Advanced esophageal cancer: Still a delayed diagnosis

Abstract

Background - Esophageal cancer is one of the 10 most common cancers in Brazil. Diagnosis is usually late and mean survival ranges from 4 to 6 months, no matter the treatment. Relief of dysphagia and increase in life quality are the main targets of palliative therapy. Aim - To evaluate patients with advanced esophageal tumor submitted to various palliative treatment options. Patients and method - We prospectively evaluated 38 patients with advanced esophageal cancer, with dysphagia and no chance of curative treatment, between September 2001 and June 2005. Patients were treated according to available resources, patient or referring physician's preference: 14 patients were treated with esophageal stent (9 self-expandable metallic, 4 plastic, 1 expandable plastic), 4 with palliative surgery, 8 gastrostomy (7 surgical and 1 endoscopic) and 12 nasogastric tube. Results - The mean dysphagia score 30 days after the procedure was improved in all groups except in the gastrostomy. Karnofsky score, reflecting quality of life, showed no improvement. The number of hospital admissions was not different among groups. Although the length of hospitalization was longer in the surgical group (42 days), it did not reach statistical significance. There was not statistically significant difference in the mean survival time among all patients. Conclusion - An ideal palliative treatment does not exist. The method must be individualized for each patient. Surgical treatment is the most expensive, once it requires longer periods in hospital. Unfortunately, the diagnosis of esophageal tumors is still delayed, limiting the benefits of top endoscopic palliation therapy.