CT Staging of Oesophageal Carcinoma

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Abstract
It has been generally accepted that the normal esophagus, usually in its entire length, is surrounded by fat which facilitates assessment of tumor extension at CT [computed tomography] examination in patients with carcinoma. As this contradicts clinical experience, 25 normal subjects and 36 patients with carcinoma of the esophagus were investigated with CT. In the mid-esophagus, where most tumors arise, the esophagus as a rule was poorly delineated against important structures such as the left main bronchus and the pericardium (left atrium). In the upper and lower esophagus,the delineation was usually better, but none of the normal subjects had a good or at least discernible fat plane in every slice. The typical tumor appeared as a concentric thickening of the wall with broad contact surfaces, without interposed fat with adjacent structures such as the trachea, left main bronchus, left atrium, aorta or vertebrae. Most patients received 24 Gy [Gray] MV treatment followed by surgery, and then 40 Gy of radiation. Ten tumors with broad contact surfaces were easily excised; of the 5 lesions which were relatively well demarcated, 2 needed sharp dissection. These facts make it very difficult to anticipate the surgical findings at CT. The only reliable sign of inoperability was big bulky tumors encroaching on neighboring organs.

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