Oesophageal Neoplasms

Oesophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Histologically, oesophageal cancers are composed mainly of two variants: squamous cell cancer and adenocarcinoma of the oesophagus. Benign tumours are rare. The aetiology of squamous cell cancer is largely unknown but adenocarcinoma progresses from Barrett’s oesophagus. Diagnosis is by endoscopy and staging is done by a combination of CT, EUS and PET/CT. Many tumour markers have been elucidated and their potential importance in diagnosis and treatment is actively pursued. Endoscopic therapy is appropriate for node negative patients with early cancers limited to the mucosa. Less than 30% of all patients with oesophageal cancer are suitable for curative treatment. Surgical treatment by oesophagectomy is appropriate for medically fit patients with T<4, N<3 and M<1 tumours. Neoadjuvant therapy (chemoradiotherapy or chemotherapy) is advocated for all tumour types. The management of patients with locally advanced or metastatic oesophageal cancer and patients with poor general medical condition must be individualised based on stage, characteristics of the tumour, patient’s medical condition and patient preference. The aim of palliative treatment is to achieve rapid and sustained relief of dysphagia. Chemotherapy alone or in combination with radiotherapy should be considered with other palliative measures. Canalisation of the tumour and restoration of swallowing is best achieved using self-expanding metallic stents. Best supportive care may be appropriate in frail patients with advanced disease at presentation.

Keywords: Adenocarcinoma, Cancer of oesophago-gastric junction, Non-surgical treatment, Oesophagectomy, Palliation of oesophageal cancer, Pathology, Squamous cell cancer, Staging.