<unk>  as shown by a filling defect during an upper GI series Clinical evaluation Although an<unk> clusive tumor may be suspected on a barium swallow or barium meal, the diagnosis is best made with an examination using an endoscope. This involves the passing of a flexible tube with a light and camera down the esophagus and examining the wall, and is called an esophagogastroduodenoscopy. Biopsies taken of suspicious lesions are then examined histologically for signs of malignancy. Additional testing is needed to assess how much the cancer has spread (see , below). Computed tomography (CT) of the chest, abdomen and pelvis can evaluate whether the cancer has spread to adjacent tissues or distant organs (especially liver and lymph nodes). The sensitivity of a CT scan is limited by its ability to detect masses (e.g. enlarged lymph nodes or involved organs) generally larger than 1 cm. Positron emission tomography is also used to estimate the extent of the disease and is regarded as more precise than CT alone. PET/MR as a novel modality has shown promising results in preoperative staging with fair feasibility and good correlation in comparison to PET/CT. It can enhance tissue differentiation with lowering the radiation dose to the patient.<unk>  endoscopic ultrasound can provide staging information regarding the level of tumor invasion, and possible spread to regional lymph nodes. The location of the tumor is generally measured by the distance from the teeth. The esophagus (25 cm or 10 in long) is commonly divided into three parts for purposes of determining the location. Adenocarcinomas tend to<unk> cur nearer the stomach and squamous cell carcinomas nearer the throat, but either may arise anywhere in the esophagus. File:Barretts esophagus.Endoscopic image of Barrett esophagus – a frequent precursor of<unk>  adenocarcinoma File:Mid<unk>  mass.Endoscopy and radial endoscopic ultrasound images of a submucosal tumor in the central portion of the esophagus File:Tumor Esophagus.Contrast CT scan showing an<unk>  tumor (axial view) File:Tumor Esophagus2.Contrast CT scan showing an<unk>  tumor (coronal view) File:EsoCaSagMark.Esophageal cancer File:Esophageal adenocarcinoma - intermed mag.Micrograph showing histopathological appearance of an<unk>  adenocarcinoma (dark blue – upper-left of image) and normal squamous epithelium (upper-right of image) at H&E staining Types<unk> s are typically carcinomas that arise from the epithelium, or surface lining, of the esophagus. Most<unk> s fall into one of two classes:<unk>  squamous-cell carcinomas (ESCC), which are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption—and<unk>  adenocarcinomas (EAC), which are often associated with a history of GERD and Barrett's esophagus. A rule of thumb is that a cancer in the upper two-thirds is likely to be ESCC and one in the lower one-third EAC. Rare histologic types of<unk>  include different variants of squamous-cell carcinoma, and non-epithelial tumors, such as leiomyosarcoma, malignant melanoma, rhabdomyosarcoma and lymphoma, among others. Staging Staging is based on the TNM staging system, which classifies the amount of tumor invasion (T), involvement of lymph nodes (N), and distant metastasis (M). The currently preferred classification is the 2010 AJCC staging system for cancer of the esophagus and the esophagogastric junction. To help guide clinical decision making, this system also incorporates information on cell type (ESCC, EAC, etc.), grade (degree of differentiation – an indication of the biological aggressiveness of the cancer cells), and tumor location (upper, middle, lower, or junctional). File:Diagram showing T1,T2 and T3 stages of<unk>  CRUK 277.T1, T2, and T3 stages of<unk>  File:Diagram showing stage T4 oesophagus cancer CRUK 271.Stage T4<unk>  File:Diagram showing<unk>  in the lymph nodes (N staging) CRUK 174.Esophageal cancer with spread to lymph nodes
Esophageal cancer
Gastroesophageal reflux disease
Hypopharyngeal cancer
Esophageal spasm
Laryngeal cancer
Oropharyngeal cancer
Esophageal disease
Esophageal candidiasis