Current staging of esophageal carcinoma

The rational treatment of esophageal cancer requires the complete evaluation and preoperative staging of this disease. As the incidence of esophageal cancer increases, more clinicians will face the difficult task of allocating the appropriate treatment course for these patients. Accurate esophageal cancer staging is critical if stage-dependent algorithms are used to direct appropriate therapies. Although all of the staging techniques discussed may potentially provide useful information, it is not possible to use all techniques in all patients, especially given the limited availability of resources. The optimal staging strategy has not yet been determined; the authors provide the general algorithm used in our institution. Ultimately,minimally invasive surgical approaches will allow surgeons to evaluate locoregional disease with little or no procedure-associated morbidity, much as mediastinoscopy is used in lung cancer staging. Although currently the use of molecular biologic techniques may only be investigational, it holds great promise in the future.