Staging of oesophageal cancer

Diagnosis of oesophageal cancer is usually made at endoscopic biopsy. Imaging is used to stage the tumour, assess response to therapy, and detect complications of therapy and recurrence. For therapy planning, differentiation of resectable (T1–T3, N0, localised N1) versus irresectable disease (T4, extensive N1, M1) is important. Endoscopic ultrasound (EUS) is the method of choice for diagnosing T1–T3 stages, and N0 versus N1, including endoscopic ultrasound (EUS)-guided fine-needle aspiration. Computed tomography (CT) or magnetic resonance imaging (MRI) are used to demonstrate infiltration of adjacent structures, distant lymphadenopathy and distant metastases, however, positron emission tomography (PET) and PET-CT are superior in this respect. If imaging suggests irresectable disease, histologic confirmation may be required in order not to prevent curative resection in false positive findings.