Esophageal cancer


Work-up esophageal cancer:
•Gastroscopy with biopsies
•Thoracic and abdominal CT+ PET-CT

Regional lymph nodes:

The regional lymph nodes, irrespective of the site of the primary tumour, are those in the oesophageal drainage areas including coeliac axis nodes and paraoesophageal nodes in the neck, but not supraclavicular nodes

Limited disease (= cT1-T2 cN0M0) options:

-EMR/ESD with analysis of the cut edge and risk criteria –> maximum SM1, 500um, no lymfangio invasion
-Chirurgische resectie

Locally advanced disease (cT3-T4 or cN1-3 M0):

Chemotherapy/radiation therapy

-Neoadjuvant chemoradiotherapy (“CROSS” schedule) = RT + carboplatinum + paclitaxel

Metastatic disease:

Palliative options for dysphagia:
-Palliative radiotherapy (brachy or external)
-Esophagus stent

-Palliative chemotherapy cisplatin/5-FU

Squamous cell carcinoma:
-Limited value of chemotherapy

Targeted therapy:
-HER2 positive –> Trastuzumab


Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090‐1098. doi:10.1016/S1470-2045(15)00040-6