Staging of Esophageal Cancer: Implications for Therapy

  • Jonathan Cools-Lartigue
  • Daniela MolenaEmail author
  • Hans Gerdes


Current staging modalities include imaging via computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), endoscopic ultrasound (EUS), and histopathologic based staging including endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and minimally invasive surgical staging. No specific modality is sufficient to accurately stage every patient presenting with esophageal cancer by itself. Accurate staging is critical to formulate an optimal therapeutic strategy needed to achieve favorable outcomes in esophageal cancer patients.


Esophageal cancer Staging CT PET-CT Endoscopic ultrasound 


  1. 1.
    van Hagen P, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.CrossRefPubMedGoogle Scholar
  2. 2.
    Cunningham D, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cen P, et al. Value of endoscopic ultrasound staging in conjunction with the evaluation of lymphovascular invasion in identifying low-risk esophageal carcinoma. Cancer. 2008;112(3):503–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Mariette C, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014;32(23):2416–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Natsugoe S, et al. Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus. 2006;19(6):468–72.CrossRefPubMedGoogle Scholar
  6. 6.
    Boonstra JJ, et al. Chemotherapy followed by surgery versus surgery alone in patients with resectable oesophageal squamous cell carcinoma: long-term results of a randomized controlled trial. BMC Cancer. 2011;11:181.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hayes T, et al. Staging in esophageal and gastric cancers. Hematol Oncol Clin North Am. 2017;31(3):427–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Mehta K, et al. Minimally invasive staging of esophageal cancer. Ann Cardiothorac Surg. 2017;6(2):110–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg. 2017;6(2):119–30.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Seevaratnam R, et al. How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis. Gastric Cancer. 2012;15(Suppl 1):S3–18.CrossRefPubMedGoogle Scholar
  11. 11.
    Takashima S, et al. Carcinoma of the esophagus: CT vs MR imaging in determining resectability. AJR Am J Roentgenol. 1991;156(2):297–302.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Quint LE, Bogot NR. Staging esophageal cancer. Cancer Imaging. 2008;8 (Spec No A):S33–42.CrossRefGoogle Scholar
  13. 13.
    Parry K, et al. Staging of adenocarcinoma of the gastroesophageal junction. Eur J Surg Oncol. 2016;42(3):400–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Luketich JD, et al. Minimally invasive surgical staging for esophageal cancer. Surg Endosc. 2000;14(8):700–2.CrossRefPubMedGoogle Scholar
  15. 15.
    Nguyen NT, et al. Evaluation of minimally invasive surgical staging for esophageal cancer. Am J Surg. 2001;182(6):702–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Foley KG, et al. Accuracy of contemporary oesophageal cancer lymph node staging with radiological-pathological correlation. Clin Radiol. 2017;72(8):693.e1–7.CrossRefGoogle Scholar
  17. 17.
    Bartel MJ, et al. Role of EUS in patients with suspected Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma: impact on endoscopic therapy. Gastrointest Endosc. 2017;86(2):292–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Meyers BF, et al. The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: results of the American College of Surgeons Oncology Group Z0060 trial. J Thorac Cardiovasc Surg. 2007;133(3):738–45.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sakurada A, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in esophageal cancer. Eur Radiol. 2009;19(6):1461–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Riddell AM, et al. The appearances of oesophageal carcinoma demonstrated on high-resolution, T2-weighted MRI, with histopathological correlation. Eur Radiol. 2007;17(2):391–9.CrossRefPubMedGoogle Scholar
  21. 21.
    van Rossum PS, et al. Imaging of oesophageal cancer with FDG-PET/CT and MRI. Clin Radiol. 2015;70(1):81–95.CrossRefPubMedGoogle Scholar
  22. 22.
    Rizk N, et al. Preoperative 18[F]-fluorodeoxyglucose positron emission tomography standardized uptake values predict survival after esophageal adenocarcinoma resection. Ann Thorac Surg. 2006;81(3):1076–81.CrossRefPubMedGoogle Scholar
  23. 23.
    Downey RJ, et al. Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: results of a prospective trial. J Clin Oncol. 2003;21(3):428–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Schmidt T, et al. Value of functional imaging by PET in esophageal cancer. J Natl Compr Cancer Netw. 2015;13(2):239–47.CrossRefGoogle Scholar
  25. 25.
    Chowdhury FU, Bradley KM, Gleeson FV. The role of 18F-FDG PET/CT in the evaluation of oesophageal carcinoma. Clin Radiol. 2008;63(12):1297–309.CrossRefPubMedGoogle Scholar
  26. 26.
    Barbour AP, et al. Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction. J Am Coll Surg. 2007;205(4):593–601.CrossRefPubMedGoogle Scholar
  27. 27.
    Findlay JM, et al. Pragmatic staging of oesophageal cancer using decision theory involving selective endoscopic ultrasonography, PET and laparoscopy. Br J Surg. 2015;102(12):1488–99.CrossRefPubMedGoogle Scholar
  28. 28.
    Puli SR, et al. Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol. 2008;14(10):1479–90.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Harewood GC, Kumar KS. Assessment of clinical impact of endoscopic ultrasound on esophageal cancer. J Gastroenterol Hepatol. 2004;19(4):433–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Lee L, et al. Predicting lymph node metastases in early esophageal adenocarcinoma using a simple scoring system. J Am Coll Surg. 2013;217(2):191–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Ning B, Abdelfatah MM, Othman MO. Endoscopic submucosal dissection and endoscopic mucosal resection for early stage esophageal cancer. Ann Cardiothorac Surg. 2017;6(2):88–98.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    de Graaf GW, et al. The role of staging laparoscopy in oesophagogastric cancers. Eur J Surg Oncol. 2007;33(8):988–92.CrossRefPubMedGoogle Scholar
  33. 33.
    Leeman MF, et al. Multidetector computed tomography versus staging laparoscopy for the detection of peritoneal metastases in esophagogastric junctional and gastric cancer. Surg Laparosc Endosc Percutan Tech. 2017;27(5):369–74.CrossRefPubMedGoogle Scholar
  34. 34.
    Okereke IC. Management of gastroesophageal junction tumors. Surg Clin North Am. 2017;97(2):265–75.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jonathan Cools-Lartigue
    • 1
  • Daniela Molena
    • 1
    Email author
  • Hans Gerdes
    • 2
  1. 1.Department of Surgery, Thoracic Surgery ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Gastroenterology, Hepatology, and NutritionMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations