CT staging of oesophageal carcinoma

It has been generally accepted that the normal oesophagus, usually in its entire length, is surrounded by fat which facilitates assessment of tumour extension at CT examination in patients with carcinoma. As this contradicts the clinical experience at the hospital, 25 normal subjects and 36 patients with carcinoma of the oesophagus were investigated with computed tomography. In the middle part, where most tumours arise, the oesophagus as a rule was poorly delineated against important structures such as the left main bronchus and the pericardium (left atrium). In the upper and lower oesophagus the delineation was usually better, but none of the normal subjects had a good or at least discernible fat plane in every slice. The typical tumour appeared as a concentric thickening of the wall with broad contact surfaces without interposed fat with adjacent structures such as the trachea, left main bronchus, left atrium, aorta or vertebrae. Most patients received 24 Gy MV treatment followed by surgery and then 40 Gy of radiation. Ten tumours with broad contact surfaces were easily excised while of the five lesions which were relatively well demarcated two needed sharp dissection. These facts make it very difficult to anticipate the surgical findings at CT. The only reliable sign of inoperability was big bulky tumours encroaching on neighbouring organs.