Diagnosis and staging of esophageal and gastric cancer

Rarely can a clinical diagnosis of cancer of the esophagus and stomach be made while the lesion is still early. By the time the patient has symptoms and reports them to the physician, these tumors are usually invasive. In high-risk populations, screening if feasible and patients with vague symptoms can be aggressively studied. Technical advances have aided in screening high risk individuals. Double contrast radiography and direct exfoliative cytology with brush smears have increased the diagnostic accuracy. In patients with esophageal strictures dilatation followed by biopsy has proven useful and safe. Gastric secretory studies of acidicity, pepsin, enzymes and tumor markers are not sensitive enough to be helpful. Serial studies of serum pepsinogen I in a high-risk individual may be of value, but this still needs confirmation. Most surgeons agree that preoperative staging can be helpful in predicting patients in whom a palliative procedure should be planned rather than a curative approach.