Esophageal carcinoma remains a devastating malignancy. Patients typically present clinically with dysphagia, which implies compromise of the esophageal lumen; therefore, advanced tumor often is found. Lymphatic drainage of the esophagus takes pluce via an extensive lymphatic network, and early and widespread metastasis occurs frequently. The esophagus is the only portion of the gastrointestinal tract that lacks a serosa; consequently, rapid local extension of tumor also occurs commonly. Accurate preoperative staging of esophageal carcinoma is necesJary in order to determine which patients will benefit from palliative treatment versus more aggressive curative resection. Late stage tumors may be treated with combination chemotherupy and radiation therapy or with expandable metallic stents rather than en bloc resection or tranahiatal esophagectomy. Recent technical advances in computed tomography (CT) and endoscopic ultrasound (EUS) 082. potentially improved preoperative staging. The utility of magnetic resonance imaging (MRI) in staging esophageal tumors requires additional evaluation, but initial studiea are promising.The purpose of this lesson is to describe the roles of CT, MRI, and endoscopic ultrasound in the diagnosis and staging of esophageal carcinoma.
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