1. CT
1.1. eccentric/circumferential thickening > 5mm
1.2. soft tissue/fat stranding
1.3. aortic invasion
1.3.1. contact of the tumour with >90 degrees of the aortic circumference
2. PET
2.1. not great for staging the primary tumour BUT
2.2. great for
2.2.1. lymph nodes
2.2.1.1. which can look normal on CT but still be involved
2.2.2. distant mets
2.2.2.1. bones
2.2.2.2. liver
3. Tx/Prognosis
3.1. localised disease
3.1.1. 40% 5-yr survival
3.2. distant mets
3.2.1. 5% 5-yr survival
4. Specific Differences
4.1. although SCC and Adeno look virtually the same..
4.2. Adeno
4.2.1. more likely to be in lower 1/3
4.2.2. more likely to invade stomach
4.2.3. better prognosis
4.2.4. if mucinous
4.2.4.1. calc
4.2.4.2. lower attenuation
4.2.4.3. high T2
5. Lymphoma
5.1. fairly rare in comparison
5.1.1. usually an extension from the stomach
5.1.2. < 30 case reports on primary oesophageal
5.2. fat planes preserved
5.3. fairly non-specific findings
5.3.1. can be concentric
5.3.2. homogenous generally
5.3.3. FDG PET avid
6. Big Two
6.1. essentially make up 90% of all malignant neoplasms
6.1.1. Adeno
6.1.1.1. more common in the West
6.1.1.2. white men more at risk than anyone else
6.1.2. SCC
6.1.2.1. most common worldwide
6.1.2.2. black men more at risk than anyone elese
6.2. Risks for both
6.2.1. alcohol and smoking
6.2.2. adeno specific
6.2.2.1. Barretts
6.2.2.1.1. chronic reflux
6.2.2.1.2. replacement of stratified squamous cells by columnar epithelial cells
6.2.3. prognosis depends on invasion and nodal spread
7. CXR
7.1. widened azygo-oesophageal recess
7.2. thickening of
7.2.1. posterior tracheal stripe
7.2.2. right paratracheal stripe
7.3. tracheal
7.3.1. deviation
7.3.2. indentation from mass
8. Fluoro
8.1. 'shouldering' of stricture
8.2. prestricture hold up
9. Endoscopic USS
9.1. this is important for staging
9.1.1. can differentiate layers
9.1.1.1. and therefore STAGING
9.2. 4 layers
9.2.1. mucosa
9.2.1.1. T1a
9.2.1.1.1. can possibly be resected
9.2.1.1.2. < 2cm, asymptomatic and non-circumferential
9.2.2. submucosa
9.2.2.1. T1b
9.2.3. muscularis propria
9.2.3.1. T2
9.2.4. adventitia
9.2.4.1. T3
9.3. if mass goes beyond adventitia
9.3.1. T4
9.4. Tx for T1b and more
9.4.1. oesophagectomy
9.4.2. may involve palliative colonic interposition
10. spread
10.1. lymphatic
10.1.1. Staging
10.1.1.1. Nodes
10.1.1.1.1. 1
10.1.1.1.2. 2
10.1.1.1.3. 3
10.1.2. primary in upper 1/3
10.1.2.1. anterior jugular and supraclavicular
10.1.3. mid 1/3
10.1.3.1. para-oesophageal and subdiaphragmatic
10.1.4. lower 1/3
10.1.4.1. paracardiac and coeliac trunk