Clinical T2N0M0 carcinoma of thoracic esophagus

The incidence of esophageal cancer continues to rise. Historically, the majority of patients had been diagnosed with more advanced stages of disease. However, with screening programs, like those in place for patients with Barrett's esophagus, many patients are being diagnosed earlier in their disease course. Results of randomized trials and meta-analyses have led to emerging guidelines advocating for neoadjuvant therapy as part of the treatment algorithm for esophageal cancer, particularly for T3 or greater T-stage and/or node-positive disease. And for those patients that present with disease localized to the esophageal mucosa, endoscopic mucosal resection has proved to be an effective and less morbid alternative to radical resection. However, there is a group of patients that lie between these two extremes for which evidence is sparse and treatment recommendations vary. In this manuscript, recent data regarding work-up and treatment are reviewed along with a closer look at those patients clinically staged with T2N0M0 (Stage IIA) esophageal cancer. Pertinent data in this subset of patients is analyzed as potential treatment algorithms are discussed.