TY - JOUR
T1 - Is endoscopic ultrasound examination necessary in the management of esophageal cancer?
AU - DaVee, Tomas
AU - Ajani, Jaffer A.
AU - Lee, Jeffrey H.
N1 - Publisher Copyright:
© The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
PY - 2017/2/7
Y1 - 2017/2/7
N2 - Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, crosssectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. A historical timeline noting advances in the understanding of EC and disease is presented, along with an algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center.
AB - Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, crosssectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. A historical timeline noting advances in the understanding of EC and disease is presented, along with an algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center.
KW - Echoendoscope
KW - Endosonography
KW - Esophageal adenocarcinoma
KW - Esophageal squamous cell carcinoma
KW - Esophagus cancer
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U2 - 10.3748/wjg.v23.i5.751
DO - 10.3748/wjg.v23.i5.751
M3 - Review article
C2 - 28223720
AN - SCOPUS:85011565251
SN - 1007-9327
VL - 23
SP - 751
EP - 762
JO - World journal of gastroenterology
JF - World journal of gastroenterology
IS - 5
ER -