Esophageal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up.

Staging should include clinical examination, blood counts, liver and renal function tests, endoscopy (including upperaerodigestive tract endoscopy in case of squamous cell carcinoma), and a CT scan of chest and abdomen. In candidates for surgical resection, esophagogram and endoscopic ultrasound have to be added to evaluate the T (and N) stage of the tumor and to assist in the planning of the surgical procedure [II, B]. When available, positron emission tomography (PET) may be helpful in identifiying otherwise undetected distant metastases or in diagnosis of suspected recurrence [II, B]. In locally advanced (T3/T4) adenocarcinomas of the esophago-gastric junction infiltrating the anatomic cardia, laparoscopy can rule out peritoneal metastases [II, B]. For selection of local treatments the tumors should be assigned to the cervical or intrathoracic esophagus or to the esophago-gastric junction [IV, C]. The stage is to be given according to the tumor–node– metastasis system with corresponding American Joint Committee on Cancer stage grouping (see table). treatment