CT stages local invasion (aorta, airway, pericardium) and nodes and metastases; PET-CT finds distant disease that makes the patient unresectable; endoscopic ultrasound gives the T stage.
Orient first
- TNM (AJCC/UICC 8th edition — verify) uses the number of involved regional nodes (N0–N3).
- Siewert classification for junctional tumours.
- Aortic contact over 90° and loss of the fat triangle suggest invasion.
Acquire the study
- CT chest and abdomen in portal venous phase with oral water distension; axial ≤ 3 mm and sagittal reformats.
The manoeuvre
- Tumour: length in cm and wall thickness in mm; location from the incisors if endoscopy gives it.
- Adjacent structures: aorta (contact angle in degrees), trachea and left main bronchus, pericardium.
- Nodes: periesophageal, subcarinal, left gastric, coeliac; supraclavicular — short axis in mm.
- Metastases: liver, lung, adrenal, bone.
What confirms it
- Histology with endoscopic T stage and imaging N and M stage.
What licenses you to exclude it
- CT cannot exclude small-volume nodal disease; PET-CT reduces but does not remove that uncertainty.
The classic misread
- Staging invasion from a collapsed oesophagus — distend it.
- Missing a coeliac node that changes the radiotherapy field.