Home | | Medicine and surgery: Principles and practice of medicine and surgery | Oesophageal carcinoma - Gastrointestinal oncology

Chapter: Medicine and surgery: Gastrointestinal system

Oesophageal carcinoma - Gastrointestinal oncology

Primary malignant cancer arising in the oesophagus. - Definition, Incidence, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Gastrointestinal oncology

Oesophageal carcinoma




Primary malignant cancer arising in the oesophagus.




Rare below the age of 40 years.



> F




Particularly common in Japan and China.




·        Squamous carcinoma accounts for more than 90% of cases. These usually occur in the middle third of the oesophagus although the lower third may also be affected. Aetiological factors include high alcohol consumption, smoking and chewing betel nuts.


·        Adenocarcinoma makes up the remaining 10% and affects the lower third of the oesophagus particularly the gastrooesophageal junction possibly following epithelial metaplasia from squamous to columnar cells as a result of gastro oesophageal reflux (Barrett’s oesophagus).


·        Familial forms have been noted.




Carcinomas spread along the mucosa and submucosa, invading adjacent structures and lymph nodes, distant metastases are rare. Adenocarcinoma tends to metastasise earlier.


Clinical features


Patients may present with progressive dysphagia, but often present late with weight loss, anaemia and malaise. On examination there may be cervical lymphadenopathy, cervical mass and hepatomegaly.




Barium swallow demonstrates an apple core defect or stricture without proximal dilatation. Endoscopy allows visualisation and biopsy of oedematous friable mucosa proximal to the obstruction. Initial staging (TMN) should include spiral CT of the chest and abdomen to look for metastases. In the absence of metastases endoscopic ultrasound is useful to assess operability. Other techniques include abdominal ultrasound scanning, MRI scanning, bronchoscopy and laparoscopy.




Wherever possible surgical resection is the primary treatment with those occurring in the lower third being the most amenable to surgery. Anatomical reconstruction requires either a gastric pull up, or a section of colon on a pedicle flap. Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil (5-FU) improves short term survival over surgery alone.


Squamous cell carcinoma may be sensitive to radiotherapy in inoperable cases, this is usually used in conjunction with combination chemotherapy (chemoradiation). Chemoradiation is the treatment of choice for localised squamous cell carcinoma of the proximal oesophagus.


Palliative treatments include stricture dilation, or endoscopic insertion of covered/uncovered metal stent, argon plasma coagulation (APC) and laser.




Surgical resection carries an operative mortality of up to 20%. Prognosis remains poor with only 5% 5-year survival.

Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Medicine and surgery: Gastrointestinal system : Oesophageal carcinoma - Gastrointestinal oncology |

Privacy Policy, Terms and Conditions, DMCA Policy and Compliant

Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.