What is the management approach for esophageal cancer with a suspicious lung lesion on CECT suggestive of metastasis?

From the Guidelines

In cases of esophageal cancer with a suspicious lung lesion on contrast-enhanced computed tomography (CECT) suggestive of metastasis, a comprehensive staging workup is warranted to confirm the presence of metastasis.

Initial Evaluation

The initial evaluation should include a chemistry profile, biopsy to confirm histologic classification and metastatic cancer, and an endoscopy with biopsy of the entire upper gastrointestinal tract 1.

• A CT scan with oral and intravenous contrast of the chest and abdomen should also be performed.
• Pelvic CT should be obtained when clinically indicated.
• EUS and PET/CT evaluation is recommended if metastatic cancer is not evident 1.

Systemic Therapy

If metastasis is confirmed, systemic therapy with chemotherapy and/or targeted therapy may be initiated, while local treatment options such as esophagectomy may be deferred 1.

• Chemotherapy regimens recommended for advanced esophageal and esophagogastric junction (EGJ) adenocarcinoma, squamous cell carcinoma of the esophagus, and gastric adenocarcinoma may be used interchangeably 1.
• Trastuzumab can be added to chemotherapy if tumor overexpresses HER2-neu 1.

Treatment Approach

The treatment approach should be individualized based on the patient's performance status, comorbidities, and toxicity profile 1.

• Two-drug cytotoxic regimens are preferred for patients with advanced disease because of lower toxicity 1.
• Pretreatment nutritional support should be considered for patients with significant dysphagia and weight loss to support them during induction chemoradiation 1.
• Esophagectomy should be considered for all physiologically fit patients with localized, resectable, thoracic esophageal cancer 1.

Lymph Node Dissection

Lymph node dissections can be performed using the standard or extended (en bloc) technique 1.

• At least 15 lymph nodes should be removed for adequate nodal staging in patients undergoing esophagectomy without preoperative chemoradiation 1.

From the Research

Management Approach for Esophageal Cancer with Suspicious Lung Lesion

• The management approach for esophageal cancer with a suspicious lung lesion on CECT suggestive of metastasis involves a multidisciplinary approach, including imaging studies, biopsy, and treatment options such as chemotherapy, targeted therapy, and surgery 2, 3, 4.
• Imaging studies such as PET and PET/CT are useful in detecting distant metastases and staging the disease 5.
• For patients with esophageal cancer and suspicious lung lesions, the treatment approach depends on the stage of the disease, the presence of metastases, and the patient's overall health status 4.
• Patients with possible metastatic disease on initial imaging may still benefit from resection, especially if the metastases are not in the liver 4.
• Personalized chemotherapy and molecular targeted therapy, such as EGFR inhibitors, may be considered for patients with metastatic disease 2.
• Surgical treatment, such as esophagectomy, may be considered for patients with localized disease and no distant metastases 3, 4.
• Endoscopic diagnosis and treatment, such as endoscopic mucosal resection and submucosal dissection, may be considered for early-stage esophageal cancer 6.