FollowUpRecurrent Disease

Patients who undergo complete resection after preopera-tive CRT are examined with CT scan every 4 to 6 months. Biopsies are performed on masses from suspicious lesions. The role of PET in monitoring for postoperative recurrence

Algorithm for Newly Diagnosed Esophageal Cancer

Initial Approach

• Confirm pathologic diagnosis and histology

• Functional status of patient (performance status)


• Endoscopy (for location in esophagus)

• Endoscopic ultrasound (for T and N stage)

• PET scan (more sensitive for distant extent)

• Laparoscopy (for extent of distal tumors)

Advanced/Metastatic Disease

Locally Advanced/Curable Disease*

FIGURE 21-1. Algorithm for newly diagnosed esophageal cancer. CT = computed tomography; GEJ = gastroesophageal junction; PET = positron emmision tomography. *Includes M1a for distal lesions. tPrimary chemoradiotherapy

1 Palliation

-pain management -nutrition optimization -swallowing intervention (RT, stent, PDT)

Chemotherapy -standard vs clinical trial -consider performance status when choosing regimen

Chemotherapy -standard vs clinical trial -consider performance status when choosing regimen

T2/3N0/1M0/1a (except cervical1") (controversial)

• Primary surgery +/-adjuvant therapy

• Primary chemoradiotherapy.

• Neoadjuvant chemoradiotherapy followed by esophagectomy (clinical trial preferred)

*Includes M1a for distal lesions "•"Primary Chemoradiotherapy remains investigational. Patients with recurrent disease are treated similarly to those with primary metastatic disease, with particular attention placed on performance status and ability to tolerate additional chemotherapy. The small subgroup of patients who have tumor progression during preoperative treatment (< 5% in our experience) are offered similar palliative interventions.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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