Staging and preoperative evaluation of upper gastrointestinal malignancies
Section snippets
Pathologic staging
The current (sixth edition) American Joint Committee on Cancer (AJCC) TNM staging system for esophageal cancer is outlined in Table 1. 3 This system accounts for different patterns of lymphatic spread of esophageal cancer based on the anatomic position of the tumor within the esophagus, which reflects treatment differences for each described anatomic region. For these purposes, the AJCC describes four anatomic regions of the esophagus as follows.
The cervical esophagus begins anatomically at the
Conclusion
Staging esophageal and gastric cancer accurately is essential to guide therapy and to minimize the morbidity associated with poorly selected treatment. Optimal pretreatment radiological staging for esophageal cancer includes spiral chest and abdominal CT and EUS. For patients with T2 or greater lesions on EUS, and tumors located at or above the carina, bronchoscopy is indicated to evaluate for invasion of the tracheobronchial tree; if the tumor is at the GEJ, laparoscopy should be considered to
Acknowledgements
The authors thank Melissa Burkett for editorial assistance, and Storm Weaver and Vivian Garcia for their secretarial assistance in preparation of the manuscript.
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