Written by Jiak Ying Tan
Last Reviewed: August 2019
Review Due: August 2020
‘squamous cell carcinoma arises from cells lining the oesophagus which is commonly associated with tobacco, alcohol, achalasia and coeliac’s disease. Adenocarcinoma arises from the glandular tissue in association with Barrett's oesophagus’
Associated with adenocarcinoma
Reflux oesophagitis +/- Barrett’s oesophagus
Associated with squamous cell carcinoma
SIGNS AND SYMPTOMS2
Weight Loss and loss of appetite
Retrosternal Chest Pain
Cough (may be paroxysmal if aspiration pneumonia)
Chronic gastro-oesophageal reflux causes inflammatory damage to the oesophageal lining. This leads to cellular metaplasia known as Barrett's oesophagus. This is where stratified squamous epithelium is replaced by abnormal columnar epithelium due to this cell types potential ability to be more resistant to gastric acid. These cells are more likely to become dysplastic and malignant.
Squamous Cell Carcinoma
Smoking introduces a large number or carcinogens to the oesophagus, directly causing DNA damage.
Alcohol is not itself a carcinogen but acetaldehyde, a product of alcohol metabolism is carcinogenic.
Site of cancer:
20% - Superior oesophagus
50%- Mid oesophagus
30% - Inferior oesophagus
Anaemia due to bleeding or chronic disease
Oesophagogastroduodenoscopy with biopsy
Look at oesophagus structure in gross appearance to look for any evidence of growth of mass, ulcers, stricture
CT chest, abdo-pelvis for staging
CT is used to assess the following for TNM staging
Treatment options are decided based on the TNM staging of the cancer, overall fitness and any underlying comorbidities of the patient.
Endoscopic Resection +/- ablation
For stage 0 or carcinoma in-situ patient
Surgery – oesophagectomy
The only radical curative treatment
For localised T1/T2 disease
There are three different approaches:
Ivor Lewis Operation – for lower oesophageal tumour
McKeown Operation – for oesophageal tumour above trachea bifurcation
Can be used for pre-op neoadjuvant therapy
Also used in palliative care when patient is unfit for surgery or the cancer is too advanced
Aim to restore swallowing
Another palliative option with the aim to restore swallowing is stenting.
Incidence in the UK is estimated to be 5 to 12 cases per 100,000 people, and the prevalence is 50 per 100,000 people.
The UK has an incidence of 10/100 000/ yr. It is around 20 times more common in China and twice as common in France. The incidence is increasing in the Western world.
Male to Female = 5:1
1. Ellis H, Calne R, Watson C. General Surgery: Lecture Notes. 13th ed. Wiley-Blackwell; 2016.
2. Krasna M, Abbas G. Oesophageal Cancer. BMJ Best Practice 2018
3. NICE Guideline 83. Oesophago-gastric cancer:assessment and management in adults. 2018;(January)