 Introduction/Background Esophageal cancer is the eighth most common cancer and the sixth most common cause of cancer death worldwide. The American Cancer Society estimates there will be 19,260 new cases of and 15,530 deaths from esophageal cancer in the United States in 2021 [1]. Squamous cell carcinoma and adenocarcinoma comprise 98% of malignant tumors of the esophagus. Worldwide, squamous cell carcinoma is still more common, but in Western countries, adenocarcinoma now predominates and accounts for more than 60% of cases. In general, squamous cell carcinoma usually occurs in the upper and middle esophagus, whereas adenocarcinoma predominates in the lower esophagus [2]. For esophageal cancers, initial clinical staging uses a combination of imaging modalities with biopsies used to confirm suspected sites of disease. Specific strategies for the evaluation of the patient with esophageal cancer vary by institution not only in terms of the modalities used but in the order in which they are used. One common strategy is initial esophagogastroduodenoscopy and esophageal ultrasound (US) to determine cell type, grade, local extent, and locoregional nodal involvement followed by fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT to provide additional information on nodal disease and to evaluate for distant metastases. Another common strategy involves using CT or FDG-PET/CT first to evaluate for findings of metastatic disease. If metastatic disease is found, further evaluation with esophagogastroduodenoscopy and esophageal US may not be warranted [3]. The identification of distant metastatic disease is critical in the evaluation of the patient with newly diagnosed esophageal cancer because it will direct them to a treatment pathway centered on palliative chemoradiation rather than surgery. A secondary concern is the confirmation of locoregional spread because this is often an important determinant in whether neoadjuvant chemoradiation is used.
Staging and Follow up of Esophageal Cancer.  Introduction/Background Esophageal cancer is the eighth most common cancer and the sixth most common cause of cancer death worldwide. The American Cancer Society estimates there will be 19,260 new cases of and 15,530 deaths from esophageal cancer in the United States in 2021 [1]. Squamous cell carcinoma and adenocarcinoma comprise 98% of malignant tumors of the esophagus. Worldwide, squamous cell carcinoma is still more common, but in Western countries, adenocarcinoma now predominates and accounts for more than 60% of cases. In general, squamous cell carcinoma usually occurs in the upper and middle esophagus, whereas adenocarcinoma predominates in the lower esophagus [2]. For esophageal cancers, initial clinical staging uses a combination of imaging modalities with biopsies used to confirm suspected sites of disease. Specific strategies for the evaluation of the patient with esophageal cancer vary by institution not only in terms of the modalities used but in the order in which they are used. One common strategy is initial esophagogastroduodenoscopy and esophageal ultrasound (US) to determine cell type, grade, local extent, and locoregional nodal involvement followed by fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT to provide additional information on nodal disease and to evaluate for distant metastases. Another common strategy involves using CT or FDG-PET/CT first to evaluate for findings of metastatic disease. If metastatic disease is found, further evaluation with esophagogastroduodenoscopy and esophageal US may not be warranted [3]. The identification of distant metastatic disease is critical in the evaluation of the patient with newly diagnosed esophageal cancer because it will direct them to a treatment pathway centered on palliative chemoradiation rather than surgery. A secondary concern is the confirmation of locoregional spread because this is often an important determinant in whether neoadjuvant chemoradiation is used.