Carcinoma of the oesophagus

Risk factors;

• Diet
• Smoking
• Alcohol
• Achalasia
• Plummer-Vinson syndrome
• Obesity
• Reflux oesophagitis
• Barrett’s oesophagus

Site

• 20% occur in the upper part
• 50% in the middle part
• 30% in the lower part
• They may be squamous cell or adenomatous

Signs/symptoms

• Dysphagia
• Weight loss
• Retrosternal chest pain
• Lymphadenopathy
• In the upper part of the oesophagus there may be hoarseness or cough

Tests

• Barium swallow
• CXR
• Oesophagoscopy with brushing/biopsy

Staging

• T1 – invading the lamina propria/submucosa
• T2 – invading the muscularis propria
• T3 – invading the adventitia
• T4 – invasion of adjacent structures
• Nx – nodes cannot be assessed
• N0 – no node spread
• N1 – regional node mets
• M0 – no mets
• M1 – metastatic spread

Treatment

• T1/T2 radical curative oesophagectomy may be tried
• Pre-op chemo improves survival
• Palliation may be required in advanced disease