After the endoscopic procedure, the surgeon will send the excised specimen to the pathology department for a thorough and careful examination to arrive at a final pathological diagnosis.
If the final pathology confirms that the cancer is located within the mucosal layer, the lesion is cut cleanly, and there is no risk of lymph node metastasis, you will not need additional treatment; if the diagnosis is submucosal invasive cancer, follow-up treatment will be required.
You may have questions: clearly the pathology was done before surgery and the doctor determined that the lesion was in the mucosal layer and there was no lymph node metastasis before recommending endoscopic surgery, but why did he say after surgery that the cancer was invading deeper or that there was a high risk of lymph node metastasis? Is this not self-contradictory?
First, preoperative imaging such as endoscopy and CT are ancillary and cannot be 100% accurate. Only pathologic biopsy of tissue removed by endoscopy or surgery is the gold standard for diagnosing esophageal cancer.
Second, it is difficult to see very small lymph nodes (eg, less than 5 mm) with imaging such as ultrasound endoscopy and CT. Although the smaller the lymph node, the less likely it is to be metastasized by the cancer, the risk of lymph node metastasis is relatively high when the cancer infiltrates deep into the submucosa. In this case, the only way to clarify whether all lymph nodes are free of metastasis is to surgically clear all regional lymph nodes around the esophagus and then do pathological examination.
Therefore, there is a possibility that the postoperative diagnosis is inconsistent with the preoperative diagnosis.
Co-authored by:
Wang Police, Endoscopy Center, Peking University Cancer Hospital