The spread of oesophageal cancer: an evaluation of clinical, barium and computed tomography assessments.

One hundred and three patients with proven oesophageal cancer were evaluated prospectively by clinical examination, upper gastro-intestinal barium studies and computed tomography (CT). The accuracy of each method in assessing the extent of disease was determined by correlation with findings at bronchoscopy (100 patients), thoracotomy (26 patients) and laparotomy (63 patients). The results indicated that CT will accurately demonstrate mass invasion of cancer into mediastinal structures. But the absence of fat-planes on CT is the least reliable indication of spread into peri-oesophageal soft tissues. Early mediastinal infiltration is best assessed by analysis of the oesophageal axis on barium swallow and the patient's symptoms. Computed tomography is not helpful in the diagnosis of mediastinal node metastases. Barium studies of the proximal stomach will accurately identify (and CT reliably exclude) local tumour extension into the stomach. CT can frequently fail to detect malignant abdominal lymphadenopathy in cachexic patients.