Malignant Tumours of the Oesophagus

Aetiology

Squamous cell carcinoma

  • More common in upper and middle thirds of the oesophagus
  • Risk factors include age (60-70 years), achalasia, smoking, alcohol use, black race and poor diet (lacking Vit A and C, iron)

Adenocarcinoma

  • Reflux disease is biggest risk factor - almost all adenocarcinomas occur in the lower 1/3 of the oesophagus on a background of Barrett’s oesophagus
  • Other risk factors include age (50- 60 years), white race, obesity and smoking

Clinical presentation

  • Progressive dysphagia - tumour obstruction
  • Feeling of lump in throat
  • General symptoms of malignancy (anaemia, weight loss, loss of energy) due to metastases

Investigations

  • Endoscopy and biopsy
  • Staging - CT, PET scan

Management

  • Surgery - resection (curative)
  • Only 40% of patients resectable at time of presentation - palliative measures include stenting and intubation

Complications

  • Bronchopneumonia due to aspiration
  • Oesophageal-broncho fistulas