Editor: Ian Penman
3. EUS for staging gastrointestinal and pancreatic cancer
Thomas J. Savides
Fig. 1 Survival rates for esophageal cancer .
Fig. 2 TNM staging of esophageal cancer [1,2].
Fig. 3 Esophageal cancer regional lymph nodes (N-stage) defined by location of esophageal cancer [1,2].
Fig. 4 T2 esophageal carcinoma. The tumor (T) invades into but not beyond the hypoechoic muscularis. AO, aorta; AZ, azygous vein;
PL, pleura; LA, left atrium.
Fig. 5 Risk of malignant lymph nodes is associated with esophageal cancer T-stage .
Fig. 6 T3 esophageal carcinoma. There is loss of the normal wall layer structure and the circumferential tumor invades into the peri-esophageal
Fig. 7 An enlarged celiac lymph node (CLN) is seen close to the origin of the main celiac trunk. Ao, aorta; CA, celiac axis.
Fig. 8 Early esophageal carcinoma. The tumor (T) is confined to the submucosal (third layer) and does not invade the muscularis propria
Fig. 9 N1 lymph node involvement in esophageal carcinoma. Although < 10 mm in size, the sonographic features are suspicious for malignancy: round shape, hypoechoic nature, and discrete borders.
Fig. 10 A malignant-looking N1 lymph node undergoing EUS-FNA. Cytology confirmed adenocarcinoma.
Fig. 11 T4 esophageal carcinoma. The tumor (T) invades the aorta (Ao) and no clear plane of separation exists between tumor and aortic
Fig. 12 Impact of EUS staging of esophageal cancer on patient management.
Fig. 13 TNM staging system for gastric adenocarcinoma [1,2].
Fig. 14 T4 gastric carcinoma. There is no plane of separation (arrowheads) between the tumor (T) and the pancreatic body (P), indicating
Fig. 15 Gastric cancer. Small volume malignant ascites (arrowhead) can often be detected at EUS when other imaging techniques fail.
Fig. 16 TNM staging of rectal cancer [1,2].
Fig. 17 Potential impact of EUS staging on rectal cancer management.
Fig. 18 Rectal carcinoma.
Fig. 19 Rectal carcinoma.
Fig. 20 TNM staging of anal cancer [1,2].
Fig. 21 EUS staging of pancreatic cancer [1,2].
Fig. 22 Pancreatic carcinoma. A large hypoechoic mass arising from the pancreatic head obstructs the common bile duct (not seen).
There is sludge in the distended gallbladder (GB).
Fig. 23 Pancreatic carcinoma. A 15-mm tumor is identified in the head of pancreas in a patient with pain and weight loss.
Fig. 24 EUS staging of ampullary cancer [1,2].
Fig. 25 Ampullary carcinoma. Linear EUS in a patient with painless biliary dilatation and abnormal liver function tests. A 10-mm ampullary
mass obstructs the common bile duct (CBD), and the pancreatic duct (PD) is also dilated.
Fig. 26 EUS staging of extrahepatic bile duct cancer [1,2].
Copyright © Blackwell Publishing, 2005