Impact of tumor size on depth of invasion and number of Lymph nodes infiltration in esophageal cancer

Introduction: Esophageal cancer (EC) is one of the deadliest malignancies worldwide and is often diagnosed in advanced stages. It is the 8th most common cancer in the world and is the 6th most common cause of cancer related deaths, having a 5-year survival rate of less than 20% despite advances in treatment. It has a poor prognosis due to the late diagnosis and the lack of early presenting symptoms. In the United States, stage IV is the most common stage at the time of diagnosis. Methods: Eighty-seven fit patients were recruited for this multi-institutional clinical prospective study in the period from the start of January 2014 to the end of December 2020, diagnosed as cancer esophagus in by endoscopic biopsy and underwent surgical treatment according to stage at the centers participating in this study. Results: In pre-operative biopsy, Adenocarcinoma was diagnosed in 39/87 cases (44.8%) distributed as (5 in GEJ and 34 diagnosed in lower esophagus) while squamous cell carcinoma (SCC) diagnosed in 48/87 cases (55.2%) distributed as (28 in lower part, 10 in middle part and 9 in upper esophagus respectively) and only one case out of 87 cases diagnosed as undifferentiated carcinoma of lower esophagus. We found significant association between the increased tumor size and the increase depth of invasion and thenumber of harvested lymph nodes. Conclusion: As the tumor size increased (cutoff point 3cm), the depth of invasion through the layers of esophagus and the number of the infiltrated lymph nodes will increase, and this is associated with poor prognosis and increase in mortality rate from the esophageal cancer.