Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View

Abstract

One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.

Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis

“…Lymph node metastasis is the single most important prognostic factor in esophageal cancer patients and is associated with poorer survival. [41][42][43][44][45] Depth of tumor invasion has also been found to be prognostic. 5,45 Systemic inflammatory indices were recently found to be associated with poor prognosis in esophageal cancer patients.…”

DNA polymerase iota (Pol ι) promotes invasion and metastasis of esophageal squamous cell carcinoma

“…Among them, invasion is recognized as one of the fundamental characters of malignant tumor cells, which enables the cells to overcome the obstacles of cell-extracellular matrix (ECM) boundary and invade into lymph and blood vessels [6, 7]. The lymph node invasion is considered one of the most important indicators for poor prognosis of ESCC patients [8, 9]. Although a number of molecular alterations have been identified, the mechanism by which cancer cells invade to lymph nodes has not been fully elucidated.…”

Assessing downgrading of esophageal adenocarcinoma after neoadjuvant chemotherapy: a case report

“…Physical examination in esophageal cancer shows no abnormality, except cervical and supraclavicular lymph nodes enlargement. 5,7 Radiologic examination may support the esophageal cancer diagnosis. Barium contrast may show filling defect to differ obstruction related dysphagia or neurogenic related dysphagia.…”

“…Approximately 75% of patients have lymph node involvement at the time of diagnosis. 5,7 Esophagectomy is a primary management of early-stage esophageal cancer although its specific role in superficial cancer is still being debated ever since the development of endoscopic mucosal treatment. Nowadays, the scientific evidence is enough to recommend the multimodal treatment of locally advanced cancers using the combination of neoadjuvant chemotherapy or chemoradiotherapy (CRT) followed by surgery.…”