local invasion by the primary tumor and staging of metastatic disease.

PET/CT is a very useful tool for staging the presence or absence of systemic metastases of esophageal carcinoma.

Esophageal Cancer Treatment

Patients who have localized disease are candidates for surgery; however, patients with systemic metastases are clearly not surgical candidates.

The treatment course and patient prognosis depends, to a great extent, on the cancer's stage. PET/CT is a very useful tool for staging the presence or absence of systemic metastases of esophageal carcinoma.

Chemotherapy has an important role in esophageal cancer. Neoadjuvant chemotherapy, a drug treatment given to people with cancer prior to surgery or radiotherapy, may be used in some cases. Patients responding to neoadjuvant therapy, which may also include radiation therapy, may then go to surgery and have a better prognosis than those who do not respond well to the treatment.

A PET/CT scan can show where tumor cells are growing, which helps your doctor determine the best course of treatment.

Esophageal Cancer Follow-up

Imaging with PET/CT can also be used to look for the return of the cancer. In many patients after treatment, a mass or scar tissue may remain at the primary site. The mass itself may be apparent on a CT scan, but CT cannot determine if the tumor has been successfully treated or if residual cancer remains that must be removed.

Like most cancer treatments, the treatment for esophageal cancer may cause side effects, so your doctor will schedule you for routine follow-up visits to help manage those side effects and check whether or not the treatment has been effective.

PET/CT can be used to image tumor response to therapy and to detect recurrence in treated lesions. After surgery and other treatments, PET/CT is extremely important for monitoring if the cancer cells have returned and if treatment should be restarted.

PET/CT can be used to detect recurrent esophageal cancer.

Esophageal Cancer PET/CT Utilization

PET/CT is a noninvasive test that physicians utilize to stage the body for the presence or absence of active tumor, localize the tumor, assess the tumor response to treatment, and detect recurrence in treated lesions.

Esophageal Cancer Indications

  1. Detecting distant metastatic disease to abdominal lymph nodes, liver, lung, bone and adrenal glands
  2. Determining resectability of disease
  3. Distinguishing recurrent disease versus scar tissue after surgery
  4. Evaluating patient response to treatment such as chemotherapy and radiation during the course of treatment
  5. Determining efficacy of treatment regimen at completion of treatment

Source: Atlas of Clinical Positron Emission Tomography by Sallie F. Barrington, Michael N. Maisey and Richard R. Wahl. Oxford University Press, Inc. New York, NY.