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The esophagus is the organ that connects the throat to the stomach. In the USA, about 15,000 people a year develop cancer of this organ. A history of smoking or alcohol use increases the risk.
When diagnosed early, the prognosis is good, with 90% of patients living more than five years. More advanced stages, however, do not respond nearly as well. Before 2000, treatment consisted primarily of surgery for all stages. Over the last fifteen years, significant improvement in pre-operative chemoradiotherapy has resulted in improved outcomes for many patients, particularly those with a tumor that had spread through the esophageal wall. Early tumors confined to the esophagus are still best treated surgically, and there are now many new surgical approaches. These recent treatment advances have made non-operative staging critical to determining the best treatment options. Although the standard approach to staging has relied on CT scan, this has not been very accurate, except where the tumor has already spread to distant organs such as the lung or liver. In many cases, surgery was needed for accurate staging.
Determining the extent of the cancer with endoscopic ultrasonography (EUS) has proven to be reliable enough that surgery is no longer needed for staging. Patients can receive optimal management based on non-operative diagnosis and staging with EUS.