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Patient care — conditions, diseases

Staging of Esophageal Cancer: If possible, it is important to determine the extent of cancer before treatment in order to select the best treatment option. Of particular concern is the presence of cancer in lymph nodes, spread of cancer to distant sites or local extension of cancer into surrounding structures, which might make attempts to remove all cancer with surgical resection impossible. Unfortunately, in many cases the true extent of spread of cancer can only be determined by surgical resection. Frequently, more advanced cancer is found at surgery than was detected by clinical tests.

Routine Staging: All patients with esophageal cancer undergo a routine chest x-ray examination and a barium swallow under fluoroscopy (direct x-ray examination of the esophagus) as part of initial staging evaluation. All patients have computerized tomography (CT) scans of the chest, upper abdomen and possibly the neck. Unfortunately, there can be considerable error in CT scanning in detecting the extent of local spread of esophageal cancer, but accuracy for detecting distant spread (metastasis) is good.

Esophagoscopy: An esophagoscopy is an examination performed through an endoscope, which is a flexible tube inserted through the esophagus that allows the physician to visualize, photograph and biopsy (sample) the cancer. All patients undergo an esophagoscopy with biopsy to determine the histology or appearance of the cancer under the microscope.

Thoracoscopy: A thoracoscopy is another procedure performed through an endoscope to examine the chest in order to determine the extent of spread of cancer in the chest.

Laparoscopy: Laparoscopy is a procedure that involves the insertion of an endoscope through a small incision in the abdomen. Laparscopy is an important tool for staging and has proven to be more reliable than CT scanning in detecting spread of cancer to the liver and the lining of the abdomen (peritoneum).

Bronchoscopy: Bronchoscopy refers to the examination of the lungs and can be helpful in identifying involvement of the trachea when the primary cancer is advanced and located in the upper part of the esophagus.

Endosonography: Endosonography refers to an ultrasound test performed through an endoscope. Ultrasound tests utilize sound waves to detect different densities of tissue, including cancer. Endosonography can detect spread of cancer into various layers of the stomach, adjacent organs and lymph nodes better than CT scanning.

Positron emission tomography (PET): Positron emission tomography (PET) scanning has also been used to improve the detection of cancer in lymph nodes. One characteristic of living tissue is the metabolism of sugar. Prior to a PET scan, a substance containing a type of sugar attached to a radioactive isotope (a molecule that spontaneously emits radiation) is injected into the patient’s vein. The cancer cells “take up” the sugar and attached isotope, which emits positively charged, low energy radiation (positrons). The positrons react with electrons in the cancer cells, which creates the production of gamma rays. The gamma rays are then detected by the PET machine, which transforms the information into a picture. If no gamma rays are detected in the scanned area, it is unlikely that the mass in question contains living cancer cells. In one clinical study, PET scanning detected 85% of lymph nodes involved with cancer, which was significantly better than the detection rate with CT scanning.

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