Esophageal cancer: a case for aggressive staging and a tailored treatment plan

A 57-year-old man with dysphagia was found to have a distal esophageal cancer. The tumor was staged radiographically (with endoesophageal ultrasonography) and operatively. The latter consisted of a thoracoscopic examination of the thoracic esophagus and surrounding lymph nodes, as well as a limited laparotomy to evaluate the stomach and the perigastric and celiac lymph nodes. It was determined that the patient had a high-risk lesion (locally advanced, T3-4 or N1). Induction chemotherapy with concurrent radiation therapy was administered. Following neoadjuvant treatment, the patient underwent an uneventful esophagectomy. No residual tumor was identified in the specimen. The patient was doing well 6 months following his surgery. This case demonstrates the use of staging to guide therapy in esophageal cancer.