Mastering esophageal cancer imaging: what radiologists need to know

Esophageal cancer, particularly squamous cell carcinoma (SCC) and adenocarcinoma (EAC), is a major contributor to cancer-related mortality. The different histopathologic subtypes have different pathological origins, epidemiology and prognosis. TNM staging system allows to stratify the prognosis and determine the most appropriate treatment. Surgery remains the gold standard for treating early-stage esophageal cancer, including various procedures that can adapt to the singular cases helping to reduce morbidity. However, esophagectomy remains burdened by considerable postoperative complications, such as anastomotic leakage, pleural effusion, pneumonia, acute respiratory distress syndrome, stricture formation, chylothorax, delayed gastric emptying, hiatal herniation, and reflux esophagitis. Accurate radiologic evaluation plays a crucial role in detecting, characterizing, and staging esophageal cancer, directly influencing treatment strategies. Radiological imaging is pivotal in determining patient’s prognosis, both for the management of post-operative complications and for long-term follow-up. A thorough understanding of the imaging characteristics and underlying pathology is essential for improving diagnostic accuracy and guiding therapeutic decision-making.