{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 4, Ep 3 of 3: Esophageal Cancer: Staging and Treatment","html":"","width":"100%","height":180,"duration":617,"description":"Esophageal cancer from histology through staging to treatment, built around the one depth boundary that decides endoscopic versus surgical care. Covers adenocarcinoma versus squamous cell, T-stage depth categories, the mucosa-to-submucosa node-risk jump, the fixed staging workup, and the regimens for locally advanced and metastatic disease.\n \nTopics covered\n\nAdenocarcinoma vs squamous cell carcinoma\nSquamous risk factors and named associations\nT-stage depth categories and nodal staging\nMucosal vs submucosal node-risk boundary\nEndoscopic vs surgical treatment selection\nStaging workup sequence\nNeoadjuvant and perioperative regimens\nMetastatic palliation and biomarker-directed therapy\n \n \nKey decisions\n\nMucosal disease stays endoscopic because node risk is near zero; submucosal invasion crosses to surgery as node risk climbs steeply.\nFavorable superficial-submucosal exception: invasion under half a millimeter, well or moderately differentiated, no lymphovascular or perineural invasion, clean en-bloc margins, and a real reason to avoid surgery.\nStaging order is endoscopy, then CT, then PET, then endoscopic ultrasound, with endoscopic resection of any visible early lesion as the depth test.\nCarboplatin and paclitaxel with concurrent radiation is the neoadjuvant standard for both histologies; a four-drug perioperative chemotherapy is the alternative for junction and gastric adenocarcinoma.\nResidual cancer in the specimen after neoadjuvant chemoradiation and surgery earns a year of adjuvant checkpoint-inhibitor therapy.\nCervical and very high esophageal squamous tumors get definitive chemoradiation, not chemoradiation then esophagectomy, to spare the larynx.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Barrett Esophagus and Esophageal Cancer\nRead this...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}