J.Jpn. Surg. Soc.. 121(4): 417-422, 2020

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Feature topic

ALGORITHM FOR ESOPHAGEAL CARCINOMA DIAGNOSIS AND TREATMENT STRATEGIES

The esophageal cancer practice guidelines edited by the Japan Esophageal Society were developed to provide recommendations concerning standard treatments for carcinoma of the esophagus, facilitating the daily clinical practice of esophageal carcinoma patient management. The first edition of the guidelines was published in 2002, and the fourth edition was released in June 2017. These guidelines are helpful in providing current standards for physicians and patients. The clinical stage of esophageal carcinoma is determined through various diagnostic imaging procedures in terms of the depth of tumor invasion, status of lymph node involvement, and presence of distant metastasis. Clinical staging is essential to determine the therapeutic strategy for esophageal cancer patients. Multimodal treatment including surgery, chemotherapy, and radiotherapy is necessary for advanced esophageal carcinoma. However, radical esophagectomy with extended lymph node dissection is one of the most invasive surgical procedures, and definitive chemoradiation is also a very invasive regimen, especially for elderly patients. The therapeutic strategy should be determined based on the assessment of clinical stage and patients’ general condition. This article explains the algorithm for determining diagnostic and treatment strategies for esophageal carcinoma patients through staging based on the 11th Edition of the Japan Esophageal Society’s Japanese Classification of Esophageal Cancer.

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