- Incidence increasing – UK 5-10/100,000
- Declining squamous cell carcinomas (due to reduced smoking), but increasing adenocarcinoma of distal oesophagus/gastric cardia (linked to Barretts)?
- Pathophysiology: – 2 types of oesophageal cancer
- o Squamous carcinoma: affects middle third of oes. Associated to cigarette smoking.
- o Adenocarcinoma: affects lower third, and merges pathologically with carcinoma of gastric cardia. Theories link this type of cancer to chronic GORD of acid and bile.
- P/c: rapidly progressive dysphagia (initially of solids then progress to dysphagia of soft foods and liquids), weight loss.
- o Barium swallow: first line
- o Endoscopy: will often provide histological diagnosis and allow for effective symptom relief (=oesophageal dilatation)
- o CT: if suitable for surgery (there is often a high prevalence of cormorbidities) – CT chest and abdo will exclude gross pulmonary and/or hepatic mets and may identify local invasion into pericardium or aorta
- o Endoscopic USS: more sensitive for detecting local mets
- o Staging laparoscopy: malignant spread to LNs can be missed on CT
- o Prognosis is poor – 5 year survival = 5%
- o Surgery: best chance for cure. But even then, with ‘curative resection, 5 year survival is only 20%
- o RT/CT: squamous carcinoma is sensitive to RT. Newer combination regimens are proving effective in adenocarcinoma
- o Palliative procedures: to make life more comfortable
- o Dilatation: of oes will relieve dysphagia although may have to be repeated
- o Laser or argon beam ablation: to ablate exophytic tumours
- o Stenting: in tumours causing mediastinal encasement, stenting with self-expanding metal stents provides good relief.