Cancer of the oesophagus

Abstract

Oesophageal cancer is still a highly lethal neoplasm and primary prevention remains a priority. It ranks high among malignant neoplasms in both developing countries and developed ones, with an estimated worldwide frequency of 310,000 cases per year. Very high incidence areas are found in the so-called 'Asian oesophageal cancer belt', which runs from European Russia and Iran to Eastern China, and also in parts of South Africa. High rates are also observed in some parts of South America, the Caribbean and in some regions of France. Of the various risk factors, alcohol and tobacco consumption show a clear dose-response relationship in the populations where they are part of the life-style. No satisfactory explanation is yet available regarding the etiology of oesophageal cancer in the Asian belt, where alcohol and tobacco play a minor role. A poor diet and the consumption of hot beverages seem to be contributing factors. Precancerous lesions have also been described, consisting mainly of a chronic form of oesophagitis. Furthermore, the malignant potential of Barrett's oesophagus and related dysplastic changes for the development of adenocarcinoma are today well established. Diagnostic strategies are based mostly on endoscopic examinations with the use of vital staining in subjects at risk. In some areas of China, 'balloon cytology' seems to be a useful tool. Surgical resection remains the treatment of choice for potentially resectable cases. However, palliation is still the most realistic goal in more than 40% of patients, performed preferably by endoscopic intubation and laser. Radiotherapy and chemotherapy, combined together and with surgery and endoscopic palliation, show some benefits in survival.