X-ray manifestations of advanced esophageal cancer

The X-ray manifestations of advanced esophageal cancer are as follows:

(1) Disappearance, destruction, and interruption of mucosal folds.

(2) Filling defects may occur in the cavity. The tumor protrudes into the cavity, forming irregular filling defects of varying sizes, which are often manifestations of proliferative esophageal fistulas.

(3) The lumen is narrow, usually limited to 3.0 to 5.0 cm, but can also be longer, with a clear boundary from the normal area. The passage of barium is blocked, and the esophagus is enlarged above it.

(4) Niches appear, which are mostly irregular. They can also be a large long niche with irregular contours. Its long diameter is consistent with the longitudinal axis of the esophagus. There may be irregular filling defects around it. Larger tumors that grow outward may form a mass shadow in the mediastinum. Cancer of the lower esophagus is often caused by the upward development of gastric cardia cancer. Sometimes soft tissue masses can be seen in the gastric cardia or gastric bubble. Cancer of the upper and middle esophagus can widen the soft tissue shadow behind the trachea, push the larynx forward, and make it easy for barium to flow back into the trachea.

When esophageal cancer perforates to form a fistula, contrast agent can be seen escaping from the esophageal outline; if esophageal-tracheal or bronchial fistula occurs, barium can enter the corresponding trachea and bronchus through the fistula, and lung inflammation may also occur; if the tumor penetrates the mediastinum, it can cause mediastinal inflammation or mediastinal abscess, widening the mediastinum, and barium can be seen entering; when esophageal cancer has intrathoracic lymph node metastasis, signs such as enlarged hilar shadow and widened mediastinum can be seen.