Advanced Esophageal Cancer Staging: PET CT, Endoscopic Ultrasound, and CT Scans

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• Diagnostic Process for Esophageal Carcinoma
• Essential Imaging Tests for Staging
• Predicting Treatment Options from Staging
• Prognostic Factors Assessment
• Importance of Early Detection
• Full Transcript

Diagnostic Process for Esophageal Carcinoma

The initial diagnosis of esophageal cancer begins with a gastroscopy or upper GI endoscopy. Dr. Jari Rasanen, MD, explains that a biopsy is taken during this procedure to confirm the presence of carcinoma. This histological confirmation is the critical first step before any staging can occur.

Essential Imaging Tests for Staging

Comprehensive staging requires a combination of three key diagnostic tests. Dr. Jari Rasanen, MD, highlights the necessity of a CT scan, a PET CT scan, and an endoscopic ultrasound. He notes that while CT is widely available, a modern hospital treating esophageal cancer must also have endoscopic ultrasound capability. The combination of these three studies allows for precise staging of the disease.

Predicting Treatment Options from Staging

The results from PET CT, endoscopic ultrasound, and CT scans directly determine the treatment pathway. Dr. Jari Rasanen, MD, states a crucial finding: if no distant metastases are detected, curative treatment becomes a possibility. This assessment checks for cancer spread to organs like the liver, lungs, or bones.

Prognostic Factors Assessment

Pre-treatment staging provides vital information about a patient's prognosis. According to Dr. Rasanen, the depth of tumor invasion into the esophageal wall is a major prognostic factor. Cancers confined to the mucosa carry an excellent prognosis. The prognosis worsens significantly as the cancer grows deeper into the esophageal wall.

Importance of Early Detection

Dr. Jari Rasanen, MD, underscores the critical impact of early-stage diagnosis on patient outcomes. He tells Dr. Anton Titov, MD, that the earlier the stage at diagnosis, the better the prognosis for the patient. This principle highlights the importance of prompt diagnostic evaluation when esophageal cancer is suspected.

Full Transcript

Dr. Anton Titov, MD: Preoperative staging for esophageal cancer. After the diagnosis, patients have to undergo a detailed assessment to select the best treatment methods. What diagnostic studies help determine the best possible treatment for esophageal carcinoma?

Dr. Jari Rasanen, MD: First of all, the esophageal cancer diagnosis is made by gastroscopy, upper GI endoscopy. Then you will get an esophagus biopsy, and you can make the diagnosis itself.

You do esophageal carcinoma staging in a modern hospital, which is treating esophageal cancer. There should be endoscopic ultrasound possibility and also CT scan, which is available everywhere, and also the PET CT scan. All these three diagnostic tests are combined. Then you can precisely stage the esophageal cancer.

Dr. Anton Titov, MD: Can you estimate prognostic factors based on the preoperative or pre-treatment assessment by PET CT, endoscopic ultrasound, regular CT or the combination of these diagnostic studies?

Dr. Jari Rasanen, MD: Certainly, you can. The most important thing is whether the patient has got any distant metastases of the disease, like, for example, in the liver or bones or lungs. If there is no distant metastasis, in that case, the curative treatment is possible.

And of course, the earlier the stage, the better is the prognosis for the patient. It means that you can determine that the cancer is limited to the mucosa of the esophagus. In that case, the prognosis of the patient is excellent.

The deeper cancer grows into the wall of the esophagus, the worse the prognosis will be.