Editing Oesophageal cancer (section)

== '''Workup''' ==

* CT CAP with IV contrast
** Look for mets, and      locoregional extent
** Not as useful in early stage      disease, and can't distinguish T3 from T4 very well
** Look for lymph nodes >1cm      in short axis
* FDG PET/CT
** Should be done in most cases      to look for distant mets
** Also look for suspicious      local nodes that can be sampled in EUS
* EUS
** Most useful in patients with      M0 disease after CT and PET - unnecessary in patients with M1 disease
** Can provide information on      T-status and evaluation of regional lymph nodes, although not as accurate      for superficial tumours (T1a-T2), where EMR gives better information
** Best use is probably to look      for, and then target with FNA, suspicious nodes that may be outside of      field and thus change management
*** Nodes are suspicious if       they have distinct borders, rounded appearance, hypoechogenic       architecture, and size >1cm
* EMR can stage suspicious     lesions in background of widespread mucosal changes
** Good for T1a-T2 lesions
* Laparoscopy
** Stage tumours around GOJ
* Bronchoscopy
** Useful in proximal and      middle third oesophageal cancers to assess for direct tracheal invasion
* For SCC, flexible     laryngoscopy and exclusion of synchronous head/neck cancer is recommended