Abstract
The prognosis of esophageal cancer depends on the depth of its invasion into the esophageal wall and the presence or absence of lymph node metastases. Selecting an appropriate treatment strategy is therefore dependent on accurate tumor staging. Recent advances have greatly broadened the available therapeutic options. For example, patients with advanced esophageal cancer first undergo neoadjuvant therapy in order to downstage the tumor. Esophagectomies are accompanied by aggressive two- or three-field lymph node dissections. Thoracoscopy has been developed to provide a less invasive surgical approach. Finally, patients with superficial esophageal cancer are treated with endoscopic mucosal resection. Recent advances in endoscopic ultrasonography (EUS) have expanded its diagnostic capabilities for assessing tumor staging. For example, imaging of tracheal invasion with an ultrasonic transducer situated in the esophagus had been hindered by the artifact produced by tracheal air. Situating the ultrasonic transducer in the trachea using a miniprobe contained within a water-filled balloon can obviate this difficulty. The decision for endoscopic mucosal resection versus esophagectomy is influenced by the presence of lymph node metastases, and an EUS-guided puncture biopsy can now be used to obtain tissue for this pathological examination.
