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Esophageal Cancer- PET Scans are key to Accurate Staging

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PET has been shown to be the most effective staging modality for the evaluation of distant metastatic disease for patients with esophageal cancer

 A cancer diagnosis is nothing without proper staging. Or I should say that a cancer diagnosis is less than nothing without accurate staging. I say this because early stage EC is a completely different prognosis than EC stage 3 or 4. Like many cancers, EC has a pre-cancer diagnosis called Barrett’s esophagus. While EC at any stage is rarely curable, localized EC has a much better average survival rate than advanced EC.
While PET scans (positron emission tomography) can be an effective diagnostic tool in helping cancer patients determine a therapy plan, according to the study linked and excerpted below, PET scans or accurate staging in esophageal cancer changes little about the oncologist’s therapy plan.
What…What? Yes, the study linked and excerpted below explains that while PET imaging helps oncology get a clearer picture of a patients E.C., the clearer picture did not change the oncologist therapy plan very often (less than 5% of the time).
While that finding might be confusing to the average newly diagnosed cancer patient it makes perfect sense to me. My experience as a cancer survivor and cancer coach is that oncologists do what their hospital is good at, not what may be best for the patient.
As the saying goes “treat the patient, not the disease.” The key is for the newly diagnosed EC patient to learn what his/her treatment options are. While your oncologist is an important person on your team, you, the patient, are in charge.
 I am both a cancer survivor and cancer coach. Have you been diagnosed with Esophageal Cancer? What stage? For more information about both conventional and non-conventional therapies for esophageal cancer scroll down the page, post a question or comment and I will reply to you ASAP.
Thank you,
David Emerson
  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer
“The use of positron emission tomography (PET) has significantly improved the staging of patients with cancer, with the greatest benefit being the avoidance of surgical resection or definitive radiotherapy in patients with the otherwise unrecognized metastatic disease.1,2 For patients with solid tumors (such as lung cancer), its use in diagnosis of the primary and staging of lymph nodes is relatively inaccurate and should not be relied upon.3
 
PET has been shown to be the most effective staging modality for the evaluation of distant metastatic disease for patients with esophageal cancer,4,5 yet apparently not as effective as for patients with lung cancer.
 Although not discussed in the review, this study actually failed to meet its goal; PET did not improve the staging of esophageal cancer, as it changed the management in only 4.4% of patients, less than the target of 5%.

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5 comments
Ed Sadler says 3 years ago

After ultrasonic exam on my tumor today the results were T3, N0 Mx by endosonographic criteria. Scheduled for a PET scan on Tuesday? My Oncologist is suggesting Chemo/Radiation followed by surgery. My tumor is located at the junction of esophagus/stomach. Do you feel this an accurate stage? Having really hard time swallowing. I’m a whit male 65 years of age.

Reply
    David Emerson says 3 years ago

    Hi Ed,

    I am sorry to learn of your EC diagnosis. Keep in mind however, that you have been staged with early EC so your prognosis should be much better than otherwise.

    To answer your question “Do you feel this an accurate stage?” While there is/are always diagnostic factors that I don’t know without seeing you, the articles linked and excerpted below speak to your situation. The first article explains why the EUS is the standard for diagnosing early EC and why your oncologist may choose to also have a PET scan.

    The second article, if I read it correctly, says that EC is a difficult to treat cancer with a poor five-year survival average. My guess is that your oncologist is working hard at the diagnosis stage (both EUC and PET) and is also treating your cancer aggressively (chemo, radiation and surgery is aggressive and may cause short, long-term and late stage side effects) but by being so aggressive, your chances of beating the odds are pretty good.

    The most important point is that a key factor in your diagnosis is that your cancer is local- no lymphnode or distand mets involvement. My guess is that your oncologist wants to confirm this with a PET scan.

    I hope this answers your question. Let me know if you have any other questions.

    Hang in there,

    David Emerson

    Esophageal cancer: staging system and guidelines for staging and treatment

    “As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers…

    Esophageal cancer: staging system and guidelines for staging and treatment

    Recommended treatment is primarily dictated by stage, tumor location, and patients’ medical fitness for receiving a particular therapeutic modality. However, definitive data from randomized trials to guide the treatment of esophageal cancer is lacking for many clinical situations. Outcomes also generally are relatively poor with many treatment strategies, so establishing optimal treatment for different clinical situations remains an area of active research (28). The NCCN guidelines reflect the lack of definitive evidence and often allow a spectrum of potential treatments for many clinical situations. Given both the generally poor overall prognosis and the potential morbidity associated with therapy, multidisciplinary evaluation by surgery, medical oncology, and radiation oncology should be considered for all patients before a treatment strategy is initiated…”

    Reply
      Ed Sadler says 3 years ago

      Thank You David for the quick reply. I start Chemo/radiation the week of April 8,2019 here in Chattanooga, TN. I’m not looking forward to it but want the best chance of beating this. I realize each individual is different and each case as well, so will stick to this and then rest up for surgery probable sometime late June. I really appreciate the info you provided and will try to stay in touch to let you know the progress.. Thanks Again, Ed

      Reply
John Herr says 3 years ago

I feel the surgeon that was recommended to me is taking too long to schedule my surgery.

Reply
    David Emerson says 3 years ago

    Hi John,

    Waiting for a surgeon to schedule your surgery can cause real anxiety. What stage of EC were you at diagnosis? Have you undergone any therapies at all at this point? Would you consider “pre-habilitation” to prepare for your surgery?

    Let me know, thanks.

    David Emerson

    Reply
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