Presentation
Dysphagia to solids for a few months with 30 kg weight loss.
Patient Data
Oesophagram with a polypoid mass in the distal esophagus, showing a 4 cm mass in the distal esophagus with coarse and fine lobulations and barium in its interstices.
Image of the tumor on upper endoscopy: a nodular mass which occupied 50 - 74% of the circumference of the distal esophagus.
Radial endoscopic ultrasound images of the esophageal carcinoma. An irregular hypoechoic distal esophageal tumor invades the adventitia/subserosa: T3 tumor.
Para-esophageal lymph nodes were seen (third image), measuring up to 1 cm: N1 tumor.
Biopsies of the mass revealed moderately-differentiated esophageal adenocarcinoma.
Case Discussion
Esophageal carcinoma staging requires endoscopic ultrasound and biopsy for T1-T3 disease:
- Tis: esophageal carcinoma in situ (pathologic diagnosis: no invasion into
- T1: invasion into the lamina propria, muscularis mucosa, or submucosa
- T2: invasion into muscularis propria
- T3: invasion into the adventitia/subserosa
T4 disease can also be diagnosed with endoscopic ultrasound, but clear invasion of adjacent structures can often also be seen on cross-sectional imaging
- T4: invasion into structures adjacent to the esophagus.
Nodal staging is based on the number of enlarged lymph nodes in the paraesophageal, perigastric, and celiac stations:
- N1: 1-2 nodes
- N2: 3-6 nodes
- N3: >7 nodes
The TNM of esophageal squamous cell carcinoma and esophageal adenocarcinoma are staged differently.