Management of oesophageal cancer

Survival rates in oesophageal cancer are very poor (Clark et al. 2000); only 6% of patients with oesophageal cancer survive for five years following diagnosis.

In patients with disease with no metastatic spread outside the oesophagus the five-year survival rate rises to between 15 and 20%. For disease confined to the oesophagus, surgery should be considered in fit patients. Surgery alone cures only 5-10%, but a combination of preoperative radiotherapy, chemotherapy and radical surgery is associated with five-year survival of 30-50% in selected patients. Approximately 90% of the patients have extensive disease at presentation; in these, treatment is palliative and based upon relief of dysphagia and pain. Surgically performed palliative procedures include excision and reconstruction or bypass. Endoscopically directed tumour ablation using laser therapy or alcohol injection and insertion of stents are the major methods of improving swallowing. Palliative radiotherapy may induce shrinkage of both squamous cancers and adenocarcinomas but risks worsening stricture formation and exacerbating dysphagia.

Psychological care is important for patients who have an inoperable tumour or an oesophageal obstruction. Nursing staff will be involved in providing nutritional support and ensuring patients receive appropriate analgesia to optimise health-related quality of life.

Evidence-based guidelines for the management of oesophageal cancer have been published by Allum et al. (2002).

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