Abstract

Upper gastrointestinal tract cancers arising from the esophagus and gastroesophageal junction are a global health problem. The most common histological subtypes are adenocarcinoma and squamous cell carcinoma, and their etiologies, locations, treatments, and prognoses differ from each other. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a valuable imaging method that is frequently used in the diagnosis, staging, and restaging of many malignancies. Although its clinical use in the diagnosis of esophageal cancer is limited, it provides important information to the clinician in staging, restaging, and evaluating the response to treatment. However, hypermetabolism secondary to inflammation caused by gastroesophageal reflux, inflammation-related hypermetabolism in the early post-treatment period, and missing metastatic lymph nodes located close to the primary lesion may lead to false negative or positive interpretations in this area. As a result, patient management could be planned incorrectly. Therefore, the Nuclear Medicine physician should be aware of the pearls and pitfalls in these cases. In esophageal cancer, locoregional disease staging is performed by CT (thorax and abdomen, if necessary, pelvic area with oral and intravenous contrast agent) and endoscopic ultrasonography (EUS). The most accurate staging in patients with possible metastasis is performed with F-18 FDG PET/CT. While CT and EUS provide anatomical information, PET provides information about blood flow, metabolism, or receptor status depending on the chosen radiopharmaceuticals.